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Orthopaedics Essentials

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Orthopaedics Essentials Frykman Classification of Distal Fracture of base of the first Neer classification of proximal humeral head # Radial # metacarpal bone 1-part 2-part 3-part 4-part GT GT+SN “CLASSIC” SN LT+SN (RARE) “VALGUS IMPACTED” Galeazzi Fracture LN (RARE) Impression # Head split Gartland’s classification of supracondylar Fracture shaft of ulnar, together with distal third of radius with fracture of humerus disruption of the proximal radioulnar dislocation or subluxation of distal joint and dislocation of radiocapitallar radio-ulnar joint joint Salter–Harris fracture = Fracture that involves the epiphyseal plate or growth plate of a bone Type I: undisplaced or minimally displaced fractures. Type II: displaced with posterior cortex intact Type III: displaced with no cortical intact Gustillo Anderson Classification of Open Fracture I – open fracture with a wound <1cm and clean II – open fracture with wound > 1cm with extensive soft tissue damage and avulsion of flaps IIIa – open fracture with adequate soft tissue coverage of bone in • Galeazzi fracture - a fracture of the radius spite of extensive soft tissue laceration or flaps or high energy with dislocation of the distal radioulnar joint trauma irrespective of size of wound • Colles' fracture - a distal fracture of the IIIb – open fracture with extensive soft tissue loss, periosteal radius with dorsal (posterior) displacement of the wrist and hand stripping and exposure of bone • Smith's fracture - a distal fracture of the IIIc – open fracture associated with an arterial injury which requires radius with volar (ventral) displacement of the I II IIIa IIIb IIIc repair wrist and hand • Barton's fracture - an intra-articular fracture of the distal radius with dislocation of Irrigation: 3L 6L 9L ORTHOPAEDICS CLASSIFICATION the radiocarpal joint • Essex-Lopresti fracture - a fracture of PART 1 (UPPER LIMB) the radial head with concomitant dislocation HTARW5B/GKS2013/3- of the distal radio-ulnar joint with disruption of Together In Delivering Excellence (T.I.D.E.) the interosseous membrane Contributors: Dr. Tham, Goh, Poh, Shaun, Justine, Shanthy, Huda, Miruna, Lin, Phrindha, Syikin, Fong, Phoon, Ling Ying, Siew Ling, Quah Letournel classification acetabular # Pipkin classification of femoral head fracture Simple Types Anterior column Anterior wall Posterior column Posterior wall Transverse Associated Types Type I - # below fovea/ligamentum (small) Type II - # above fovea/ ligamentum (larger) Type III - type I or II with associated femoral neck # (high risk of AVN) Type IV - type I or II with associated acetabular # T-type Transverse Posterior column Anterior + posterior Both columns + posterior wall + posterior wall hemitransverse Garden classification of femoral neck # Russel Taylor classification of subtrochanteric # Garden I fracture Garden II fracture Garden III fracture Garden IV fracture incomplete and complete and complete and complete displaced with minimally nondisplaced partially displaced no engagement of the 2 displaced principal fragment Evan classification of intertrochanteric # Schatzker classification of tibia plateau # Evan 3 Displaced 3 Evan 4 Displaced 3 Evan 5 Displaced 4 Evan I Evan 2 parts fracture with parts fracture with parts fracture with Undisplaced 2 Displaced 2 posteromedial large posteromedial comminution parts fracture parts fracture comminution comminuted involving both fragment trochanters Lateral tibial Lateral tibial Focal Medial tibial Bicondy Tibial plateau # w/o plateau # depression plateau #, lar tibial plateau depression with with no with or plateau fracture with Lisfranc classification of tarsometatarsal injury depression associated without # diaphyseal split depression discontinuity Winquist classification of femoral shaft fracture Sanders classification of calcaneal fractures I. Tiny cortical fragment lateral II. Butterfly fragment is I - # are non-displaced # (displacement < 2 mm). large but there is still medial II - # consist of a single intrarticular # that divides the 50%of cortical intact calcaneus into 2 pieces. IIA: # occurs on lateral aspect of calcaneus. between the main IIB: # occurs on central aspect of calcaneus. fragments IIC: # occurs on medial aspect of calcaneus. Homolateral Isolated Divergent III. Butterfly fragment Type IIA Type IIB Type IIC III # consist of 2 intrarticular fractures that divide the calcaneus into 3 articular pieces. involves more than IIIAB: 2 # lines are present, 1 lateral and 1 central. 50% of the bone IIIAC: 2 # lines are present, 1 lateral and 1 medial. ORTHOPAEDICS CLASSIFICATION IIIBC: 2 # lines are present, 1 central and 1 medial. width IV # consist of # with more than 3 intrarticular PART 2 (PELVIC & LOWER LIMB) IV. Segmental fractures fractures. HTARW5B/GKS2013/3b- Together In Delivering Excellence (T.I.D.E.) Type IIIAB Type IIIAC Type IIIBC Type IV Contributors: Dr. Tham, Goh, Poh, Shaun, Justine, Shanthy, Huda, Miruna, Lin, Phrindha, Syikin, Fong, Phoon, Ling Ying, Siew Ling, Quah Localisation of level of injury Wrist extension DENIS THREE COLUMN CONCEPT Vertebral spine Spinal Cord Segment C6 Anterior column: C1-C7 Add 1 Elbow flexion AAL: Anterior longitudinal ligament T1-T6 Add 2 AAF: Anterior annulus fibrosus T7-T9 Add 3 Middle column: T10 L1,L2 PLL: Posterior longitudinal ligament T11 L3,L4 PAF: Posterior annulus fibrosus T12 L5,S1 L1 rest of sacrococcygeal Posterior column: Wrist flexion segment Finger flexion Finger SSL: Supraspinous ligament abduction ISL: Interspinous ligament LF: Ligamentum flavum Upper limb myotomes PC: Facet capsule and dermatomes Finger Extension T1 # Type & DENIS CLASSIFICATION OF SPINAL TRAUMA Anterior Middle Posterior Central cord Anterior cord column column column column lesion lesion MAJOR INJURIES MINOR INJURIES involvement Compression None or • Upper > lower • Motor - • Transverse process # Compression None limb involved • Sensory - • Articular process # # distraction • Sacral sparing • Proprioception + • Par interarticularis # None or Burst # Compression Compression • Due to • Due to • Spinous process # distraction hyperextension/ hyperextension None or Spine OA with disc or bone Seatbelt Distraction Distraction compression compressing ant spinal a Compression Distraction Distraction Fracture/disl rotational/ rotational/ rotational/ ocation ± ± ± shear shear shear Cord hemisection Posterior cord (Brown Sequard lesion Criteria of unstable spine injury Bulbocavernosus Syndrome) Stable fractures - don't cause spinal deformity or neurologic deficit, • On palpation gap between 2 spinous processes reflex • Proprioception - • Ipsilateral involves monitoring anal still able to weight bear increased • Motor + paralysis with • Neurological deficit sphincter contraction in Unstable fractures - unable to weight bear, may progress and • Sensory + contralateral loss • Vertebral compression >1/3 response to squeezing of pain sensation causing further neurological and structural damage. the glans penis or • Vertebral displacement >1/3 • Due to unilateral tugging on an indwelling • Vertebral canal compromisation > 1/3 lamina or pedicle Foley catheter TLICS:Thoracolumbar Injury Classification and Severity Score • Bilateral facet joints dislocation # • According to Denis 3 columns concept: 2 columns Morphology Posterior Ligamentous complex (PLC) disrupted 0 No abnormality 0 Intact great toe • Root pain - dorsiflexion • Sensory saddle shape distribution with 1 Compression 2 Suspected / Indeterminate Lower limb myotomes perianal anaesthesia, symmetrical 2 + Burst fracture 3 Injured Conus • Motor changes - and dermatomes medullaris 3 Rotation/translation • Sphincter involved + 4 Distraction Hip flexors • Reflexes – knee jerk normal • Ankle jerk lost Neurological status • Root pain + 0 Intact Knee extensors • Sensory may invoke any part of lower Cauda limb, asymmetrical 2 Root injury equina • Motor changes ++ (wasting) 2 Complete cord / conus medullaris injury syndrome • Sphincter ± 3 Incomplete cord / conus medullaris injury Ankle • Reflexes – knee jerk normal/ 3 Cauda equina dorsiflexor • Ankle jerk lost/ Ankle plantar ORTHOPAEDICS ESSENTIALS Treatment flexion PART 3 THE SPINE TLICS <= 3: non-operative HTARW5B/GKS2013/4- TLICS = 4: consider for operative or non-operative intervention Together In Delivering Excellence (T.I.D.E.) TLICS >=5: operative Contributors: Dr. Tham, Goh, Poh, Shaun, Justine, Shanthy, Huda, Miruna, Lin, Phrindha, Syikin, Fong, Phoon, Ling Ying, Siew Ling, Quah Name Active Ingredient Indication Contraindication Advantage Disadvantage 1. Opsite semi-permeable-thin, adhesive superficial wounds highly exudative wounds • some moisture evaporation • exudate may pool transparent polyurethrane film as secondary dressing • reduce pain • maybe traumatic to remove • barrier to external contamination • allows inspection 2. Jelonet non-adherent moist (Tulle Gras burn allergy • reduces adhesion to wound • does not absorb exudate Bactigras dressing) wounds healing by secondary • moist environment aids healing • requires secondary dressingg PARAFFIN gauze impregnated with paraffin intention • allergy or maybe with antiseptics or • may delay healing when antibiotics impregnated 3. Kaltostat Calcium alginate moderately/highly exudative wounds dry wound • forms gel on wound & hence moist • may require secondary dressing CALCIUM natural polysaccharide from need for hemostasis hard eschar • environment • not recommended in anearobic ALGINATE seaweed • reduces pain infections • can pack cavities • gel can be confused with slough • absorbent in exudative wounds • or pus in wound •
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