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Common Orthopedic Pitfalls  for Emergency Specialist
The Emergency Specialist’s Approach For Orthopaedic Patient
Why is consultation necessary? ,[object Object],[object Object],[object Object],[object Object]
Orthopedic Consultation in the Emergency Department ,[object Object]
Orthopedic Consultation in the Emergency Department ,[object Object]
Tintinalli 6 th  Edition  ,[object Object]
Orthopaedic Emergency Examples?
Orthopaedic emergency ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management in Musculoskeletal Injury ,[object Object],[object Object],[object Object],[object Object]
วิธีการทำ  Ice compression  ที่ถูกต้อง ,[object Object],[object Object]
Principles to approach severe musculoskeletal injury ,[object Object],[object Object],[object Object],[object Object],Principles to approach severe musculoskeletal injury
A. First aids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Principles to approach severe musculoskeletal injury
Technique of Immobilization  ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
Methods of immobilization ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Purpose of immobilization ,[object Object],[object Object]
Complication of immobilization ,[object Object],[object Object],[object Object],[object Object],; pressure sore, compartment syndrome ; inadequate immobilization (loss reduction,  delayed, mal or nonunion) ; muscle atrophy, osteoporosis,  joint stiffness, maceration of skin ; inadequate immobilization  (loss reduction, delayed, mal or  nonunion)
 
 
A. Taylor brace B. Chairback brace
C. Jewett hyperextension brace D. Lumbosacral support
Strap immobilization ,[object Object],[object Object],[object Object],; A band or slip used in attaching parts to each others
 
 
Gibney’s strap Ankle sprain Nondisplaced fracture of ankle
 
 
Velpeau’s strap Injury of  shoulder  region
Slab immobilization ,[object Object],[object Object],[object Object],[object Object],[object Object]
Sugar tong slab Fracture  of  humeral shaft
U slab for fracture of forearms Fracture of forearm Fracture of distal radius or ulna
Short arm slab
Long arm slab
Thumb spica slab
Short leg slab
Long leg slab
Casting ,[object Object],[object Object],[object Object],[object Object],-  Degree of deformity -  Fracture type (simple, oblique, spiral)
 
Three point fixation ,[object Object],[object Object],[object Object],[object Object]
 
 
 
 
Advice to give patients before casting ,[object Object],[object Object],[object Object],[object Object]
Complications of casting Pressure sores Cast sores
Measured time from the point which the plaster is wetted to  the point at which the cast has become firm A period during setting time when the plaster became dry or  sticky like rubber and color changed. At this point, the  plaster should keep still without any movement or molding  Setting time Critical setting time
Duration for completely dry of plaster of Paris ,[object Object],[object Object],[object Object],[object Object],Depend on Normally 48 – 72 hours
Well-molded, one solid piece Laminated layer
 
Casting  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Casting (cont.)
Short arm thumb  spica cast
Long arm cast
Hanging cast
Long leg cast
 
Sarmiento or Functional cast
Bolero cast
Shoulder spica cast
Hip spica cast
Adult hip spica cast
Minerva cast
Body jacket
Traction ,[object Object],[object Object],[object Object]
Skin traction ,[object Object],[object Object],[object Object]
Modified Buck’s traction
[object Object],[object Object],Skin traction
Skeletal traction 1 lbs of traction for every 7 lbs of body weight (usually uncomfort if > 35 lbs)
Skeletal traction in  upper extremities Dunlop traction  for supracondylar fracture In children Overhead olecranon pin traction
Skull traction ,[object Object]
[object Object],Skull traction
[object Object]
 
Exception for non-immobilization ,[object Object],[object Object],[object Object],Early, protected, gentle active motion
Principles to approach severe musculoskeletal injury ,[object Object],[object Object],[object Object],[object Object],Principles to approach severe musculoskeletal injury
B. Initial treatment of major fractures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Principles to approach severe musculoskeletal injury (shock) (shock) (shock) (shock)
Associated injury ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],C. Standard radiographs of fractures / dislocation Principles to approach severe musculoskeletal injury
ถ้าเป็นผู้ป่วยที่หมดสติ ควรจะมีการ   x-ray  อะไรบ้าง ,[object Object],[object Object],[object Object]
D. Immediate definitive treatment of fracture ,[object Object],[object Object],[object Object],Principles to approach severe musculoskeletal injury
Objective of treatment in orthopaedic patient  ,[object Object],[object Object],[object Object]
Management of Common Fractures and Dislocations
Definition ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Stability of joint ,[object Object],[object Object],[object Object],[object Object]
Special types of fractures ,[object Object],[object Object],[object Object],[object Object]
Stress fracture ,[object Object],[object Object],[object Object],[object Object]
Birth fracture ,[object Object],[object Object],[object Object],[object Object]
Diagnosis of joint injuries ,[object Object],[object Object],[object Object],[object Object],[object Object]
Common affected part related to age of patient ,[object Object],[object Object],[object Object]
Suspected fracture or dislocation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Suspected fracture or dislocation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Suspected fracture or dislocation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Suspected fracture or dislocation ,[object Object],[object Object],[object Object]
Suspected fracture or dislocation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Suspected fracture or dislocation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Suspected fracture or dislocation ,[object Object],[object Object],[object Object],[object Object]
How to describe ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Site ,[object Object],[object Object],[object Object],[object Object]
Extent ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Configuration ,[object Object],[object Object],[object Object],[object Object]
Relation between fragment ,[object Object],[object Object]
Relation to external environment ,[object Object],[object Object]
Complications ,[object Object],[object Object]
Duration for bone healing ,[object Object],[object Object],[object Object],[object Object],[object Object]
Complication of fractures ,[object Object],[object Object]
Goal of treatment ,[object Object],[object Object],[object Object],[object Object],Acceptable alignment
Methods of treatment for closed fracture ,[object Object],[object Object],[object Object],[object Object]
Methods of treatment for closed fracture ,[object Object],[object Object],[object Object]
Methods of treatment for  open fracture ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Different point of musculoskeletal injury between children and adult ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prognosis of epiphyseal plate injury ,[object Object],[object Object],[object Object],[object Object],[object Object]
Before any treatment Firstly Do No Harm
Acceptable Alignment Indication form Surgery Proper Treatment
Open Fracture
1 2 3 4 5 6
1 2 3 4 5 6
Open fracture The fracture in which a break in the skin and underlying soft tissues leads directly into or communicates with it and its hematoma
Diagnosis ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Gas can also be produced by  Clostridium perfringens   and enteropathogens such as  Escherichia coli .  The presence of air or gas in the soft tissues on initial radiographs in the presence of a fracture strongly suggests an open fracture.
[object Object],[object Object]
Open fracture ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Infection rate ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Recommendations for acute management of open fractures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Examination of the wound and initial emergency management ,[object Object]
[object Object],[object Object]
[object Object],Predebridement culture from the wound in the  emergency department before administration  of antibiotics or any antiseptics is not useful
Orthopaedic patients : Antibiotics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
[object Object],[object Object],[object Object],[object Object],Compartment Syndrome
Compartment Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object]
ท่านจะทำอย่างไร ?
Traumatic amputation ,[object Object],[object Object],[object Object]
* Safety time for inappropriate technique for warm  ischemia ; 6 hr * Safety time for inappropriate technique for cold  ischemia ; 12 hr (fingers ; 30 hr, but less in major  limb according to more muscles involvement) * The amputated part should be sent for X-ray Traumatic amputation
Traumatic amputation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Traumatic amputation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Mangled Extremity Severity Score (MESS) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
                                                             
A score of less than 7 points suggests that salvage  should be attempted.  Conversely, amputation should be considered  if the score is more than 20 points.
Open Knee Injury
Pitfalls of  Musculoskeletal Problem  in Children
 
 
 
 
 
Staging of fracture in young children ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
 
 
Do you know these? ,[object Object],[object Object],[object Object]
Three Part Fracture Two Part Fracture
Common Musculoskeletal Problems ,[object Object],[object Object],[object Object]
Fracture of Distal Radius ,[object Object],[object Object],[object Object],[object Object],[object Object]
Fracture of distal radius ,[object Object],[object Object],[object Object],[object Object],[object Object]
Fracture of Necessity ,[object Object],[object Object],[object Object],[object Object]
Imperturbability ,[object Object],[object Object]
Five factors ,[object Object],[object Object],[object Object],[object Object],[object Object]
“ Treat First and Ask Questions Later”
Most practices On average only 10 to 15 minutes per patient for the evaluation, testing, treatment, disposition, and documentation
The way of approach ,[object Object],[object Object],Do I need to resuscitate this patient? How great is the threat? How soon must I act?
Management, Not Diagnosis ,[object Object],[object Object]
Decision Thresholds “Index of Suspicion” ,[object Object],[object Object]
[object Object],[object Object],Decision Thresholds “Index of Suspicion”
[object Object],[object Object],Decision Thresholds “Index of Suspicion”
Common Pitfalls ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How to approach patients ,[object Object],[object Object],[object Object],[object Object]

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