Orthopedic Scheme *Definition: Discontinuity of a bone/joint surface. *Historical background: 1" mentioned(BC) -1" surgical intervention(around...s) *Anatomic consideratior ~emberiologic(ossify) -surgical - biomechanics *incidence: common age, sex, place -risk factors *Aetiology (mode) Ae.: high-low injury - direct -indirect injury pathological *Diagnosis: -History & Pt complaint(C/o): What brin: the hi Onset,Coarse,Duration X 1LPain + history of trauma 4) elaalasle Silda sajafcad eantod 2.Swelling: site,size,shape,surface,consistency +Deformity. 3. Disturb of function: +4 stiffness TT Instability Locking Giving away 4.Other: Snap (click), Tingling, Numbness(level) S.associated injuries: chest, abd. -Examination (Ex.): whole limb, bared “Look: 3D/S5S skin,scar,swelling,sinus, symmetry(m.wasting). “Feel: TT TRUCK temperature,tenderness, crepitus *Move : 4c Cust slay: tive then passive + ROM + m.power *special tests + imp. “Neurovascular: intact / impaired. ets pes pee document, medicolegal -Investigations (Vx) + imp.: LX Ray: is mandatory as part of examination ‘Adequate :A. contain name age date B. 2 views: AP/lateral for all except hand &foot AP/oblique + other specific, 2 joints: above bellow , 2limbs compare, 2 occasions: some ‘occult #appear later(stress #) C. Comment: OLD ACID : open or closedi* L: location D: displacement A: articular C: comminution I: intrinsic bone quality. D: degree 2.€T: Best view for bone and articular surface with details Spine fracture 3D CT is agood reconstructive Hazard for dangerous irradi NB.Bone appear white & water black 3.MRI (see more soft tissue) Search for water in widest view eg csf, synovial T1(black): show pathologic lesions (tumors) T2(white):Water = edema= effusion Structures appear dense Ligaments eg ACL PCL MCL LCL Cortical bone Disc , spinal cord NB . expensive but high resolution A.Ultrasound (US is the new part of examination) : for soft tissue & joints capsule, ligaments- one of the best imaging techniques in musculoskeletal radiology because it is low in cost, has high spatial resolution, wide availability in hospitals, is well-tolerated by Patients and is not biologically invasive, as it uses sound waves and non ionizing radiation. (CLASSIFICATION) .... imp.: diagnostic, prognostic, communication Stab -CBC (WBCS) in sepsis exceeds 50,000/uL, with more than 75% PML, CRP 11( 7 withen 2hrs 42ds) early dx , ESR TT (4 withen 2ds L2wks) follow up. -Pre-&post-op. profile: bleeding, HB%, liver, kid., DM, viruses, Hs Dr. Magoud Page S Scanned with CamScanner*Complications: Choose the commom for the site #General early: shock: *Neurogenic(pain) ttt by morphia *hypovol. ttt resustation fluids #General late: prolonged bed recumbancy *chest: infection, atelectiasis, pulmonary embolism +GIT: gastric ulcers, paralyti constipation *UT: UTI, stones, retention *LL: ulcers, matrophy, DVT «Local + — # late .*Volkmanns isch * injury muscle. .* Myositis ossi. * injury tendon. Deformity * injury N. .*Seudeuk atrophy * injury Vs.. *Compartement § * injury growth plat san'*Gross arrest * injury joint : Arthritis * bone. *Delayed/Non/Malunion * injury viscera. ..*Psychoneurosis, *Treatment (ttt): -Aim: 1. releif pain, regain function(ROM) 2. stability,bone reduction, joint congruity 3. decrease complication -Factor affecting ttt: Sly Ghally Ut Surgeon: capability, facilities Patient: age, general codition, occupation Hand dominant (UL), ambulation(LL) Fracture: pattern, comminution, deformity, soft envelope, bone quality. -General: ABCD...Resus. Stabiliz the pt. 1 aid immobilization Analgesics lines 1.Morphia: nalophery pethiden amp. 5 se pat clay ypu) eye das 2.NsAID+paracetamol (perflgan vial) 3. local analgesia (best, no general complications, best done using US) Hematoma block or N block 4, Mechanical analgesia (reduction+ slab) | pain , swelling & NVcompression Indication(i.), method, approach, postop. ‘Sofi Tissue Ready for Surgery + No blisters © Skin not shiny © Positive wrinkling © No pitting edema IMN (.)-segmental-open-failed plate -pathologic-osteoprotic Ex fix (j.)-open-infected-burn-bone loss DCO ( damage control orthopedic) do minimal surgery allow less general damage by systemic inflammation till return general normal function prevent DIC. Operative indications: (PV ON U ) 333 P | *Polytrauma pt with multiple # *Bilateral # *Pathologicalif Vascular injury Open # ‘Neurologic injury (spine) *Uncompliance pt *Union (non,mal) *Unstable (shaft>50% displacement/ angle >20°_40°/ no rotation accepted) (Articular surface >2mm ) alzjol< -TTT of complication don't forget? & complications of ttt ? Dr. MaSoud Page 6 Scanned with CamScanner-Follow up: -from early-till recovery -Cli General :operation skin scar swelling Local: union/3 W/ no pain, Ex.no pain on ROM active & passive, x ray callus Standard x ray true/dead views: Estimated Time to Return to Work: Return time modifiers + Multly by 2 for mutiple injures Cannot return to work ‘outside of hme with ‘lateral lower extremity ‘pon-weight bearing ‘After 6 month ad 25% or each cortex thats not healed on Xray J. AG Lat. ‘Hip _| Mid limb Tile pray ee Shoulder | oration ily | lee SoROM gain Keel | Carella (TLC) | 2 condyles 1, eabity to bear weight + elbow | forwarl (Ib bwen as 1 omescle strength Ankle | Foot (hand) | 2 malleolus (RU) reeovers)/4 fiand | forwant overlap -Physottt : Open / Closed chain exercises. Stretching/Strenthing. Rehabilitatio “Rest Iweek RICE protocol (rest-ice- compression-elevation ) *(PAPARF) Ja hu PAPAR F sal Pendulum 2w- foul ace Assisted “Aw ell ST (not full RO! Passive Sdwe el Ge Active bw ely Resisted = WB POWUASs 4a at Oe Free ROM >12w sont 3 a Oe = NWB: non wi bear then progressive partial weight bearing WBAT :wt bear as tolerated (25% /week) till FWB.-full wt bear * Orthosis for rest Ist w /then 6w in public or complications (brace for bone-hinge for joint 15°/w). “Distal is distal hc saul) Distal H, F, T, Talus, Calc. if un stable need longer period habilitation >6m, After clinical examing the pt: % Functional recovery = 4/ s¢=.2<>« (Pain recovery + %ROM gain + %al weight + %muscle strength recovery) fag oh pad GS IY PAY al Aus Caen AS pall $UIM 665 O53 da 9S ity to bear fed eon Pain recovery = VAS ‘hoe «Harber ror 0 1 Th Bon Oseibes Vor Poe tio atessng Unter! Pan mn Pan o 1 2? a 4 &§ 6 7 8 9 © ASK PATIENTS ABOUT THEIR PAIN INTENSITY - LOCATION —ONSET—DURATION.—VARIATION—QUALITY NOMURT = MURTS HURTS MURS MURS MURTS UTLEST _UTTLEMORE EVENMORE WHOLELOT WORST Dr. Ma§oud Page 7 Scanned with CamScanner