Operative treatment

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雾稗湛
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1 Operative Treatment of Fractures K S Leung - CUHK-AADO 2006 Management of Orthopaedic Trauma 5 phases: 5 1. First-aid: at the scene 2. Accident and Emergency Department 3. Definitive - Damage control - 4. Management of complications 5. Rehabilitation Practical Approach to Patients with Fractures! Save life. Resuscitation: A, B, C. A,B,C! Save limb. detect and treat neuro-vascular injuries! Fix the fractures. early and speedy fixation. Aims of Fracture Treatment! Alignment Reduction! Apposition Fixation! Asepsis! Activity Rehabilitation Fractures Protection alone or Immobilisation with external splintage Closed Reduction Internal Fixation External fixation Functional bracing Traction Cast Immobilisation Open reduction + Internal Fixation + Endoprosthesis Advantages of operative Treatment! Reduction of fractures!anatomical!alignment! Stable fixation of fractures! Early mobilisation! Early regain of functions! Short hospital stay

2 Disadvantages of Operative Treatment!Anaesthesia!Infection!Fracture healing!allergic reaction!refracture Methods of Operative Treatment! Open reduction and internal fixation! Open reduction and external fixation! Closed reduction and internal fixation! Minimally invasive surgery 1. Displaced intra-articular fractures Aims :!"#$%&' 2. Multi - Trauma Patient Anatomical reduction Stable internal fixation Early mobilisation Multi-trauma Patients!Mortality! Haemorrhage! Adult Respiratory Distress syndrome (ARDS)! Multi-organ Failure!Sepsis Damage Control Surgery Second-Hit Phenomenon Blood loss in closed fractures L 3-4 L L 1 L Multi-trauma Patients Early Fixation of Fractures!Decrease ARDS ARDS! Decrease in mortality! Decrease complications! Facilitate nursing care! Facilitate rehabilitation

3 3. Diaphyseal fractures of long bones in adults 4. Geriatric hip fractures Pain relief Avoid bed-ridden Mobilisation Prevent deformity Regain independence Geriatric Hip Fractures (I)! Problems-! Increasing incidence! Social and family Problems! Multiple medical Problems! Poor bone quality (osteoporosis)! Prolonged rehabilitation Middle East 5.706% North America % Oceania Africa 0.701% 0.601% Russia 4.404% Latin America % 2050 Europe % Asia % Geriatric Hip Fractures (II) Treatment Aims!"#(! Early regain of independence! Minimise isolation! Minimise bed rest Therefore! Early operation! Early mobilisation

4 5. Open fractures Severe soft tissue trauma Contamination Fracture comminution Principles of Management The Solution to Pollution is Dilution! Repeated and thorough debridement - jet lavage! Early skeletal fixation! Delayed wound closure! Enhancement of fracture healing! Antibiotics! Mobilisation 6. Difficult fractures! those prone to nonunion! those prone to malunion! those prone to be pulled apart by muscle actions! Metastatic tumour! Primary tumour 7. Pathological fractures! Metabolic diseases! Paget s disease! Osteogenesis imperfecta! Osteoporosis 8. Fracture failed non-operative treatment Implants and Instruments! Plates and screws! Wires and cables!,! Intramedullary nails! Interlocking! External fixator! Absorbable implants

5 Plates and Screws )*+, AO Principle AO (Arbeitsgemeinschaft für Osteosynthesefragen) Interfragmentary Compression Primary bone healing! Lag screws -! Dynamic compression plates DCP! Tension bands wiring TBW! Articular and juxtaarticular fractures Lag screw Interfragmentary stability Primary bone healing $%&'() Primary Bone Healing!"#$%& Fracture line Cutting cone New bone Remodelling of Haversian system

6 Locked plates! Internal fixator! Osteoporotic bone! Inter-fragmentary compression??? Intramedullary Nails! G Küntscher GK! Splintage! Closed method of treatment! Minimal surgical trauma! Biology of fracture healing Secondary Bone Healing! Haematoma formation! Callus formation! Callus remodeling! Bone union Callus A preferred way of fracture healing

7 Intramedullary Locked Nails! Anatomical alignment! Modern method for diaphyseal fractures! Extends the application of IM nails!distal Locking Technique!!!

8 External Fixator! Open fractures! Pelvic fractures! Ligamentotasis!Distal radius!distal tibia! Bone transport

9 ! Soft tissue! Bone Local Complications! Malunion! Delayed union! Non-union! Joint! Arthrosis! Stiffness! Infection! Growth disturbance! Sympathetic Osteodystrophy Systemic Complications! Hypovolaemic shock! Fat embolism! Adult respiratory distress syndrome (ARDS)! Clotting! Thrombo-embolism! Crush syndrome! Tetanus Indications for Operative Treatment! Displaced intra-articular fractures! Multi-injured with fractures! Multiple fractures! Diaphyseal fractures of long bones! Geriatric fractures! Open fractures! Pathological fractures Conclusion! Atraumatic Biological fixation! Aseptic! Biomechanic Early mobilization! Economical Thank you!!

2 AOTrauma Course Basic Principles of Fracture Management Value statement AOTrauma is committed to improve patient care outcomes through the highest q

2 AOTrauma Course Basic Principles of Fracture Management Value statement AOTrauma is committed to improve patient care outcomes through the highest q Course program AOTrauma Course Basic Principles of Fracture Management AO 创伤基础教育班教育日程 June 06-08,2014, Kunming, China 2014 年 6 月 6 日 -8 日昆明, 中国 Home to Trauma & Orthopaedics 2 AOTrauma Course