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Outline on Common Orthopaedic Emergencies

Outline on Common Orthopaedic Emergencies

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Published by Bhaskar Borgohain
health, medical sciences, orthopaedics, fractures, trauma, x ray evaluation, open fractures
health, medical sciences, orthopaedics, fractures, trauma, x ray evaluation, open fractures

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Published by: Bhaskar Borgohain on Jan 05, 2010
Copyright:Attribution Non-commercial


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Dr Bhaskar BorgohainAsst Professor of OrthopaedicsNEIGRIHMS, Shillong, India “A stitch in time saves nine”It is a common medical myth that orthopedics has no real emergency. Alimb & or life threatening condition is called emergency. HERE ARESOME OF THEM to remember 
Compartment Syndrome
:A clinical syndrome characterized by elevatedcompartment pressure within a tight osseo-fascial compartment. Pain out of  proportion, pain on passive stretching & a tense limb.Key to management:Early clinical diagnosis, removal of all encircling bandages down to the skin, proactive, liberal & adequate fasciotomy,stabilize #, moderate limb elevation & monitoring. Note the variousfasciotomy incisions for common sites of compartment syndrome --leg, foothand and forearm. After an adequate fasciotomy the distal-most peripheralarteries should start pulsating.
Gas Gangrene:
A rapidly progressive limb & life threatening infectivegangrene with anaerobic bacteria. (Clostridia)
Key to management:IV Antibiotics (penicillin or cephalosporin), AGGS(Optional), Aggressive debridement & removal of dead space oAmputation, Hyperbaric oxygen therapy (Optional)Fat Embolism Syndrome:a subacute onset potentially life threateningcondition of obscure origin mainly involving the CNS and the lungs thatoccurs after long bone fractures.Key to management:Early diagnosis with high index of suspicion, adequateoxygenation, ICU care, aggressive symptomatic management & immediate #stabilization.
Acute cervical Spine Injury:
 high cervical cord injury can cause instantrespiratory paralysis due to involvement of root values of both the phrenicnerves. Temporary Immobilization for transportation is essential,Key to management:Resuscitation with oxygen, IV Fluids, may need aTracheostomy + Ventilatory support, Foley’s catheterization, Ryle’s tube toavoid aspiration, Radiological investigations, Skeletal Traction . High doseIV Methyl prednisolone (within 1
8 Hrs of injury)Symptomatic management, avoidance of bed sores through good nursingcare, Input- output chart. Clinical diagnosis of type of neural deficits:complete Vs incomplete cord lesion depending on return of bulbocavernosusreflex after resolution of spinal shock, identification of type of cordsyndrome, if incomplete Decompression & definitive # fixation.
Unstable Pelvic Fracture with Hypotension:
Profound shock mayoccur in major pelvic fractures and more than three litres of blood may belost internally even without major arterial bleed.Key to management:ABCDE FGHI of Resuscitation, quick assessment of radiographs, Avoidance of patient movements,Priority surgery after resuscitation –supra pubic cystostomy, external fixator for #, control of major internal visceral bleeding through Laparotomy +/-Internal fixation of the # at one sitting. Fracture hematoma & Venous bleedcontribute to major # related Hypotension. . Arterial cause is rare cause of Hypotension in pelvic #s, contrary to common myth.Cauda Equina Syndrome with Acute lumbar Disc Prolapse:A neurologicalemergency where disc lesion at any level below D10 causingcompressive or ischemic damage to cauda equina can produce a painful sciatica, saddle-shaped anesthesia (S2 spinal segment), penilesensory loss in association with urinary retention with or withoutoverflow incontinence & impotence as sympatheic outflow is alsoinvolved.

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