Influence of patient factors and the

mechanism of injury on fracture

management

AO Trauma Basic Principles Course

Learning objectives

• Name the patient factors that influence fracture healing

• Explain different mechanisms of injuries that influence fracture
healing
• Discuss how different treatment options will influence fracture
healing
What is this? …A fracture?
This is much more than a fracture

• Patient: age, comorbidities, expectations, associated injuries,

physiological status, etc
• Local factors: soft-tissue injury, circulation, neurological status, etc
• Surgeon and the team: can we manage this?
• Infrastructure
This is much more than a fracture

• Patient: age, comorbidities, expectations, associated injuries,

physiological status, etc
• Local factors: soft-tissue injury, circulation, neurological status, etc
• Surgeon and the team: can we manage this?
• Infrastructure Mechanism of injury
Mechanism of injury: high versus low energy

• E=mv²/2 (E=mgh)
Example: fall from 10 meters
Example: fall from 10 meters
Absorbed energy determines the fracture pattern and...
…the soft-tissue injury and…
…associated injuries

• Life
• Limb
• Function

Advanced Trauma Life Support (ATLS)

Soft tissue
45-year-old patient, motorcycle accident, isolated injury
Active waiting: timeout for analysis and planning
AO
…associated injuries

• Life
• Limb
• Function

Advanced Trauma Life Support (ATLS)

Resuscitation (ATLS protocol)

• Airway with C spine protection

• Breathing/ventilation/oxygenation
• Circulation: stop the bleeding Surgeon
• Disability: neurological status
• Expose, environment, body temperature
Save life, save limb, save function
10-year-old boy hit by falling tree, hemodynamically
unstable
Save life before limb!
Save life, save limb, save function
30-year-old woman
20-year-old carpenter
Our decision: amputation, but as distal as possible
Save life, save limb, save function
22-year-old paraglider landed on a mine field,
first treated in a local hospital
Decision making?
Function: the best is not good enough
The team and resources

• It is not enough to know what is good, you must be able to do it...

(G.B. Shaw)
Marko Godina

Heterotopic
transplantation
25 years ago

Courage, ideas
Resources
Take-home messages

• Do not look only at the fracture

• Many factors can impact significantly the management and
outcome
• Save life, save limb, save function
• You must learn about decision-making: patient, fracture (injury),
surgeon, and set up