Orthopedic Injury Evaluation


DEFINITIONS OF FRACTURES AND THE ORTHOPAEDIC TRAUMA ASSOCIATION (OTA) CLASSIFICATION SYSTEM
  • Closed fractures: Break in the bone or cartilage with skin intact
  • Open fractures: Any fracture where there is a traumatic wound allowing the outside to communicate with the bone
    • High risk of infection
    • Treatment includes prophylactic antibiotics, tetanus prophylaxis, irrigation and debridement, and emergent orthopedic consultation.
Components of OTA classification system of fractures
1. Bone: Describes the bone(s) that is/are involved, e.g., radius.
2. Segmental location: Describes the location of the fracture relative to the bone, e.g., physis (see Chapter 5, Pediatrics, for Salter-Harris classification system), proximal, diaphyseal, distal
3. Type: Describes the complexity of the fracture, e.g., simple, wedge, complex, articular
4. Group: Describes the orientation of the fracture line, e.g., hairline, greenstick, torus, nightstick, linear, transverse, oblique, segmental, spiral, crush
5. Subgroup: Describes further the relative orientation of the fracture line, e.g., displacement, separation, shortening, angulation, rotation

 
ASSESSMENT OF NEUROVASCULAR STRUCTURES

Common Injuries and Associated Neurovascular Complications
TYPES OF FRACTURES OR DISLOCATIONS NEUROVASCULAR COMPLICATIONS
Anterior shoulder dislocation
Musculocutaneous nerve injury
Axillary nerve and artery injury
Extension supracondylar fracture
Posterior elbow dislocation
Brachial artery injury
Ulnar and median nerve injury
Radial nerve injury for supracondylar fracture
Knee dislocation Popliteal artery injury
Peroneal and tibial nerve injury
Humeral shaft injury Radial nerve injury
Medial epicondylar fracture Ulnar nerve injury
Lateral tibial plateau fracture Peroneal nerve injury

 

MANAGEMENT OF ORTHOPEDIC INJURIES
  • Analgesia
  • Reduction if necessary
    • Reassess neurovascular status.
  • Splints
    • Shoulder immobilizer
    • Sling
    • Long-arm gutter
    • Sugar-tong
    • Short-arm gutter
    • Thumb spica
    • Knee immobilizer
    • Posterior ankle mold
    • Ankle stirrup
  • Orthopedic consultation or referral
COMPLICATIONS OF ORTHOPEDIC INJURIES
  • Malunion or nonunion
  • Avascular necrosis
    • Hip dislocation
    • Scaphoid fracture
    • Talus fracture
    • Proximal humerus fracture
  • Infection
  • Vascular injury or hemorrhage
  • Nerve injury:  Pain, paresthesias, weakness, or paralysis
  • Soft-tissue or organ injury
  • Compartment syndrome
  • Fat emboli syndrome
    • Most common after long bone and pelvic fractures
    • See petechiae, altered mental status, hypoxia.
  • Volkmann ischemic contracture
    • Flexion contracture of hand/wrist due to untreated forearm compartment syndrome and resultant muscle ischemia.
  • Reflex sympathetic dystrophy (complex regional pain syndrome)
     

 

All open fractures require emergent orthopedic consultation because of high risk of infection
Neurovascular evaluation:
PMS
Pulse
Motor
Sensation
The 5 Ps of compartment syndrome:
Pain (most common symptom)
Paresthesias
Pallor
Paralysis
Pulselessness (late finding!)