Orthopaedic Emergencies Part 3 - Everything You Need To Know - Dr. Nabil Ebraheim
24.6 هزار بار بازدید -
12 سال پیش
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Dr. Ebraheim’s educational animated video
Dr. Ebraheim’s educational animated video about Orthopaedic Emergencies.
Open fractures can be classified by the Gustilo-Anderson Classification. A Grade I Injury is a clean wound less than 1 cm long with minimal soft tissue injury and minimal bone comminution. Grade II Injury is a moderately contaminated wound less than 1 cm with moderate tissue injury and moderate bone comminution. Grade III Injury is a highly contaminated wound, usually less than 10 cm, segmental fractures, farm yard injuries, high velocity gunshot wounds and fractures occurring in a highly contaminated environment regardless of the size of the wound. Grade IIIA are sever soft tissue injuries with crushing comminuted fracture; soft tissue coverage of bone possible. Grade IIIB is very severe loss of soft tissue cover with poor bone coverage and variable. May be moderate to severe bone comminution, it usually requires soft tissue reconstructive surgery in the form of local or distant flap. Grade IIIC is a vascular injury that requires repair or amputation. There is a very severe loss of soft tissue cover with variable, may be moderate to severe bone comminution. Injury to the femoral artery from the posteriorly displaced proximal fragment of a grade IIIC open supracondylar fracture of the femur. There is a high rate of amputation, nonunion and infection.
Hip infection (septic arthritis) is a serious disease, especially in children. The intraarticular structures will be inflamed and the increased intracapsular pressure will decrease the blood supply to the femoral head. Infection is associated with a high risk of avascular necrosis. Position the limb in the stage of effusion-flexion, abduction, external rotation. Complications are severe and much more common in children. Complications include pathological dislocation, avascular necrosis, osteomyelitis and pelvic abscess. Urgent aspiration followed by drainage of the hip joint combined with intravenous antibiotics will be the treatment protocol.
Necrotizing fasciitis is an insidiously advancing soft tissue infection characterized by widespread tissue necrosis. The most common causative organism – group A beta – hemolytic streptococcus. There is a high mortality rate with sepsis and renal failure. Amputation and mortality rate is increased due to a delay in diagnosis. Pre-disposing factors include trauma, surgery and urogenital and anogenital infections. There are three types: Type I (polymicrobial), Type II (group A beta – hemolytic streptococcus) and Type III (Gas gangrene – clostridial myonecrosis). Immediate surgical debridement combined with intravenous antibiotics and possibly hyperbaric oxygen. Soft tissue compromise associated with fracture blisters, ecchymosis, and severe bruising which indicate a greater degree of deep soft tissue damage. Blood-filled fracture blisters are associated with high wound complications. Initial management involves application o fa spanning external fixator with the fracture dislocation held in reduction with traction. The definitive management involves replacing the spanning external fixation with a hybrid fixator or plate once the soft tissue edema is resolved and the skin is wrinkled, usually in one to three weeks. Spanning external fixation can often be combined with percutaneous fixation of large articular fragments. Soft tissue compromise is more common with tibial plateau fractures and tibial pilon fractures with diaphyseal extension. Calcaneal avulsion fracture is an emergency! Urgent reduction and fixation is mandatory to avoid soft tissue complications. Fragment is displaced and rotated which compressed the skin at the back of the heel. The pressure will create skin necrosis and significant soft tissue complication.
Open fractures can be classified by the Gustilo-Anderson Classification. A Grade I Injury is a clean wound less than 1 cm long with minimal soft tissue injury and minimal bone comminution. Grade II Injury is a moderately contaminated wound less than 1 cm with moderate tissue injury and moderate bone comminution. Grade III Injury is a highly contaminated wound, usually less than 10 cm, segmental fractures, farm yard injuries, high velocity gunshot wounds and fractures occurring in a highly contaminated environment regardless of the size of the wound. Grade IIIA are sever soft tissue injuries with crushing comminuted fracture; soft tissue coverage of bone possible. Grade IIIB is very severe loss of soft tissue cover with poor bone coverage and variable. May be moderate to severe bone comminution, it usually requires soft tissue reconstructive surgery in the form of local or distant flap. Grade IIIC is a vascular injury that requires repair or amputation. There is a very severe loss of soft tissue cover with variable, may be moderate to severe bone comminution. Injury to the femoral artery from the posteriorly displaced proximal fragment of a grade IIIC open supracondylar fracture of the femur. There is a high rate of amputation, nonunion and infection.
Hip infection (septic arthritis) is a serious disease, especially in children. The intraarticular structures will be inflamed and the increased intracapsular pressure will decrease the blood supply to the femoral head. Infection is associated with a high risk of avascular necrosis. Position the limb in the stage of effusion-flexion, abduction, external rotation. Complications are severe and much more common in children. Complications include pathological dislocation, avascular necrosis, osteomyelitis and pelvic abscess. Urgent aspiration followed by drainage of the hip joint combined with intravenous antibiotics will be the treatment protocol.
Necrotizing fasciitis is an insidiously advancing soft tissue infection characterized by widespread tissue necrosis. The most common causative organism – group A beta – hemolytic streptococcus. There is a high mortality rate with sepsis and renal failure. Amputation and mortality rate is increased due to a delay in diagnosis. Pre-disposing factors include trauma, surgery and urogenital and anogenital infections. There are three types: Type I (polymicrobial), Type II (group A beta – hemolytic streptococcus) and Type III (Gas gangrene – clostridial myonecrosis). Immediate surgical debridement combined with intravenous antibiotics and possibly hyperbaric oxygen. Soft tissue compromise associated with fracture blisters, ecchymosis, and severe bruising which indicate a greater degree of deep soft tissue damage. Blood-filled fracture blisters are associated with high wound complications. Initial management involves application o fa spanning external fixator with the fracture dislocation held in reduction with traction. The definitive management involves replacing the spanning external fixation with a hybrid fixator or plate once the soft tissue edema is resolved and the skin is wrinkled, usually in one to three weeks. Spanning external fixation can often be combined with percutaneous fixation of large articular fragments. Soft tissue compromise is more common with tibial plateau fractures and tibial pilon fractures with diaphyseal extension. Calcaneal avulsion fracture is an emergency! Urgent reduction and fixation is mandatory to avoid soft tissue complications. Fragment is displaced and rotated which compressed the skin at the back of the heel. The pressure will create skin necrosis and significant soft tissue complication.
12 سال پیش
در تاریخ 1391/02/08 منتشر شده
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