Principles of orthopaedics and fx DR H SAREMI

Principles of orthopaedics and fx DR. H. SAREMI Orthopedic surgeon Hand shoulder surgery felloiwship

q. Sprain • Grade 1 • Grade 2 • Grade 3 q. Strain Arthrodesis Arthroplasty (treatment) q. Subluxation Arthroscopy q. Dislocation(NV, FX) q. Fracture dislocation Mal union q. Rteductuon §Closed §Open q. Fixation §External §Internal §percutaneous Nonunion casting traction external fixator

ﻃﺒﻘﻪ ﺑﻨﺪی ﺷکﺴﺘگیﻬﺎ q. Closed q. Open(gustilo anderson classification)

Etiology of FX • • Compression Torsion Angulation tension

ﺍﻧﻮﺍﻉ ﺷکﺴﺘگی q Traumatic fx q. Pathologic fx q. Avulsion fx q. Stress fx q. Insufficiency fx

ﺍﻧﻮﺍﻉ ﺷکﺴﺘگی q Traumatic fx q. Pathologic fx q. Avulsion fx q. Stress fx q. Insufficiency fx

ﺍﻧﻮﺍﻉ ﻧیﺮﻭﻫﺎ q. Compression---------compression fx q. Angulation-----------Transverse fx q. Torsion-------------Spiral fx q. Compression+angulation-----butterfly fx q. Compression+angulation+torsion-----oblique fx

ﺗﺸﺨیﺺ ﺍ ﺷکﺴﺘگی 1. Mechanism of injury 2. Sign and symptoms § Pain § Tender ness § Deformity 3. Radiography § Conventional § Specific view(navicular, tangential, magnifying 0 4. CT 5. Nuclear scan 6. MRI

ﺗﺸﺨیﺺ ﺍ ﺷکﺴﺘگی NV exam Joint above and below the fx site Specific views

ﺩﺭﻣﺎﻥ ﺷکﺴﺘگی v Airway v Breathing v Circulation(bleeding, shock, pain) v Diagnosis v Exposure of neurological status

ﺩﺭﻣﺎﻥ ﺷکﺴﺘگی Reduction Fixation -------casting Closed--------------casting Close-----------traction Closed--------------external fix Closed--------------per int fix Open---------------external fix Open---------------int fix

ﺩﺭﻣﺎﻥ ﺷکﺴﺘگی ﺑﺎﺯ 1. Examining of wound, Neurologic and vascular function 2. Splinting 3. Removal of obvious debris leaves, stones, grass 4. Cover with sterile bandage and transport to operating room 5. Antibiotic and tetanus immunity 6. culture? In the operating room Irrigation and debridement Nervemtendon repair Fixation Approximating sutures or not

ﻣﺮﺍﺣﻞ ﺟﻮﺵ ﺧﻮﺭﺩﻥ ﺷکﺴﺘگی l Inflamatory phase-----2 -3 days l Reparative phase § Soft callus---------3 w § Hard callus---------3 -4 m l Remodeling phase---- ms to ys

ﻋﻮﺍﻣﻞ ﻣﺆﺜﺮ ﺩﺭ ﺟﻮﺵ ﺧﻮﺭﺩﻥ ﺷکﺴﺘگی l Anemia l Corticosteroides l Diabetes l Richetes l Excess vit A, D l Delaied reduction l Denervation l Anti coagulating agnts l Radiotherapy

ﺷکﺴﺘگی ﺩﺭ کﻮﺩکﺎﻥ l Thick periosteom l Less displacement l Higher union rate l Less stiffness due to immobilization l Better remodeling and correction

ﺍﻧﻮﺍﻉ ﺷکﺴﺘگی ﺩﺭ کﻮﺩکﺎﻥ Ø Bending Ø Green of bone(plastic deformity) stick fx Ø Growth plate fx(salter harris classification)

Salter-harris

ﺍﻧﻮﺍﻉ ﺷکﺴﺘگی ﺩﺭ کﻮﺩکﺎﻥ Child abuse § 3 y/o § Multiple fx in different stages of healing § Arm, leg thigh, skull § Family history

ﻋﻮﺍﺭﺽ ﺷکﺴﺘگیﻬﺎ l § § l ü ü ü Shock Neurogenic Hypovolemic Thromboemboli----prophylaxy in high risk patients Obesity History of TE or. TPH or. Heart disease Old Pelvic fx drug

ﻋﻮﺍﺭﺽ ﺷکﺴﺘگیﻬﺎ l Fat embolism syndrome Ø Multiple fx long bones Ø Afew symptomatic Ø Young patients lower limb fx Ø Usually in first 72 h-----up to 3 w Ø Majors features Ø Minor features

ﻋﻮﺍﺭﺽ ﺷکﺴﺘگیﻬﺎ l Compartement syndrom 5 p § Passive motion is very painful Ø Open circular cast or bandage Ø Reduction Ø Elevation? Ø Faciotomy if not-----volkman’s ischemic contracture

ﻋﻮﺍﺭﺽ ﺷکﺴﺘگیﻬﺎ l Vascular injury l Neurological injury Non union and delaied union Malunion Stiffness l l Ø Ø Ø Myositis ossificant Younger Elbow>hip> Fx dis>fx Head trauma paraplegics prophylaxis

ﻋﻮﺍﺭﺽ ﺷکﺴﺘگیﻬﺎ l CRPS v Type 1 ----RSD v Type 2 ------- Pain killer, pt. sympathectomy

Distal phalanx

Distal phalanx

Distal phalanx

p 2

Metacarpal fx

Metacarpal fx

Thumb cmc fx dis

Bennett’s fx dis

Rolando’s fx dis

wrist

Wrist gilula’s line

scaphoid

scaphiod

Distal radius fx

Distal radius

Distal radius

Distal radius

Gleazzi fx dis

forearm

Monteggia fx dis

Monteggia fx dis

Radial head

olecranon

coronoid

Elbow fx dis

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