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    Luís Alves
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    Principles Nonoperative Treatment

    Copyright:

    © All Rights Reserved
    Flag for inappropriate content
    16 views39 pages

    Principles Nonoperative Treatment

    Uploaded by

    Luís Alves
    Principles Nonoperative Treatment

    Copyright:

    © All Rights Reserved
    Flag for inappropriate content
    of 39
    + Inmoouerion 185 + History oF Nonopenanve FRACTURE TREATMENT. 155 + Enpemovocy 156 ‘+ Teowiaues 162 Traction 163 Spinal Traction 165 Casts 166 Braces 171 Casts or Braces? 174 Slings, Bandages, and Support Strapping 176 PRINCIPLES OF NONOPERATIVE FRACTURE TREATMENT Charles M. Court-Brown + Spectre Fractures 178 Upper Limb 178 Lower Limb Fractures 185 Pelvic and Acctabular Fractures 189 Spinal Fractures 190 + Spectre Fracrure Tyres 190 Periprosthetic Fractures 190 Stress Fractures 191 Metastatic Fractures 191 “Tue Furune of Nonoreranve Fracture TREATMENT 192 Iwrropuction [Nonoperative fracture management was the only method of Fracture management until about 1750, Since then there have Dbeen advances tn operative fracture treatment, which accel: erated considerably ater World Wat TI because of improved surgieal techniques, etter anesthesia and_ postoperative tuestment, and the introduction of antibiotics. Even today. nonoperative management remains a very important tool in the armamentatium of the orthopedic trauma surgeon, The concentration of severe injuries into specialized trauma cen- ters in many counties has unquestionably improved their ‘eatment but has also caused surgeons to overestimate the tole of operative treatment in the full spectrum of fractures. In fact, nonoperative fracture trestment remains the most common method of fracture management, although its role thas changed significantly during the last 30 to 49 years. This chapter presents an epidemiologic analysis of nonoperative fracture management from a major trauma center, sllustrates ‘common nonoperative techniques, and discusses indications {or their use History of NowoPeraTive FRACTURE TREATMENT ‘The ancient Egyptians were the frst to document how face vores shoul be managed and to record the basic results oftheir management!” The Edin Stith Papyeus dates frome 2800 to 3000 BC and was wanslate ity 1930 the United States * Tt is composed ofa series of case reports of specific injures and their associated prognoses, good snd bad, Case 37 describes 3 ‘coexisting humeral fracture and wound over the upper sm Ie suggests that if the to ate not connected the arm should be splinted and the wound dressed. Ifthe wound and fac: ture connect the prognosis is poor and the ailment should sot be treated! In those days, spintge relied on bandaging ‘over splints of wood and linen snd wsing gle to stifen the bandages There does not appear to have been any significant advance in fracaure management unt the Ancient Geeek Empire, with Hippocrates heing credited with many advances that were prob sly the results of clinical work of many doctors Hippocrates ddesebed se diferent methods of applying roller bandages depending onthe facture locaton. The bandages were stllened (02015 Woters Kianer. All Rights Reserved 155 SECTION ONE General Principles: Principles of Treatment with cerate, which was an ointment consisting of lard or oil mixed with wax, resin, or pich to essentially create a cast It ‘was customary to defer definitive management, usually frctsre rmaniptlation, wntl the swelling had diminished, which olten took about 7 days. Tis interesting to note that delayed manage- rent stil remains popula in the treatment of some fractures The Ancient Greeks aso used mechanical ads to facilitate the reduction of fractures and dislocations, and Ulppocrates is credited wth the first aut of fracture healing time. However, he was either an optimist of the ancient Greeks had a supe: rior genetic makeup because be said that femoral fractures and tibial fractures united in 50 and 40 days, respectively" TFurher progress occurred in Ancient Rome and in Asis Dut sc is Albueasis, an Arsbie physician, who is eredited with advancing nonoperative Iractre teatment and for acting as 4 conduit through which the philosophies of Ancient Rome and Greece could be transferred to Westem Europe. Albuca sis clearly upset his colleagues by suggesting that im femoral

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