Orthopaedic Trauma Overview

Pelvic Fractures

• Stabilizing the pelvis with an external fixator aims to reduce the risk of hemorrhage and improve overall stability of the fracture.

Compartment Syndrome

• Main cause is increased pressure within a closed anatomical space, leading to compromised circulation and function of tissues.
• Commonly affects the anterior compartment of the lower limb.

Osteoporosis and Fractures

• The most common site of fracture in the elderly with osteoporosis is the hip, often due to minimal trauma.
• Neck of femur fractures carry a 30-day mortality rate of about 10% to 30%.

Patella and Tibial Shaft Fractures

• Usual cause of patella fractures includes falls onto the knee or direct trauma.
• In cases of tibial shaft fractures, the decision for conservative versus surgical treatment is based on fracture location, stability, and alignment.

Muscle and Nerve Damage

• Compartment syndrome may lead to irreversible muscle and neurovascular damage if not treated promptly.

Childhood Fractures

• The most common cause of femur fractures in nonambulatory infants is non-accidental injury.
• Fracture patterns, such as spiral fractures, are red flags for potential non-accidental trauma.
• Fractures in children under 1 year are typically caused by falls or abuse.

Fracture Types and Mechanisms

• Fractures involving the growth plate in children are classified as Salter-Harris fractures.
• A definition of a fracture is a break in the continuity of bone.
• Spiral fractures suggest a twisting mechanism of injury, while comminuted fractures involve more than two pieces of bone.

Differences in Fracture Types

• Open fractures involve a break in the skin, while closed fractures do not.
• Pediatric fractures tend to heal faster than adult fractures and often exhibit plastic deformation before fracture.

Upper Limb Fractures in Children

• The most common type of fracture in upper limb trauma among children is a distal radius fracture.
• Remodelling in pediatric fractures occurs over months post-injury, taking advantage of the growth potential in children.

Nerve Injuries

• Secondary palsies associated with fracture manipulation have a spontaneous recovery rate of around 60%.
• Humeral shaft fractures present a higher risk of radial nerve injury which can cause neuropraxia.

Humeral Fractures and Management

• Essential for successful nonsurgical treatment of humeral fractures is proper alignment and stabilization.
• Common management for forearm fractures includes casting or bracing, with surgical intervention reserved for unstable cases.

Necrotising Fasciitis

• Early symptoms include pain out of proportion to physical examination findings, with critical symptoms developing within 4 to 5 days.
• The most critical factor for survival in necrotising fasciitis is prompt surgical intervention.
• LRINEC score is used to assess the severity of necrotising fasciitis.

Complications and Treatment

• Complications from necrotising fasciitis can include systemic infections and may necessitate amputation to prevent death.
• Characteristic fluid observed during surgical debridement is often necrotic tissue and malignantly appearing fluid.

This quiz provides an overview of orthopaedic trauma, covering topics such as fracture description, types of fractures, avulsion injuries, and sites of bone injury. The quiz is prepared by Mr Georgios Arealis, MD, PhD, FRCS.