0071643192.pdf

ORTHOPEDICS

EVALUATION OF ORTHOPEDIC INJURIES

DEFINITIONS OFFRACTURES AND THEORTHOPAEDICTRAUMAASSOCIATION(OTA)

CLASSIFICATIONSYSTEM

■ 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, irriga-

tion and debridement, and emergent orthopedic consultation.

Components of OTA classification system of fractures (see Figure 4.1):

1. Bone:Describes the bone(s) that is/are involved, eg, radius.


2. Segmental location: Describes the location of the fracture relative to the
   bone, eg, physis (see Chapter 5, Pediatrics, for Salter-Harris classification system),
   proximal, diaphyseal, distal


3. Type: Describes the complexity of the fracture, eg, simple, wedge, complex,
   articular


4. Group:Describes the orientation of the fracture line, eg, hairline, greenstick,
   torus, nightstick, linear, transverse, oblique, segmental, spiral, crush


5. Subgroup:Describes further the relative orientation of the fracture line,
   eg, displacement, separation, shortening, angulation, rotation

ASSESSMENT OFNEUROVASCULARSTRUCTURES

See Table 4.1 for common injuries and their associated neurovascular

complications.

MANAGEMENT OFORTHOPEDICINJURIES

■ 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 OFORTHOPEDICINJURIES

■ Malunion or nonunion

■ Avascular necrosis

■ Hip dislocation

■ Scaphoid fracture

All open fractures require

emergent orthopedic

consultation because of high

risk of infection.

Neurovascular

evaluation—

PMS

Pulse

Motor

Sensation

FIGURE 4.1. The AP

view of the forearm

shows a simple, trans-

verse distal radial shaft

fracture with approxi-

mately 90% displacement.