orthopaedic trauma อ.ธีรชัย

8/16/2019 Orthopaedic Trauma .

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สารบัญ

บทท 1 Fracture Principles 1

บทท 2 Emergency Splinting and Casting 21

บทท 3 Fractures and Dislocations of Upper Extremity 35

บทท 4 Fractures and Dislocations of the Hand and Wrist 46

บทท 5 Fractures and Dislocations of Lower Extremity 58

บทท 6 Spinal Injuries 79

บทท 7 Fractures and Dislocations in Children 98

บทท 8 Open Fractures 110

บทท 9 Fractures and Dislocations for General Practitioner 120

บทท 10 Complications of fracture 134


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Fracture Principles

1

!""# $ % Fracture Principles __________________________________________________________________________________________

Terminology of Fractures &'()(#*&+, $-&(./0&12&!"#$%& '!'(()!*'+,(%& '!'(-(./!01 2#!(345!6)!768-69'3:9-;1 2#


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Fracture Principles

2

Relation of the fragment to each other

!'(1#6B)!R4/7080H E$%. 2#/5 "%'=:",$@8$ (proximalfragment) -JO$6B)! AB3

joint (DRUJ) -+B1 2#$6BQ4

(0?"# $ %.2 !'(-(./!01 2#!(345!6)!@'901 2#


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Fracture Principles

3

3')1@A&'(12& -0"$ ((5J%. 2 1.3)Nightstick fracture : !(345! ulnar 6)!-$1 2#=N'!DR9/>5!M98;B#=D#=@& '(,[email protected]’s fracture : !(345! radial styloid 6)! -$1 2#=N'!R0-V#(G70891#69Q$:@'(G%(>

AB8,>5!91#69Q$:3

Subluxation D:-)F;, $-G : !'(


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Fracture Principles

4

(0?"# $ %.5 Inflammatory phase

(0?"# $ %.6 Repairative phase

Fracture Healing

-91 2#-!H4!(345!6)! ("'=!'/N39.!BM!-;1 2#T"#9AT9768!(345!@H4 7$%. 2$. EN3!B"',>?=6B)!!'(R4/:)=-DJ%. 2N3$& '9'J(3/Q!@G708

Cortical bone healing -!H4%. 2 diaphysis D#= long bone 9. 3 (3/3+1# ((5J%. 2 1.4)1. Inflammatory phase (3/3#)!-:


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Fracture Principles

5

(0?"# $

%.7 Remodeling phase

union P58JY,/N3M9"9.#'!'(-NS:(8'=!(345!769"D? E$;#!


8/142

Fracture Principles

6

BA/?(.38FH&'((2&I'&(./0&12&1. 768!(345!@H4 solid union

2. :'9'(>!B)

#'!'(J,4AB3!4-NS


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Fracture Principles

7

Screening test

708(3/3-,B':) E$U-91 2#;

!"#"$%&'()*"+,#$-'.#/0#%1*1!1 2'3%#*

1. !(345!PH4(5J R!"==# 64:) E$6(1#


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Fracture Principles

8

3. &'(@("'/-#!T-(/G769"

6. !'(>"'/-#!T-(/G%"'J!@H"'/-#!T-(/G%"';H-L* T? 2=N3/!@),#/"'=%. 2M48708


11/142

Fracture Principles

9

ankle mortise 70845!'(A/!D#=D8#@"#

%. Recognition -JO$!'(@(,N,H$HNK)/768M48,"'9.!(345!6)!6(1#D8#-+B1 2#$6(1#M9" 6(1#9.

!'(

63!7)$$-)0(

!(I.%. 2-JO$ impacted fracture

M9"N&

'-JO$@8#=%&

'!'(N)44?=!(345!

-;('3N3%& '7680H E$!(345!%. 2#)4-D8'6'!)$-+B1 2#$6BQ4!B'/-JO$ displaced fracture


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Fracture Principles

10

!'(N)4!(345!-D8'%. 29. 2 ,H]. +1#%. Closed reduction -JO$!'(N)40H E$!(345!R4/M9"-6S$(#/6)!R4/@(= ,H].$. E@8#=708

-#!T-(/G-JO$-+(1 2#=91#@(,N45,"'!(345!-D8'%. 26(1#M9"

1.1

!'(N)40H E$6)!R4/,H].!'(4)44?= (closed manipulation) 708!'(4)44?=R4/A;%/GAB3P5 80",/6B)=N'!%. 2768/'0'6(1#/':B",=7689.!'(/14D#=!(345!%.B3$8#/ 708!(I.%. 29.!'(64:) E$9'! 6(1#!(I.%. 2!(345!6)!9'$'$M9":'9'(>N)44?=768-D8'%. 2C'/7$+() E=-4./,M48

2. Open reduction -JO$!'(N)44?=0H E$6)!768-D8'%. 2R4/!'(P"'@)4-D8'MJ

!'(@(?=!(345!768#/5 "$H 2=-JO$!'((#768!(345!@H4R4/]((90'@H R4/A;%/G%& '6$8'%. 2N)4A$,!(345!768#/5"7$-!IbG%. 2/#9()


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Fracture Principles

11

!'(-D8'-W`#!M9":'9'(>N)4768!(345!#/5 "7$B)!*I3$. EM48 6'!768P5 8JY,//1$D? E$B=$& E '6$)!-;./=-BS!$8#/!(345!!SN364:) E$ :(QJ,Y'!(345!6)!B)!*I3$. EM9":'9'(>()!*'R4/!'(-D8'-W#̀!

2. &'(P37)F(, $-8/Q857


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Fracture Principles

12

-;1 2#6B.!-B. 2/= fracture disease %. 2N3-!H4D? E$ M489.P5 8L?!*'AB3:(QJM,8,"'!'(9.active pain-free mobilization -;1 2#7689. physiologic load @"# bone muscle complex N3B4J\F6' joint stiffness AB3 muscle atrophy M48N?=9.!'(;/'/'9+H4+8$RB63%. 2N3/?4@(?=!(345!

768#/5 "!)768P5 8JY,/%& ' early exercise M48 >8'%& ' ORIF AB8,P5 8JY,//)=@8#=708 externalimmobilization -0"$-W`#! PB!'(()!*'N3M9"4.-%"'%. 2+,(

!'(%& ' internal fixation -JO$-;./=!'(/?4@(?=!(345!768#/5 "!)


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Fracture Principles

13

Indications for Surgical Reduction and Stabilization

(internal fixation 6(1# external fixation)1. Displace intrarticular fracture !'(%& ' reduction R4/ closed method -JO$MJM48

/'!9'! open reduction :'9'(>%& '768M48 anatomical reduction, promotecartilage healing -;1 2#J[#=!)$ post-tramatic arthritis

2. Unstable fractures %. 2M9":'9'(>N)4-D8'%. 2R4/ close manipulation3. Major avulsion fracture T? 2=%& '7689. disruption D#= musculotendinous unit 6(1#

ligament -0"$ avulsion fracture olecranon, patella4. Displaced pathologic fracture 7$P5 8JY,/%. 2!"#$!(345!6)!/)=:'9'(> ambulation

M48-;1 2#B4+,'9-NS


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Fracture Principles

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Contraindications to Surgical Reduction and Stabilization

!'(%& ' internal fixation 7$!(I.-6B"'$. EN3%& '7689.R#!':B89-6B,M48:5=1. Osteoporotic bone !'(/?4D#=RB63!)

2.

:C';D#= soft tissue 49/':B


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Fracture Principles

15

fractures, fracture dislocation %. 2!4%)?= 3-4 :)J4'6G6B)=N'! injury #'NN3(#768PH,6$)=


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Fracture Principles

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External Fixation

-JO$-+(1 2#=91#/?4@(?=!(345!R4/708 wire, pin 6(1# schanze screw /?4-D8'MJ/?4@(?=!(345!M489) 2$+=-;./=;#%. 2N3768P5 8JY,/-+B1 2#$M6,D8#M482. 45AB


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Fracture Principles

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5. 7$!(I.%. 2 pin P"'$!B8'9-$1 E#6(1##/5 "7!B8D8##'N%& '768-!H4D8#@H4ADS= (joint stiffness)6. pin #'NN3%H 29A%=-:8$-B1#4 -:8$J(3:'%M48

4)=$) E$!'(708 external fixator @8#=+& '$?=>?=J\NN)/@"'=U +1# B)!*I3D#=!(345!6)!B)!*I3

AB3@& 'A6$"=D#=JBY#/M,87$("'=!'/M48 Steinless implant 7$ (/'=+GB"'=>8'@8#=!'(>#4RB634'9!(345!+,(N3>#4##!6B)=N'! 18-24 -41#$

4#FT '5'41;'*VFT '5'4"# $) $*


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Fracture Principles

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- humerus. forearm M9"70"!(345!%. 2@8#=()

• "T '94 intraarticular fracture BQ8@=/+:'&"'/-#!T-(/G7$(3/3-,B'@"'=!)$

• &(./0&12&@:-8X7'"A&('*1(,-947

- M9"N& '-JO$ !(345!6)!


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Fracture Principles

19

• X7'@2/6;:D/)"'/-#!T-(/GD8'=@(=D8'9-J(./


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Fracture Principles

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8. epiphyseal plate 7$-4S!-JO$:",$%. 2#"#$A#%. 2:Q4 T? 2=9.R#!':M48()?= ligament injury 7$-4S!

9. '9J(3,)@H,"'9.!'(-+B1 2#$6BQ4PH4(5JD#=D8#6(1#9.7+(4?=768!"#$6(1#M9"10. C';-#!T-(/G%. 2-6S$M9"+(#

12. ()!*'$8#/-!H$MJ -0"$ P5 8:5=#'/Q%. 29. impact fracture neck of femur 6(1# fractureodontoid T? 2=9#=-6S$M9"0)4-N$ !S768P5 8JY,/!B)


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Emergency Splinting and Casting

21

!""# $ 2 Emergency Splinting and Casting--------------------------------------------------------------------------------------------------------------------------------------

• Emergency splint of the spine

A.

!"#$%&'() *+,-./0 +1234,5'3,6'7896:6;, 6'7896:6;4-#:#3'+#.=.7'&5;3;??@,)A1@-"A.7:+?63=!" #$%&'

D. N;&@ neurogenic shock () *DA0-6J O:?@C5&'9A#46P-''A6;(7 O=.3=6#;=63=!" #$%&'>+#."=

6J O:DL2 *3DL0 *, venous return

• Upper extremity splinting

A. 3'5;C#!#;QC#!#;Q


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%&'"# $ 2.3 Pillow splint 9.5 thomas splint () *F"A/#3= ring 63= thomas splint ?@'7:810D&Mischium tuberosity 9C#!#;Q+#D65;3'" 5>:(5;D+')'- 6#3Q&11@&7=Q23 /#3=4,5L7: elasticbandage 9:5:DA0:4$ 9C#>:A1M) acute ankle and

foot trauma DC5: ankle sprain, calcaneal fracture C#-;,810D&M distal leg, ankle 4-#-)

P-'>C#+,3:,;-7-9$C#!#;6:+:" L7:1386;!" #$%&'9C#

4,#-;,$1@A8(7 O= 2 6#;= >C#>: lower extremityfracture DC5: femur, tibia

• 56%2789:;)5 casting

DWX3A$1@A38-#&'!#;P$1%= RJ *=!5;:A11,&0Y)37-.;1L0DHI9C#,;A9C#A7:P-'(7 *&4$

2. fiber glass (K ;?;A.;1.7=DQ1;@+T ,):K O ;+:7AD8; 96B=91= ,)


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5 6% / .?4+2+56%2789:;)5 Basic principle A. C+46"# $:A1@-"A+7A() *D+#A1@-"A/1=


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•

>:A1@-"A+7A() *D+#

A.5 short arm cast >: Colles’ fracture ?@3;H7'A;1'J->+#6#3,233'" 5>:(5; pronation 9.5 PTB cast .5&:8:?@'J-810D&M femoral condyle 9C#DWX3A6:;- 4 :0 O& 810D&M6;>C#6:;-6 :0 O& >:D-BA3;?>C#DWX3A 6 :0 O&/7-Q1J *=>+#D+C# 810D&M96:

>C# 6:;- 3 :0 O& 810D&M6;>C#6:;- 4 +123 6 :0 O&3. +;A810D&M13'+7A8&,,;A A;1>.5DWX3AP-'138 (circular cast) ,)P3A;.

DA0- compartment syndrome Q&1D


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%&'"# $ 2.7 A;1L7: webril (78D++#+:;6J O:DL2 *3A7:638DWX3AA-!0&+:7= 810D&M$G %,A1@-"A+123.#:D(#; Q&113= webril DL0 *,3)A 3-4 C7 O:

6. A;19C5DWX3A ?78C;'DWX3A,;A53:9C5DWX3A(GAQ17 O= (1"$() * 2.8) ?G5,::K O ;>+#+,-13?:V3=3;A;HN;'>:DWX3AF"A9(:() *-#&':KO ;9


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26

8. A;1+#DA0-91=A-D^L;@() * D10 *,+#DWX3A9/A6M@DQ:() *3;A;HF5;'D(4-#.@-&A 4,5>C#!#;Q+#DWX3A4,59+#= +#;,+#3'" 5:0 *=3'5;=.,8"1MT4-# ?J=Q&14-#178A;1D$C#810D&M96:Q&1+:;$1@,;M 8-10 C7 O: .5&:,;A>C#DWX3A6:;- 4 :0 O& slab810D&M6;Q&1+:;$1@,;M 10-14 C7 O: ?@>C# 4 :0 O&+123 6 :0 O&9


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%&'"# $ 2.(2 A;1/7-C53=DWX3A

webril 810D&M96:+1236;A53:9C#DWX3A&;=(78+#DWX3AD$_'A:K O ; +123:K ;4$+#9+#=3. 3'5;>C#63=96B= DC5: 4,# D6#;4$DA;>:DWX3A DL1;@?@(K ;>+#DA0-9!:DWX3A4. 'A.5&:() *4-#1788;-D?B8D+:231@-78+7&>? P-'D^L;@C5&= 2-3 &7:91A

5. 4,5Q&1>C#.) $;AA; 6)-D6)':8:DWX3A+123(K ;>+#DWX3A.A$1A (K ;>+#,3=4,5D+B:13'

D


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28

D. 56%N)-9:; )5/0K>.-9:;)5/#3=>C#[email protected];1MT Q&;,1" #Q&;,CK ;:;U DC5:D-)'&A78A;1>.5DWX3A +;A,)P3A;.:7AHJAI;

Q&14-#+7-$Z087/0?:DA0-Q&;,CK ;:;U

A;1F3-DWX3A?@(K ;D,2 *3Q18AK ;+:-A;117AI;A1@-"A/0--)9+#!" #$%&'(1;8FJ=A;1(K ;=;:63=D+#!" #$%&':7 *=+123:3:>:(5;() *.8;' .5&:>+U5?@F3-DWX3AP-'/7-33AD$E: 2 W;

(bivalve) (1"$() * 2.13 ) (;=-#;:6#;= L+#/7-4-#F:7-3. >C#$;AA;16)-9:&() *?@/7->+#D+B:C7-D?:

4. A;1/7-DWX3A?@/7-()+#6J O::9:&/7 O=^;AA78!0&DWX3A() *?@/7-P-'>C#:0 O&,23D$ E:/7&C5&'/1J=>+#DA0-Q&;,,7 *:Q=(1"$() * 2.14 )

5. D,2 *3/7-D.1B?/;,9:&>C#A114A1/7- webril 9


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%&'"# $ 2.(5 U-slab +123 sugar tong

%&'"# $ 2.(6 Long arm cast

%&'"# $ 2.(7 Short arm cast

E.

9:;)5"# $ 234!8)B,1. U-slab +123 sugar tong (1"$() * 2.15) >C#A78

fracture shaft of humerus >C# slab +:;$1@,;M 6-8 C7 O: &7-?;A distal end clavicle C#A78 supracondylar fracture humerus, fracture forearm 6388:3'" 5810D&M() *DA;@63=A


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%&'"# $ 2.(8 Thumb spica cast

4. Thumb spica cast >C#A78 fracture scaphoid,Benette’s fracture Q&;,';&D+,23: short arm cast>.5>:(5; dorsiflexion wrist 15-20 3=H; ,233'" 5>:(5;

AK ;.5Q


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• Traction

EF-'%K71GS+#,)A;16'78DQ:6M@() * traction DC5: A;1>C# proximal tibiatraction P-'>C# Pearson attachment A78 Thomas splint (Balanced traction)

3. .5>+#.@3;- PA:6:33A (; tincture benzoin 13?:9+#=2. +C#DC23A-J=810D&M spreader bar 'A96:+1236;>+#."=A&5;1@-78+7&>?

$1@,;M 10 R,.

Skeletal traction

D$E:A;1'J-P-'/1=D6#;4$() *A1@-"A P-'>C# Kirschner wire (K-wire) +123 Steinmann pinwire +123 pin () *>C# ?@,) 2 1"$988Q23 !0&D1)'8 (smooth) 9


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D1)'8?@>.54-#=5;'A&5; 9/53;[email protected]#';AA&5; ,)P3A;./0-DC2 O3,;AA&5; 9/5A;1'J-A78A1@-"A9:5:A&5;

C0.556%278 pin C%*) wire1. 3Y08;'>+#!" #$%&'(1;8FJ=D+/G!:A;1>.5 3Y08;'&0Y)A;1Q15;&`

2. /1&?-"D.#:D.5(GAQ17 O= 9?FJ=A;'&0N;Q810D&M() *?@>.5D$E:3'5;=-)

3. +.5 pin ?;A810D&M() *,) vital structure A53:D.,3” DC5:olecranon pin ?@>.5?;A-#;: medial 4$ lateral DL2 *3++#.@3;- 810D&M:7 O:/#3=4,5,) infection

5.

^)-';C;810D&M!0&+:7=9+#A1)-!0&+:7=DL0 *,9.5810D&M>A:D-BA

8. +#;,>.5 pin >A.5 pin D6#;4$>:6#3 /#3=D6#;>?.5?@3'" 5 distal /53 olecranon process 1 ¼ :0 O& >.5>:(5;=3H3A 90 3=H;?;A-#;: medial 4$ lateral DL2 *3D


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%&'"# $ 2.22 /K ;9+:5=>:A;1>.5roximal tibial traction

4. Proximal tibia /K ;9+:5=() *>.53'" 5 distal 9.5>:(5;D65;D+')'-?;A-#;: lateral 4$ medial DL2 *3DC#D$E: definite treatment 4-# () *:0',>C#A7:,;AQ23 Gardner-wells tongs (1"$() * 2.24) &0Y)>.5(K ;4-#P-'+.5P-'9:&() *?@>.53'" 5/1=A781"+" (external auditory meatus) +123 tip mastoidprocess P-'D+:23>8+"6J O:4$ 1 :0 O& Q.5&5;4,5,)D.#:D+#+5;=?;AH)1I@D(5;`A7: 46?: indicator (,)6#;=>-6#;=+:J *=D(5;:7 O:) P!


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34

9.-=&5;$


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Fractures and Dislocations of Upper Extremity

35

!""# $ 3 Fractures and Dislocations of Upper Extremity __________________________________________________________________________________________

• Sternoclavicular (SC) joint injury

!"#$%%&'()* 2 +, -./& 012!%. Anterior dislocation +3'45* medial end clavicle *6*78 9*:-;6$:-& ';#* wound infection, mediastinitis

2. Posterior dislocation >#/*medial end clavicle +3'45*0:#;# arm sling 0/2 &-@H#-G-'4GN'&B1+-&J2:&@3!A&04J#&@3!A& G@/+@#-$&-?+3'45* deformity ;#!J2/H6 2(M/?G2%$04J#>6$78 9*'/J-?K* '1B* !J3>#0/2*-*(@3:-L 4-6

>


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+/0"# $ 3.% &-@=># figure of eight

+/0"# $ 3.2 &-@4


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37

+/0"# $ 3.3 Acromioclavicular joint dislocation 3 type

• Acromioclavicular (AC) joint dislocation

'&B1+-&&-@?K14@K%SI&7-17%$ ligament 2 '>2* OK% acromioclavicular (AC) ligamentC8 D$?81 AC joint !J3 coracoclavicular (CC) ligament C8 D$'()*G


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+/0"# $ 3.4 Traction-countertraction

• Anterior shoulder dislocation

>-'4GN'&B1+-& indirect force !7*%?6 #=*A#- abduction external rotation 4@K%hyperextension >#/*=4R#4012@, -'@5+

)*+;/>?@?:4A*) reduction=*%1IG+3=42H6 2(M/? sling and swath 0/2'()*'/J- 6

>


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39

+/0"# $ 3.5 Impacted fracture

proximal humerus

+/0"# $ 3.6 Displaced fracture of

proximal humerus

=*H62(M/?AI D:I%-?N:-&&/#- 45 (] :IF%&->04J#GB1 (stiffed shoulder) 012>6$ +8$O/@=42 earlyROM exercise A6$%-?N @


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40

+/0"# $ 3.7 radial nerve %2%:+-&12-*4J'&B1 radial nerve palsy 012 +3

G@/+." wrist drop ;-4J#/*:-&&-@@


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4V

&-@@


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42

• Fracture Olecranon

'&B1+-& 2 >-'4GN OK% direct injury J


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43

)*+;/>?@?:4A*) reduction

• A1>%"&-@'OJK D%*04/72%16/#-0:#:I'>I?$&@316&7


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44

• Monteggia fracture

Fracture proximal V/3 ulnar @#/:&


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+/0"# $ 3.%3 Fracture distal V/3 radius @#/:&


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Fractures and Dislocations of the Hand and Wrist

46

!"#$% & 4.' Dinner fork deformity !" #$%&' Colles fracture

($$% & 4 Fractures and Dislocations of the Hand and Wrist-----------------------------------------------------------------------------------------

•

Distal radius fractures()*'+,-./+01+!" #$%2.3%456 $%2.3&' 2 +78 495:68 ;5:68!" #9" osteoporosis 91+(+?.

@:+ minor fall 0+7399 S O.6&P3 short arm cast 0,9")UC0:&'+:,G1.=?'&@%3:>B4:@-&P3B?V"&. O.6G35>$?@:,E:07:6

)U@@16 (P4' 5:68W/ 3)XB6 +:,&P3>:'9!" #K'1. &'+,E"!" #W/ 3)XB65:68'35661>!R :>:'9";B:9G35>+:,&P3N359W4:G1. 071>@:+@1.+,-./+(N3:!" #6L..3B6 K-Wire 0,G45+:,.96:=7%0,


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!"#$% & 4.2 Local hematoma anesthesia

&P36:P:5 cc. Y".(N3:2)%,?(BE,5601+F7-./. (75:68 ('@:+9"51G,:(=" #6>&'+:,.96:

2. Regional anesthesia '?69&P3&'+,E"!" #+,-./+01+(;7@1.+,-./+2.3

-./%012)!30")456*$% & (reduction) 071>@:+&036:,->1%;B:9,/ 3=L+@'W/ 3)XB60:6(@Q%F73B &03W/ 3)XB6'5'0>:6%'(G"6>6(7Q+'356 *567897:6727;" $9"2.307:6B?V"O.65:@@-&P3+:,.L>O.6G,> 0,K4B>'R A :0'1+ (P4'Chinese finger trap F73BFG4;B:9K'1.N5>F$!6TFG47-;' &';'=/>5:68!" #W?B0'1>%:> 5:@@-G35>.L>.3B6;B:9,-91.,-B1> ($,:-5:@(+?.+:,Y"+N:.N5>W?B0'1> (degloving skin) !R :&03(+?.)UC0:G:99:5"+9:+9:6

- N1 A'G5'!" # J Disimpaction (,? #9.3B6+:,!R :&03+,-./+01+!" #(+6+1'(;7.L>=4B' distal fragment &'NE-!" #N35956/ 4&'!4:extension $,359+1%.1'=4B' dorsal cortex &039:P'+1' ($@1%01BF949


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48

!"#$% & 4.4 Disimpaction O.6 hyperextension

!"#$% & 4.5 Traction distal fragment !"#$% & 4.6 Volar flexion of distal fragment

$1'([\5+F'4'(+?'2) 071>@:+'1 A'+Q$1' webrilF7-([\5+ short arm cast O.6=4B'%'56/4,-.1%GR # :+B4:N35I5+(7Q+'356 =4B'74:>56/ 4 just proximal G45 metacarpophalangeal joint

&03W/3)XB6=:9:,K>5I5+ F7-+R :958.9;G? ;B,@- reduction O.6&P3 fluoroscopy 564:>2,+QG:9&'!:>)]?%1G?=4B'&0C4

+Q!R : closed reduction &=4([\5+ F73B@L>=4>(5+M(,6T($


51/142


49

radial height 9:++B4: 5 99. +,E"!" #()*';'0'8 49=:B0:+29456/ 4&'(+E^T!" #659,1%2.35:@@-G1.([\5+55+F73B.L>&094 FG4;B,!R :.3B6;B:9,-91.,-B1>($,:-5:@!R :&03('5:68 0:+W/ 3)XB6294=:9:,K./F7G'(5>2.3G35>5V?%:6&03

C:G?2.3!,:%KL>N35;B,)]?%1G?071>@:+(N3:([\5+;B,@-9"+:,&03(5+=:,N35;B,)]?%1G?071>@:+(N3:([\5+&03W/3)XB60,

=? #>!" #=R

:;1C5"+),-+:,

;&03W/ 3)XB6(,? #9N61%N35N3:>(;"6>

2.3F+4

N352074

N35I5+

N35'? AB9 &'P4B>=1).:0TF,+5:@@-61>&P3 arm sling 2)+X5' (9$6:%:70,$6:%:7 (P4' 0:+W/ 3)XB6%3:'2+79:+9";B:97R :%:+!" #@-(.?'!:>2)9:G5'+7:>;$6:%:7($(+G5:+:, J-2 B1' 0:+W/ 3)XB69";B:9,/ 3;B:9(N3:&@(+" #6B+1%+:,,1+D:2.3." +:,(.?'!:>=-.B+ 5:@'1.9:_:6&' 24-48 P1 #BO9>

LP08P )*!>+0:!-L@G O * F97J. ),-(9?'=_:$N5>([\5+ +:,&P3>:'N5>9.L>.3B6+:,.96:=7%F7-&P3(5+M(,6TP4B6 (fluoroscopy) +:,.L>071>@:+ J0-J4 B1'2)[email protected] .1>'1 A'@L>;B,@-'1.G,B@MR A :+45'@-(+?.)UC0:'" A


52/142


50

!"#$% & 4.8 Smith’s fracture !" #9" volar displacement

L3>+0:!-L(F,+;B,@-'1._:6&' 2-3 B1' ($+,-./+(clinical union)

Q*-3H$!)@67>- P4B>F,+ 2.3F+4 5:+:,%B9 ML #>5:@!R :&03(+?. skin complication 0,071>

Malunion $%2.3%4565:@(+?.2.3@:+ inadequate reduction 0,F93@-9" malunion %3:> F7-!" #=R :;1C ;+1'_:B-F!,+M35'!" #@-(+?.@:++,-./+01+P'?.'" A (P4' N35G?. 9 +R :9@-9")UC0:9:++B4: malunion

Smith’s fracture (Reverse Colles fracture);G,>N3:9+1% Colles fracture

)*!!+),*+:,@1..L>+,-./+(N3:!" #@-!R :6:++B4: Colles

fracture O.6.L> traction &'!4: supination F7-.1'

distal fragment @:+.3:' volar 2).Z:' dorsal N35


53/142


5J

!"#$% & 4.'0 Volar Barton’s!"#$% & 4.9 Dorsal Barton’s fracture

!"#$% & 4.'' Chauffeur’s fracture

=R :;1C ;&=4([\5+ long arm cast N35I5+>5 90 5>I: supination F7- dorsiflex wrist=4B'&0C4&')U@@8%1''?69W4:G1..3:' volar F7-&=4 volar buttress plate )Z5>+1'294&03 distal

fragment (;7G35>+:, anatomicalreduction N5>W?BN35

)*!!+),*+:,@1..L>+,-./+(N3:!" # !R :2.36:+F7-91+@-294),-=%W7=R :(,Q@ +:,,1+D:&')U@@8%1''?69

,1+D:O.6+:,W4:G1.@1.(,"6>W?BN35&03(,"6% 6L..3B6 plate screw 0,F+'098'55+ @L>9"O5+:=K/+F+'098'G"(N3:%,?(BE radial styloid ML #>&'5."G91+(+?.@:+ direct injury &')U@@8%1'91+(+?.@:+ high energy traumaG,B@,4:>+:6@-+.(@Q%%,?(BE radial styloid ML #>G35>$6:6:9F6+&03."+1% scaphoid fracture ML #>@-+.(@Q%%,?(BE&+73(;"6>+1' ;


54/142


52

!"#$% & 4.'2 Vascular supply N5>scaphoid (N3:9:!:> distal

!"#$% & 4.'3 Safe position

=R :0,1%+:,(N3:([\5+%,?(BE9 O.6(Y$:-&'!4:!" #N359I: (=3'(7 scaphoid @-(N3:@:+!:> distal (,/)!" # 4.J2) .1>'1 A'6? #>,5601+56/ 4 proximal 9:+(!4:&.+Q@-9"O5+:=(+?. avascular necrosis N5>proximalfragment2.3=/> ()*')UC0:=R :;1CN5> chronic wrist pain +:,G,B@,4:>+:6@-%B9 +.(@Q%%,?(BE snuffbox .3:' dorsalF7- scaphoid tubercle .3:' volar 0:+=>=16&03=4>(5+M(,6TN35991+@-(0Q',5601+2.3P1.(@'NL A'0,294$%P1.(@'+Q5:@!R : bone scan &')U@@8%1'+:,&P3 CT scan @-P4B6&'+:,B?'[email protected]:>,B.(,QBF7-F94'6R :NL A'

• Hand fracture

('@:+9@-7-(5"6.545' &P3

=R :0,1%!R :>:' .1>'1 A'071++:,,1+D:O.6!1 #B2) ; 0:+@R :()*'G35>(N3:([\5+%,?(BE9


55/142


53

!"#$% & 4.'4 71+DE-+:,01+N5> distalphalange

!"#$% & 4.'5 Mallet finger !" #(+?.@:+

(=3'(5Q'N:.F7- avulsion fracture

*LG *K-64?87-$&',-.1%0'L #>('@:+9" pulp septum 6L.56/ 4

)*!!+),* =4B'&0C491+()*')UC0:N5> soft tissue, nail 9:++B4: fracture,1+D:O.6 splint DIP joint .3B6 aluminium splint @'0:6(@Q%&P3(B7:

),-9:E 2-3 =1).:0T 0:+9" subungual hematoma +Q&P3 paper clip7'2`(@:-(7 nail bed +Q!R :+:,(6Q%M459

Mallet finger

(+?.@:++:,K/++,-F!+&03 DIP joint >5564:>,B.(,QB &'NE-N35(06"6. !R :&03(+?. extensor incontinuity ML #>5:@@-()*' tendon rupture 0, extensor tendon 55+@:+dorsal base N5> distal phalange (,/)!" # 4.J5) G,B@,4:>+:6@-$% DIP joint %B956/ 4&'!4: flexion

F7-294=:9:,K(06"6. DIP joint &03G,>2.3 (5+M(,6T&'+,E" Bone avulsion @-(0Q'P? A'+,-./+(7Q+ S%,?(BE dorsal base of distal phalange +,E" tendon rupture @-294$%=? #>W?.)+G?)*!!+),*

&'+,E"=:(0G8(+?.@:+ tendon rupture 0,


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54

!"#$% & 4.'9 Buddy splint

!"#$% & 4.20 Boxer’s fracture !" #91+9"dorsal angulation F7- Volar

comminution

Fracture of Proximal and Middle Phalanges

=4B'&0C4(+?.@:+ direct injury ('@:++,-./+56/ 4G(5+M(,6T+Q>4:6G45+:,B?'?@Y16 =? #>=R :;1C!" #G35>G,B@ ;./F'BN5>(7Q%B4:9"

+:,%?.098'W?.,/) (malrotation) 0,9"P+,-./+2).Z:'071>9'? AB(9


57/142


55

!"#$% & 4.20 Bennett’s fracture

)*!!+),*Closed reduction O.6>5 MP joint F7- PIP joint 90 5>I: (Jahss’ Method) &P3'? AB+.

%,?(BE apex of angulation .3:' dorsal &=4 AP Slab &'!4:>5 MP joint 90 5>I: %,?(BE'? AB+356

=:9:,K accept angulation 2.3KL> 40 5>I: =4B'&0C4@L>91+@-294;456W4:G1. 6+(B3'+,E"G35>+:,;B:9=B6>:90,I:

Metacarpal Shaft fracture

(+?.@:+ direct injury @-$%)UC0: 3 564:> ;+:6@-$%[X:9carpometacarpal joint (CMC) +,-./+01+P'?.'" AK


58/142


56

!"#$% & 4.2' B?V" closed reduction PIP joint

!"#$% & 4.22 Complex MP joint

dislocation

PIP Joint dislocation

()*' most common ligamentous injuries in the hand !" #$%%456()*' dorsal dislocation

G,B@,4:>+:6$% PIP joint 56/ 4&'!4: hyperextension (5+M(,6T5:@$% avulsion fracture N5> volar base N5> middle phalange

)*!!+),*&' simple dislocation ,1+D:O.6 closed reduction (,/)!" # 4.2J)J. hyperextension PIP joint (7Q+'356$,359+1% traction2. +. base N5> middle phalange $,359+1% flex PIP joint &=4 splint 2B3 J-2 =1).:0T

MP Joint dislocation

$% dorsal dislocation 2.3%456 F%4>()*' 2 P'?. ;I: =4B'complex dislocation MP @-56/ 4&' extension ),-9:E 205>I: (,/)!" # 4.22)

!"##$!%"

-

simple dislocation ,1+D:O.6 closedreduction 9"N1 A'G5'.1>'" A

J. flex wrist ($ finger flexor 2. hyperextension MP joint 80-90 5>I: .1' proximal phalange G75. $,359+1%;456

S flex MP joint =:(0G8!" #G35>.1' proximal phalange G75.($+1' volar plate 294&03(7


59/142


57

- complex dislocation +:,!R : closed reduction 91+294=R :(,Q@FG4+Q;B,@-75>!R :G:9B?V"simple dislocation K3:294=:9:,K.L>N35+71%(N3:!" #+Q,1+D:O.6+:,W4:G1.

!"#$% & 4.23 B?V" Closed reduction dorsal MP joint dislocation


60/142

Fractures and Dislocations of Lower Extremity

58

!"#$% & 5.' AP compression injury

!"#$% & 5.2 Lateral compression

injury

($$% & 5 Fractures and Dislocations of Lower Extremity---------------------------------------------------------------------------------------------------------------------------------------

• Fracture of the pelvis

!"#$%!&'()!"*+,-!./0*&,12 2 34 *56!7,89: ;. Lower energy injury &'9+ [email protected]#A5!!"#BC! !@+!"#BC!5


61/142


59

!"#$% & 5.3 Vertical shearing injury

3. Vertical shearing ("%FC/ H 5.3) ./B")&W Vital sign stable

- AP compression injury "-!J*A$L7'@ pelvic sling N/N pelvis N($&I@*,*!-+,"


62/142


60

diagnostic peritoneal lavage (DPL) N"(&6U supraumbilical &5


63/142


61

!"#$% & 5.5 Allis’s maneuver for anterior

dislocation of the hip

!"#$% & 5.4 Anterior dislocation

of the hip

• Hip dislocation

S*6#+/ DR


64/142


62

!"#$% & 5.7 Sciatic nerve R%!!$A$L,-6!"#$%!,"


65/142


63

!"#$% & 5.8 Allis’s maneuver for

posterior dislocation of the hip

!"#$% & 5.9 Shenton’s line

3. ,*! test stability B?@6 stable, joint space&C9*!-+ 2 I@*) B0$)69*&FK+ simpledislocation 7,@709 skin traction E6@F"#.*U

5-7 6-+ ,*L&3MN7,@&$(+A$L7'@E.@;4 D *L-+'96L2-4 0-F$*,O

4. ,*! test stability B?@6I@=,?2$V4 D *(unstable) 1@= ) C 4 *!*"P9*1-$3-$!"#$%!096+C/ HB1!!?-N&I@*C/ HLT$$*.$@6L plate, screw

• Fracture of Proximal femur

BN9)E$@&FK+ 3 !?2 9. ;. Fracture neck of the femur &"( H.3*! anatomical neck RT)N"(&6U just proximal

19= intertrochanteric line &FK+ intracapsular fracture2. Intertrochanteric fracture "=L,-!P9*+ intertrochanteric line &FK+ extracapsular

fracture

3. Subtrochanteric fracture "=L,-!P9*+N"(&6U lesser trochanter B?#14 H *?)EF=/! 5V..

),!9:,3-9);-!1. Shenton’s line ("%FC/ H 5.9) ;


66/142


64

• Fracture neck of femur

&FK+ intracapsular fracture 5 N E $ @N9=L7+P% @FQ6L0%)=*L2C/ H./ osteoporosis .-!&!($3*!minor trauma 7+!?29.;+,+2 9.0*6.-!&!($3*! high energy trauma

?-!JU#!*",-!BN9)&FK+ 2 !?2 9.>. Non displaced E$@B!9 impacted fracture (incomplete fracture) B?# complete

fracture C/ HE.9 displaced P% @FQ6L!?2 9.+/ D3#./=*!*" groin pain "@*6.*$@*+7+1@+I*&$(+!#&P?! (antalgic gait) limitation of motion

2. Displaced E$@B!9 partially B?# totally displaced P%@FQ6L!?2 9.+/ D3#&3MNF6$.*!N"(&6U0#A5! IL-NE.9E$@&?L L


67/142


65

• Intertrochanteric fracture

&FK+ extracapsular fracture P9*+"#,69*) greater B?# lesser trochanter 1"63"9*)!*LN"(&6UC/ H!$&3MN=L% 9C/ H greater trochanter 096+7,893#5N"=L'4 D * (ecchymosis) I*3#0- D+B?#external rotation '-$&3+!69* fracture neck of femur

),!!2)8,096+7,89!"#$%!,-!N"(&6U+/ D5N7+;+0%)=*L2 ,*!"-!J*A$L conservative treatment

3#1@=)+=+$T) traction +*+F"#.*U 6 0-F$*,O VT H)./A=!*0&0/ HL)C/ H3#&!($A";BC"!V@=+ &'9+venous thrombosis, pressure sore, pneumonia, UTI ,*!0S*5"9*)!*LP% @FQ6LBIM)B") E.9./I@=,@*.7+!*"P9*1-$3#+(L."-!J*A$L!*"P9*1-$C4 *internal fixation("%FC/ H 5.>>)&5


68/142


66

),!!2)8,FG332N-+!"#$%!,-!N"(&6U+/ D,*!&!($3*! high energy trauma 3#"-!J*A$L internal

fixation !"U/C/ H&!($3*! metastatic cancer 3# C 4 * ! * " P 9*1-$&=*&+. Non displaced fracture ,"


69/142


67

2. Displaced fracture "-!J*A$L!*"P9 *1-$ ORIF $@6L plate, screw ,"


70/142


68

!"#$% & 5.'4 '+($19*):I=) knee dislocationA$L$%C(̂ C*)!*"&?0-F$*,O ,?-)3*!+-D+3T)5(3*"U*"-!J*ligament injury 19=EF =*33#&I@*&[_=! ,"


71/142


69

3. swelling

• Immediate +T!RT) hemathrosis 3*! rupture ACL, PCL meniscustear, intraarticular fracture, tear joint capsule

•

Late 096+7,89&FK+ effusion 3*! inflammation4. Instability I@=&I9*,?6.

• Giving way ./;6*."%@0T!69*&I9*3#&;?


72/142


70

Anterior cruciate ligament (ACL) injuries

ACL $@*+ proximal &!*#3*! medial I=) lateral femoral condyle ;9=+EF$Z*+,?-) 6( H)EFC*) distal B?#anterior I=) tibial plateau C4 *,+@*C/ HFZ=)!-+ tibia E.97,@&?


73/142


71

Medial Collateral Ligament (MCL) injuries

MCL ,"-2 6-+B"! 709 knee brace F"#.*U 2-4

0-F$*,O &50 V.. I=) tibia VT H)&FK+ cancellous bone !?E!!*"&!($!"#$%!,-!.-!&!($3*! axial loading "96.!-N varus ,"2 0-F$*,O

2.

Displaced fracture "-!J*A$L!*"P9 *1-$ 7'@ plate B?# screw


74/142


72

• Tibial fractures

!"#$%! tibia ,-! 5NE$@N9=L&+. varus ,". failed closed reduction E.90*.*"R accept alignment E$@2. ipsilateral fracture femur, tibia (floating knee)

3. multiple trauma

4. fracture with compartment syndrome, vascualr injury

5.

open fracture


75/142


73

• Ankle Sprains

&FK+ sport injury C/ H5NN9=LC/ H02$ 85% &FK+ lateral ligament injury .-!&!($7+IU#N($&C@*&I@*$@*+7+ (inversion) B?# plantarflexion &0@+&=M+C/ HI*$N9=LC/ H02$;


76/142


74

!"#$% & 5.'5 Denis-Weber classification

• Ankle Fracture

!"#$%!I@=&C@*,-!.-!&!($3*!B")N($,.2+I=)!"#$%! talus 7+ ankle mortise ,*! injury"2+B")3#C4 *7,@./!*"&;?


77/142


75

!"#$% & 5.'6 Hawkin’s classification

Hawkin’s E$@BN9) talar neck fracture &FK+ 4 type $-)+/ D ("%FC/ H 5.>6)Type I non displaced

Type II displaced "96.!-N subtalar subluxation ,"


78/142


76

!"#$% & 5.'8 ?-!JU#C*)!*L6( S*;I=)Lisfranc’s joint

&=!V&"LO calcaneus lateral B?# axial view ,*!1@=)!*"$% subtalar joint '-$: 3#&=!V&"LOC9*5(&^J;


79/142


77

!"#$% & 5.'9 Jones fracture B?#avulsion fracture base of fifth

),!!2)8,7+ non displaced VT H)&;?9 )

>. avulsion fracture 3*!!*"RT)!"#'*!=*35N&FK+ extraarticular ,"


80/142


78

!"#$% & 5.20 buddy splint

),!!2)8,Avulsion fracture .-!3#1($&"M6B?#.-!E.9;9=L./FG8,* 096+7,897'@!*""-!J* 1*.

= * ! * " A$L&I@*&[_=!,"


81/142

Spinal Injuries

79

!""# $ 6 Spinal Injuries---------------------------------------------------------------------------------------------------------------------------------------

!"#$%&%'()*+,-!"#./+,#)!0"1/ 234$*56 786 spinal injury +9:;

C.

!"#3#->8%&>9D AID 7$P56 7>!%.>GBQH$#FG21/ 234$*&T:&G88%&KO A "(I"-F&1/ 234$*56 786 cervical

spine injury >G&D(I"-9#%>$PF9G&2" G"!1/234$*869".+1,9#%>$PF9G&2" +,-=8:#/2ME!B)$ FG2M;M)*=$2!:B2&T2"

9:;T6 ARE; sympathectomy 56 7>!%.'"! spinal cord injury!#P656 71/ 234$*86 spinal cord injury '&

.);&) A&8D 7H#D 7.%8 G"!B2


82/142

Spinal Injuries

80

%&'"# $ 6.( Three columns concepts of Denis

!#-./!M)&G,);G)! *);>3?&3XYG"56 7I9=.29:3?&9#%>$P56 7R/!8H*!)9N"I>#*L@

2. Middle column 3#-!$P CC-C2 +82!#-./!'-86!"#>,D 7!%. spinal cord injury =.2M/;8"!


83/142

Spinal Injuries

8C

%&'"# $ 6.2 +M.;BO "+G&:;@3?&M:$&3,"*MQ.@!%. injury =.25) A; spinal cord +,- nerve rootG"! 86injury BO 7 "!$:" L2 ,;8" '->3?& injury B:5:"&) A&(Lower motor neurone lesion) KE 7; prognosis '-.6!$:" spinalcord injury

Neurogenic shock

F&1/ 234$*56 786 spinal cord injury '->!%. hypotension >&D 73?& fluid 8"!>!%&=3GBQ


84/142

Spinal Injuries

82

Bulbocavernosus reflex (#/356 7 6.3)>3?& reflex arc #-.)9 S2-4 !#-BQ 2& afferent fiber S.*969 glans penis G#D#"

C. sensation B"8#-.)9 dermatome2. muscle power F&+B:,-#-.)9@


85/142

Spinal Injuries

83

%&'"# $ 6.4 !"#3#->8%& sensory level

B"8 dermatome

%&'"# $ 6.5 sacral sparing +M.;RE;!"#=8:R/!5O ","*@$P1%$G&);>ID7<B#$'./ spinothalamic tract 9#%>$P anterolateral @$P occipitalarea C34 9#%>$P HG,D<sensation >(I"-9#%>$P perineum >5:"&) A&KE 7;>#6*!$:"sacral sparing (#/356 7 6.5) '-FT2>3?&B)$9

B#$'!,2"8>&D A,6 A*;S.* nerveroot +B:,-#-.)9 B) A;+B: C5 deltoid ,;=3'&RE; SC toeflexor (#/356 7 6.6) +,- motor 56 79:;9

86H$"8MO "H)Y8"!F&!"#3#->8%&1/ 234$* spinal injuryS.* sacral sparing >3?&B)$9:;T6 ARE; functionalrecovery G"!86 sacral sparing G8"*H$"8$:"1/ 234$**);86H$"8B:&D 7


86/142

Spinal Injuries

84

%&'"# $ 6.6 !"#B#$' motor power @8D 7&D A


87/142

Spinal Injuries

85

• Cervical Spine Injury

!"#9".>'W9@3?&3XYG"MO "G#)9&)!

_E!0"+,-+I5*L5) 7$=3 F&56 7&6 A'E;'-@


88/142

Spinal Injuries

86

%&'"# $ 6.8 Lateral view of cervical spine

- CC G#D3?&$;+G$&3#-!TD 7#*L1/ 234$* cervical spine injury 8)!5O "=.2*"! >&D 7

!"#$$%&'()%*+,$-+&./

C. Lateral view (#/356 7 6.8) B2GW&B) A;+B: CC '&RE; C7 >ID 7$P lower cervical spine R2"1/ 234$*H#*LG#D#*L5:" Swimmer’s view

2. ./ curve @$P&) A&


89/142

Spinal Injuries

87

3. ./ structure B:"; U >#6*;,O ".)9'"!.2"&G&2"=3.J"&G,); S.*>#% 78'"!

3.C prevetebral soft tissue shadow &D 7!%& 5 88. RD!%& C0-C5 8%,,%>8B#

3.2 +&$@3?& funnel shape ,D 7


90/142

Spinal Injuries

88

%&'"# $ 6. 9 Open month view

4.2 ./ ring @GW

5.C ./ spinous process KE 7;3!B%'-B#;!)& G"!86

6.3

./ body @


91/142

Spinal Injuries

89

%&'"# $ 6.(0 Jefferson’s fracture

%&'"# $ 6.(( SOMI brace

• Jefferson’ s Fracture (#/356 7 6.C0)Burst fracture @!%.'"!

vertical loading 5O "FG2 occipital condyle

!#-+5!!)9 lateral mass @$P

upper C-spine 8)!'-=8:H:GW,D 7immobilization .2$* skull traction 4-6 M)3."GL+,-FM: SOMI brace (#/356 7 6.CC) (sterno-occipito-mandibular-immobilization) B:!B odontoid process 3!B%B2!D#*L5:" AP TD 7


92/142

Spinal Injuries

90

%&'"# $ 6.

(2 Odontoid fracture

%&'"# $ 6.(3 Non-displaced fracture +,- displaced fracture

Type II I9=.29:

$%V6HD,D 7#*LF&5:"AP, open mouth '-=8:>GW&#I6*; non-displaced !)9 displaced >5:"&) A& (#/356 7 6.C3)C. Non-displaced fracture >#*LI9#


93/142

Spinal Injuries

9C

• Lower C-Spine (C3 – C7) Injuries

Minor Compression, avulsion fracture

-

compression fracture 56 786H$"8M/;5";.2"&G&2",.,;&2ID 7,D 7@2"56 7+B:=8:H$#>!%& 20 !%S,!#)8 G"!.E;=8:>@2"!W5O "!"#1:"B). open reduction I#2TD 7&D 7@2"56 7=.2!W8)!B2


94/142

Spinal Injuries

92

2. !#P656 786 neurological deficit +,-I9$:"86T% A&!#-./!!. spinal cord, nerve root#)!0"S.*!"#1:"B).>,D 7G8D• Thoracolumbar Spine Injury

9#%>$P T-L junction >3?&9#%>$P56 786 injury =.29:&D 7$P&6 A#*L56 7M:; HD#*L LS-Spine AP, lateral +,- oblique


95/142

Spinal Injuries

93

%&'"# $ 6.(4 AP view of lumbar spine

!"#$$%&'()%*+,$-+&./ Thoracolumbar region

C. AP view ./,)!0P-S.*5) 7$=3@3?/3M6 7>G,6 7*81D&12"86@,W!&2


96/142

Spinal Injuries

94

%&'"# $6.(5 Compression fracture

F&!#P6 metastasis tumor 8"56 7 spine M:$& body +,- pedicle '-R/!involve !:3?&!#-./!56 7 dense !$:" 'E;>GW& osteolytic =.2T).>'&!$:"56 7 body S.* pedicle &) A&'-G"*=3G#D'&

2.6

Transverse process F&!#P656 786!"#.E;!#-T"!@$P.2"&@2"; @*)9B)$,Q!&) 7;'-3$.8"! &

reduction &


97/142

Spinal Injuries

95

%&'"# $6.(7 Burst fracture

%&'"# $6.(6 Jewette brace

(Thoraco – lumbar brace)

'&H#9 C2 M)3."GL G#D#W$ >8D 7<`[

F&1/234$*M/;

middle column (#/356 7 6.C7) M:$&@,D 7#6*!$:" retropulse-fragment 86S#*LF& lateral view '->GW&86!"#*Q9B)$@


98/142

Spinal Injuries

96

%&'"# $ 6.(8 Chance fracture

%&'"# $6.(9 Fracture - dislocation

2. Burst fracture 56 786 neurological deficit RD!%. injury 'Q.G8Q&'-3?&stable fracture #)!0"S.*>@2">`[3?& ligamentous injury !"#

healing '-=8:.6>5:"!)9 bone healing 86S

• Fracture Dislocation (Translational

injury)

>3?& injury 56 7#Q&+#;56 7MQ. >!%.'"!combination force '"!G,"*5%_5";#$85) A;!"#9%.G8Q& (#/356 76.C9) '->!%. injury 5) A; 3 column S

'"!>#*L AP, lateral


99/142

Spinal Injuries

97

I$! spondylolisthesis H$#'-&E!RE; fracture dislocation0+%%607+

>&D 7@2"56 7 (stabilization +,- spinal fusion) >ID 7'W93$. #$8RE; decompression neural tissue 56 7R/!!#-./!!.5)9


100/142

Fractures and Dislocations in Children

98

!""# $ 7 Fractures and Dislocations in Children

---------------------------------------------------------------------------------------------------------------------------------------

!"#$%#&'$()$*#+,-*./+(&)012,3* 45"6'4.7*78'$9'*:- &0; ?$01,&'1*'@6AB'" ./+C56*/D'%7#E *#+,-*452%&12/F),,2@F G);H&4*#+,-*=5 G.7*78'$9'*:- &0;1

%&'()*'+*,-'.%*/0123%4 $15652,7'89:;*NA2DKOI G$P48NQ01:- &0;$9'*=J ' reduction

3. *#+,-*;>*012,3*7A,P,&2#36*68':- &0;*K'.7*78'$*>1 012,3*%8610;*K'!,@ conservative treatment 451&)@#'@=5 G9J '2ST17&)$:8'7>,

6. B'6+.=#*O&)1=5 GNQ78'$9'*:- &0;1 ./+@>$45 growth plate =5 G)'99+=J '0;&2(&'09:A,68'2ST1#)@*#+,-*;>* 6AU5.*&SW


101/142


99

45"J 'D>N=E 3 "J '=5 G4>*9+P,&@A12*5 G@6*>Q*#+,-*;>*012,3* "F)

@. Greenstick fracture (#-S=5 G 7.M) 2ST1 incomplete fracture =5 GNQ2RN'+012,3*2N#'+*#+,-*45"6'4@F,;@H 81P,&,5 2S#5@Q2%4F)10C&P4&,AQ=5 G@>$2(5@6 X )@- 84',>,91;>*9+NQ68'P4&

,&'1;1I G$9+;>*)5*,&'1;1I G$9+@>$P48;>* *#+,-*;>*01:- &0;*P4&.*8=5 G2S#'+24F G)))*.#$,>,P4&*39+;>*(',9'**>1=>1=5 greenstick fracture 9+NQQ#A26Ldiaphysis =5 G45 cortex .(3$X

2. Torus >+41 Buckled fracture (#-S=5 G 7.2) 2ST1 incomplete fracture )5*C1A,;1I G$ OI G$2*A,9'*.#$)>,=J '0;&*#+,-*@812(&';'*>1 4>*9+NQQ#A26L metaphysis ()$ distal radius

3. Plastic deformation 2ST1*'#!*8$$)()$*#+,-*:A,PS9'*#-S2,A4 .782)*O2#@E9+P48NQ#)@;>* *#+,-*2,3*@F,;@H 81P,&,5 24F G)1J '4',>,,&6@.#$1&)@ X *#+,-**39+"F1#-S2,A4P,&(Elastic recoil) 24F G)))*.#$4'*)5*2/3*1&)@912*A1"6'4%'4'#V=5 G9+@F,;@H 81P,&*#+,-*

*39+P48"F1#-S2,A4 .78@>$P4845#)@#&'60;&2;312ST1*'#2S/5 [email protected]/$2RN'+!"#$%#&'$B'@01()$*#+,-* (Plastic deformation) 24F G)))*.#$2NA G44'*(I ?12#F G)@ X *#+,-**39+;>*45#)@0;&2;31 (fracture)

• Epiphyseal plate or growth plate injuries

growth plate ;#F) epiphyseal plate 2ST1 cartilagenous disk .=#*)@- 8#+;68'$epiphysis ./+ metaphysis ()$ long bone 0;&*'#29#A ?$ growth plate 9+@I,

*>Q epiphysis !,@C> ?1()$ germinal layer OI G$2ST17&1*J '21A,()$ cell Q#A26L growth plate 01

+-A"# $ 7.@ Greenstick fracture 9+45 cortex ,&'1;1I G$=5 G;>*P48%4Q-#LE

+-A"# $ 7.2 Torus fracture *#+,-*9+@812(&';'*>1


102/142


M00

hypertrophic zone 2ST1C> ?1=5 G45*'#.Q8$2O//E=J '0;&452O//E;/64 X 9I$2*A,*'#.@*Q#A26LC> ?115 ?P,&Q8)@24F G)45B@>17#'@2*A,(I ?1

Salter .%* Harris B,0.!9;C5D,/1; epiphyseal plate injury 2AE5 5 C5D, (#-S=5 G 7.3)

2NF G)Q)*VI$"6'4#H1.#$ .16='$*'##>*K' ./+*'#N@'*#LE!#"

Type I 2ST1*'#Q',293Q=5 G:8'17/),.16()$ epiphyseal plate .@* epiphysis ./+metaphysis ))*9'**>1 4>*2*A,012,3*2/3* 2)*O2#@E)'92;31*'#2/F G)1()$ epiphysis 2/3*1&)@;#F)Q'$#'@)'99+NQ2N5@$ tenderness =5 G growth plate #>*K'!,@*'#2(&'2YZ)*P6& 3 %>S,';E4>*P48NQSW*=J 'P,&P48@'* !,@0C& periosteum Q#A26L,&'1=5 G45 ThurstonHolland’s sign 2ST17>6 splint 2(&'2YZ)*P6& 3-4 %>S,';E )'99+=J '0;&2*A, growth disturbance P,&Q&'$P484'*1>*

Type III 2ST1*'#Q',293Q=5 G45*'#;>*:8'1:A6(&)./+:8'1.16 growth plate =J '0;& growthplate Q'$%861V-*=J '/'@ *'##>*K'21F G)$9'*2ST1*'#.7*:8'1:A6(&)7&)$9>,*#+,-*0;&2(&'=5 G2,A4P4868'9+,&6@6AU5 closed ;#F) open reduction ;'*P48%'4'#V=J ' anatomical reduction 45!)*'%2*A, growth disturbance P,& 21F G)$9'*45Q'$%861()$ growth plate V-*=J '/'@

Type IV 2ST1*'#Q',293Q"/&'@*>Q type III .7845*'#.7*:8'1Q#A26L metaphysis ,&6@*'##>*K'./+:/*'##>*K'2;4F)1*>Q type III

+-A"# $ 7.3 Epiphyseal plate injury .Q8$7'4 Salter ./+ Harris


103/142


M0M

Type V 2ST1*'#Q',293Q9'*.#$)>,*#+.=*()$ growth pate =J '0;&2*A,*'#Q',293Q01=H*C> ?1()$ growth plate !,@9+P482;31#)@;>*C>,2919'*2)*O2#@E %8610;*9+6A1A9R>@P48P,&012QF?)$7&1 .789+4'NQSW ?1 2ST1*'#Q',293Q=5 G45:/78)*'#29#A ?1;@H,*'#29#AQ.78$!"#$%#&'$./+#-S#['$()$*#+,-* =J '0;&*#+,-*()$2,3*OI G$7A,:A,#-S

45*'#2S/5 [email protected]/$2(&'%- 8%B'N2,A4P,&Remodeling 9+2*A,P,&,501%B'6+78)PS15 ?M. 2,3*7&)$45*'#29#A1()$*#+,-*(Bayonet apposition) 9+.*&P(P,&,5012,3*

4. deformity =5 G45)@- 801 plane ()$ joint motion !,@2RN'+.16 flexion, extension 9+.*&P(P,&,5*68' varus, valgus

Remodeling 9+P48P,&:/01*#L578)PS15 ?M. intraarticular fracture2. *#+,-*;>*=5 G45*'#;,%> ?14'* !*8$4'*;#F)QA,;4H14'*3. displaced epiphyseal plate fracture

4. diaphyseal fracture

,>$P,&*/8'64'./&668'*#+,-*;>*012,3*%8610;*K'!,@6AU5)1H#>*KE (conservative))@8'$P#*37'4Q'$*#L5*345"6'49J '2ST17&)$:8'7>,*#L5=5 G45(&)Q8$C5 ? P,&.*8

M. Faild close reduction ,I$*#+,-*P482(&'!,@2RN'+2,3*!72. Displace intraarticular fracture

3. Displaced epiphyseal plate injury Salter-Harris type III, IV

4. Children with multiple fracture or head injury


104/142


M02

• Fracture of Clavicle

NQP,&Q8)@012,3* %'4'#VNQP,&7> ?$.78.#*"/), (birth fracture) 91VI$6>@2,3* 7J '.;18$=5 GNQP,&Q8)@"F) middle third 012,3*='#*=5 G45S#+6>7A"/),@'* ;/>$9'*"/),2,3*9+P48@)4(@>Q.(1(&'$1> ?1 21F G)$9'*45)'*'#293QS6, (pseudoparalysis) *'#7#69#8'$*'@012,3*='#*9+"/J 'P,& crepitation ;#F);'*2ST14';/'@6>1*39+"/J 'P,&*&)1*#+,-*1-1 X (I ?14' (callus) "6#7#692,3*='#*,&6@68'45 brachial plexus injury ;#F) birth palsy #864,&6@;#F)P48 012,3*!79+NQ45)'*'#Q64 *,293Q

!"##$!%"

012,3*='#*P487&)$=J '*'#,'4*#+,-* ."80;&2,3*1)12R@ X 26/'9+)H &40;+6>$)@8'(@>Q

Q#A26L*#+,-*=5 G;>* 0C&26/' M-2 %>S,';E*39+;'@293Q ./+9+"/J 'P,& callus OI G$4>*9+2ST1=5 G6A7**>$6/()$QA,'4'#,' .N=@E"6#0;&"J '.1+1J '68')5* 5-6 2,F)1 9+45*'#S#>Q.78$*#+,-*0;-S#['$*/>Q2ST1S*7AP,&2)$ 012,3*!7%'4'#V#>*K'!,@ arm sling 91;'@293Q%8610;*K'2;4F)1:- &0;*Q#A26L(&)D)* 4>*NQ01C86$)'@H 5-M0 (6Q %8610;1NF ?1 2ST1*#+,-*;>*=5 GNQB'6+:A,#-S "F) cubitus varus P,&Q8)@*#+,-*;>*Q#A26L15 ?.Q8$2ST1 2 C1A, "F)

M. Extension type NQP,&VI$ 96% *#+,-*9+;>*01=8'(&)D)*2;@5@, !,@CA ?1;>*%861S/'@4>*9+2"/F G)1PS,]'1;/>$

2. Flexion type NQ1&)@ *#+,-*;>*01=8'=5 G(&)D)*%861;/>$(&)D)**#+.=*NF ?1 CA ?1;>*%861S/'@4>*9+2"/F G)1PS,]'1;1&'

1)*9'*15 ? Gartland @>$P,&.Q8$C1A,*#+,-*;>*7'4S#A4'L*'#2"/F G)1()$CA ?1*#+,-*=5 G

;>*2ST1 3 C1A, 2NF G)Q)*.16='$01*'##>*K',>$15 ? (#-S=5 G 7.4)Grade I non displaced fracture 9+2;31#)@#&'6!,@=5 G2@F G);H &4*#+,-*@>$P48(',Grade II partially displaced fracture 45*'#2"/F G)1()$*#+,-*))*9'**>1Q'$%861

!,@#)@;>*,&'1;1&'9+)&'))*!,@=5 G45*#+,-*%861;/>$@>$7A,*>1)@- 8Grade III totally displaced fracture 45*'#2"/F G)1;/H,()$*#+,-*))*9'**>1;4,

P4845%861*#+,-*=5 G%>4:>%*>1


105/142


M03

*'#7#69#8'$*'@9+NQ(&)D)*Q64P484'*1>*01*#L5 non displaced fracture *#L5=5 G2ST1 Grade III 9+NQ68'(&)D)*:A,#-SQ'$"#> ?$4)$"/&'@ S shape ;#F))'92;31#)@QH 4̂ 9J ? '2/F),

2#5@*68' dimple sign 9'**'#=5 G*#+,-*%8617&1=A G44',&'1;1&' 7&)$7#692%&12/F), radial artery./+2%&1S#+%'= radial, median ./+ ulnar ,&6@2%4) 2N#'+*#L5 Grade III 45!)*'%2*A,neurovascular injury P,&

2)*O2#@E01 Grade I )'9,-@'* 2;312RN'+#)@#&'62/3*1&)@ )'9%>$2*72$'()$P(4>1(fat pad sign) OI G$S*7A9+P482;3101,&'1 posterior 01 grade II, III 2)*O2#@E9+2;31P,&C>,291

!"##$!%"

M. Grade I 4>*9+P48"8)@Q64 #>*K'!,@0%8 posterior long arm slab P6& 2-3 %>S,';E;'*(&)D)*Q640;+6>$*#L5=5 G$)D)*4'*)'9*,2%&12/F), ,>$1> ?17&)$,- perfusionQ#A26L4F)2%4);/>$9'*0%8 slab

2. Grade II =J ' closed reduction P,& !,@,>1CA ?1;>*%861S/'@ distal fragment 4',&'1;1&'*#+,-*4>*9+P482"/F G)14'*21F G)$9'*45 periosteal hinge ,&'1;/>$ 0%82YZ)*posterior long arm slab $)D)*)@8'$1&)@ 90 )$D'2ST126/' 4 %>S,';E %>$2*7)'*'#2;4F)1 Grade I

3. Grade III #>*K'!,@9>,,I$*#+,-*2(&'=5 G (#-S=5 G 7.5) ./+S])$*>1*'#2"/F G)1;/H,!,@0C&K-wire @I,:8'1:A6;1>$ (Percutaneous pinning) ./+0%8 posterior slab 78))5* 4 %>S,';E7&)$%>$2*7)'*'#()$B'#+.=#*O&)1=5 G9+2*A,(I ?1 P,&.*8 compartmentsyndrome, neurovascular injury

+-A"# $ 7.4 Gartland classification 7'4S#A4'L*'#2"/F G)1()$*#+,-*


106/142


M04

+-A"# $ 7.6 Milch’s classification

&"'()*#!+,-.

M. *'#Q',293Q()$2%&1S*7A=5 GNQQ8)@ "F) 2%&1S#+%'= radial ./+ median

2. Compartment syndrome 4>*2*A,01*#L5=5 GQ644'* !,@2RN'+01 Grade III ;#F);/>$9'*=J ' reduction ./&6$)D)*4'* X =J '0;&.(1%861S/'@Q64 9I$P48"6#0%8circular cast 0%8:- &S[6@2;/8'15 ?

3. Cubitus varus (.(1")*) NQP,&P48Q8)@1>*@>$P48=#'Q%'2;7H=5 G.18C>, %8610;*Q#A26L15 ?2ST1 epiphyseal plate injury OI G$4>*9+6A1A9R>@:A,N/', %'2;7H2*A,9'*.#$*#+.=*:8'14'7'4.16*#+,-* radius :8'1 radial head ./+*#+.=*lateral condyle ;#F)2ST1*'#,I$*#+C'*()$*/&'421F ?)*/H 84 extensor =5 G45 origin Q#A26L15 ? *'#7#69#8'$*'@9+NQ(&)D)*Q64 *,293Q "/&'@ supracondylar fracture

':+


107/142


M05

+-A"# $ 7.7 */P**'#2*A, Pulled elbow

!"##$!%"

01 nondisplaced fracture 2)*O2#@E9+2;31#)@#&'6(1',2/3*Q#A26L%861S/'@()$metaphysis Q#A26L lateral ()$ distal humerus #>*K'!,@0%82YZ)* long arm slab 4 %>S,';E

01 displaced fracture 2)*O2#@E9+2;31CA ?1 metaphysis (1',2/3* X 2"/F G)1.@*9'*Q#A26L lateral ()$ distal humerus C>,291 VF)68'2ST1 displace intraarticular fracture OI G$7&)$#>*K'!,@*'#:8'7>,9>,*#+,-*2(&'=5 G @I,,&6@ K-wire 0%82YZ)* long arm slab )5* 4-6 %>S,';E

• Subluxation of the Radial Head

(Pulled elbow, Nursemaid ‘s elbow)

subluxation ()$ radial head NQP,&Q8)@012,3*!,@2RN'+2,3*2/3* )'@H 2-3 (6Q NQ

1&)@012,3*=5 G45)'@H4'**68' 7 (6Q *'#=5 G45*'#2"/F G)1;/H,()$ radial head P,&Q8)@012,3*45%'2;7H9'*012,3*2/3*%861*#+,-* radial head @>$29#A7AV-*,I$.(1C>,291 ;#F)P48=#'Q%'2;7H=5 G.181)1 2C81PS!#$2#5@1*/>Q4'P48@)4@*.(1"#-Q)*68'2/81*>Q2NF G)101;&)$P48P,&7*9'*=5G%-$;#F)2"#F G)$2/817)1.#*=5 G radial head2"/F G)12,3*9+293Q4'*./+#&)$P;& ;/>$9'*

1> ?1%>*N>*2,3*9+;@H,#&)$P;&.789+P48@)4$)D)*;#F)@*.(1(&'$1> ?1 4F)9+@>$*J 'S/[)@P,&,5 N8).482,3*)'9Q)*68'26/'N@'@'4$)D)*0;&2,3**39+#&)$P;&

7#69#8'$*'@ 9+NQ68'2,3*9+;&)@.(1(&'$1> ?1(&'$/J '7>6 )'9$)D)*2/3*1&)@S#+4'LM0-20 )$D' (&)D)*9+P48Q64P482;31#)@CJ ? ',-2;4F)1S*7A 012,3*2/3*)'99+C5 ?PS=> G6 X Q#A26L(&)D)*;#F)S/'@.(1;#F)(&)4F) Q'$"#> ?$9+=J '0;&6A1A9R>@N/',68'SW*9'**'#7#69;'9H,*,


108/142


M06

+-A"# $ 7.8 *'#9>,,I$ radial head */>Q2(&'=5 G

293Q 2N#'+2,3*4>*9+#&)$P;&7/),26/' 2)*O2#@E9+P48NQ"6'4:A,S*7A0, X .78*3.1+1J '68'"6#0;&2)*O2#@E=H*#'@ 2NF G)6A1A9R>@.@*!#"#+;68'$ pulled elbow *>Q supracondylar fracture of humerus 01:-&=5 G45S#+%Q*'#LE;#F)P,&S#+6>7AV-*,I$.(1C>,291)'99+P489J '2ST17&)$2)*O2#@E*3P,&

*'#6A1A9R>@.@*!#"#+;68'$ pulled elbow *>Q supracondylar fracture of humerus (SCFH)pulled elbow SCFH

M.S#+6>7A V-*,I$.(1;#F)S#+6>7AP48C>,291 /&44F)@>1NF ?1;#F)7*9'*=5 G%-$ 2C81 2"#F G)$2/81 7&1P4&

2.C86$)'@H 2-3 (6Q P482*A1 7 (6Q )'@H9+4'**68' 2C81 4-5 (6Q(I ?1PS VI$M2 (6Q

3.7#69#8'$*'@ ,-S*7AP48Q64 *,293Q radial head Q64Q#A26L(&)D)* *,293Q2;1F)Q#A26Llateral epicondyle

4.2)*O2#@E S*7A 2;31#)@;>*9'*2)*O2#@E

!"##$!%"

24F G)6A1A9R>@P,&C>,29168'2ST1 pulled elbow *3.1+1J 'N8).4868' 2,3*45(&)2"/F G)1Q#A26L(&)D)* OI G$#>*K'!,@*'#9>,*#+,-*2(&'=5 G OI G$2,3*9+293Q1A,;18)@01C86$%> ?1 X P489J '2ST17&)$R5,@'C'

;#F),4@'%/Q;/>**'# reduction "F) 9>, forearm 0;&)@- 801=8' full supination ./+ full flexion ()$(&)

D)* (9J '$8'@ X "F) 2,3*.Q4F)()%7'$"E./&62)'4F)2(&'PS9>Q;-7>62)$) !,@.N=@E0C&Y['4F)S#+")$D)*2,3*0;&;>6.484F)6'$=5 G radial head .N=@E0C&4F))5*(&'$9>Q forearm 0;& full supination ./+$)D)*2734=5 G)@8'$#6,2#36 (#-S=5 G 7.8) 9+45 resistance 7)10*/& full flexion ./+#- &%I* clickQ#A26L;>6.484F) .%,$68' radial head 2"/F G)1*/>Q2(&'=5 G2,A4 2,3*9+#&)$P;&)5* 4-5 1'=5 ;/>$9'*1> ?12,3**39+2#A G40C&.(1(&'$1> ?1P,&2;4F)1S*7A

;/>$,I$2(&'=5 GP4 89J '2ST17&)$2(&'2YZ)*;#F)0C& arm sling S/[)@0;&2,3*0C&.(1P,&7'4S*7A .78"6#.1+1J ':-&S*"#)$68'P48,I$.(12,3*01=8'=5 G9+=J '0;& radial head 2"/F G)1)5* Q'$*#L5=5 G2,3*2ST1 2-3 6>19+45*'#)>*2%Q Q64 ()$ annular ligament 7)1reduction )'99+P48P,&@A1 click .78V&'.N=@E9>,0;&.(1)@- 801=8' full supination ./+ full flexion elbowP,&.%,$68' reduction P,&./&6 )@8'$P#*37'4012,3*


109/142


M07

*/H8415 ?9+P48@)4(@>Q.(1=>1=5 2,3*9+2#A G4(@>Q;/>$9'**'#)>*2%QQ#A26L1> ?1/,/$ %8610;$1> ?1;'**#+,-*)>10,,>1;1I G$;>*./&645 displacement 0;&N@'@'47#69(&)=> ?$ 2 ,&6@

012,3*9+NQ*#+,-*;>*Q#A26L15 ?P,&;/'@#-S.QQ P,&.*8M. Torus >+41 Buckled fracture %8610;1NF ?1 2,3*)'99+4'NQ.N=@E=>1=5 ;#F)Q'$"#> ?$9+4'C&'21F G)$9'*"A,68'P482ST1P#4'*.78=J 'P48;/'@6>1./&6@>$P48;'@ 7#69#8'$*'@NQQ#A26L2;1F)(&)4F)Q64 *,293Q (@>Q(&)P,&S'1*/'$ 2)*O2#@E9+NQ68' cortex %861 metaphysis ()$ distalradius 45#)@@81)'92ST1,&'12,5@6;#F)=> ?$%)$,&'1

!"##$!%"

*#+,-*;>*C1A,15 ?2ST1*#+,-*;>*=5 G9+P482"/F G)1./+4>*9+P4845 deformity *'##>*K' "F)immobilization 01C86$%> ?1 X ,&6@ short arm slab 91;'@293QS#+4'L M-2 %>S,';E ;#F)Q'$"1

;'*P48293Q4'**30C&2N5@$ elastic bandage N>1P6&2. Greenstick fracture 2ST1 incomplete fracture =5 G2*A,Q#A26L diaphysis NQQ8)@

Q#A26L*#+,-* radius ./+ ulnar (#-S=5 G 7.2) %'2;7H4>*2*A,9'**'#/&40C&4F)@>1NF ?101=8'2;@5@,(&)D)* 7#69#8'$*'@9+2;31.(1:A,#-SC>,291 2)*O2#@E9+NQ*#+,-*;>*!,@=5 G45 cortex ,&'10,,&'1;1IG$@>$P48;>*%4Q-#LE

!"##$!%"

7&)$9>,*#+,-*0;&2(&'=5G 45 2 6AU5 "F) 6AU5.#* ,>,*/>Q0;&*#+,-*;>*!,@%4Q-#LE ./+2(&'

2YZ)* long arm cast 4-6 %>S,';E 6AU5=5 G%)$ P487&)$,>,0;&;>*%4Q-#LE .787&)$0%82YZ)* ./+,>,0;&45 over correction 2/3*1&)@ 2NF G)S])$*>1*'#;,7>6()$ periosteum ,&'1=5 GP48R5*(',OI G$9+=J '0;&*#+,-*!*8$*/>QPS=5 G2,A4 2(&'2YZ)* long arm cast 4-6 %>S,';E

3. Plastic deformation 2ST1*'#!*8$()$*#+,-*!,@P482;31#)@;>*!"##$!%"

=J ' closed reduction !,@0C&:&'4&612ST1*&)10;&%861 apex ()$ angulation *,/$Q1:&'4&61./&69I$*,S/'@*#+,-*=> ?$ 2 (&'$ 2NF G),>,0;&7#$./+2(&'2YZ)*P6& 3-4 %>S,';E


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M08

+-A"# $ 7.9 Monteggia fracture

+-A"# $ 7.@0 Galeazzi fracture

4. Complete fracture of radius and ulnar *#+,-*;>*Q#A26L15 ?6A1A9R>@P,&P48@'* 9+2;31*'#!*8$:A,#-SC>,291

!"##$!%"

closed reduction ,I$9>,*#+,-*2(&'=5 G 2(&'2YZ)* long arm cast P6& 4-6 %>S,';E )'99+@)4#>Q shortening ;#F) bayonet apposition P,&2/3*1&)@ OI G$%'4'#V remodeling P,&

5. Monteggia fracture (#-S=5 G 7.9) "F) *'#;>*()$*#+,-*Q#A26L proximal M/3 ulnar #864*>Q45 radial head dislocation 7#69#8'$*'@9+NQD)*Q64*,293Q 0;&N@'@'4;'9H,*,293QQ#A26L radial head 2%4)01*#L5=5 GNQfracture proximal ulnar 2)*O2#@E)'9,- radialhead dislocation P,&@'* !,@S*7A radialhead 9+C5 ?PS@>$ capitellum => ?$ AP ./+ lateralview 012,3* radial head ;#F) capitellum )'99+@>$P482;31C>,2919'*2)*O2#@E %8610;1,>Q.#* "F) =J ' closed reduction ()$ radial head !,@,I$*#+,-*7'4.16@'6 (longitudinal traction) ./+=J ' full supination 0C&;>6.484F),>1 radial head 2(&',&'101./+,&'1;/>$ 91P,&@A12%5@$ click 0%82YZ)* long arm cast $)D)* 90 )$D' forearm )@- 801=8' full supination 4-6 %>S,';E

6. Galeazzi fracture (#-S=5 G 7.M0) "F)*'#;>*()$*#+,-*Q#A26L distal M/3 radius #864*>Qdistal radioulnar joint (DRUJ) dislocation 7#69#8'$*'@9+NQS/'@.(1Q64 2;31 ulnar styloid 1-1

*68')5*,&'1;1I G$ 2)*O2#@E9+2;31#)@;>*C>,291./+45*'#.@*))*()$ DRUJ OI G$%8610;Q Monteggia fracture "F) 7&)$ reduction DRUJ *8)1 !,@,I$ longitudinaltraction ./+ full supination %8610;*9+*/>Q2(&'=5 GP,&2)$ 2(&'2YZ)* long arm cast$)D)* 90 )$D' fore arm )@-801=8' full supination 4-6 %>S,';E


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M09

7. Distal radius fracture %8610;*9+2ST1 dorsal displacement

!"##$!%"

closed reduction =J 'P,&P48@'* 2N#'+%8610;1 distal fragment PS,]'1 volar 2(&'2YZ)* short armcast ./+=J ' 3 point fixation 2;4F)1 Colles Fracture 0%82YZ)*S#+4'L 4-6 %>S,';E

• Fracture Shaft of Femur

NQP,&Q8)@4>*2*A,9'*)HQ>7A2;7H=5 G#H1.#$ 7#69#8'$*'@9+2;31"6'4:A,S*7A :A,#-SC>,2912C81 ('%> ?1 ('!*8$ P48@)4(@>Q('(&'$1> ?1 2)*O2#@E9+2;31#)@;>*P,&C>,291

!"##$!%"

NA9'#L'7'4C86$)'@H "F)012,3*2/3*S#+4'L.#*2*A,VI$ M0 (6Q #>*K'!,@9>,,I$*#+,-*2(&'=5 G0%82YZ)* hip spica

P6&S#+4'L 6-8 %>S,';E %'4'#V0;&*#+,-*2*@O&)1*>1P,& S#+4'L M O4. 21F G)$9'*4>*9+45overgrowth ()$('(&'$=5 G;>* )'@H M0 (6Q(I ?1PS %8610;*K'2;4F)1*>Q:- &0;S,';E*32N5@$N) 012,3*!7=J 'closed reduction 0%8 long leg cast 4-6 %>S,';E


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Open Fractures

110

!""# $ 8 Open Fractures---------------------------------------------------------------------------------------------------------------------------------------

Open fractures

Open fractures !"#$"%&'('$) *+,- *./0123(45$"%667/8$9:;$8/) ?$,@ (5'2!4=1A8 ?$CF$4(BB84H(FF4012!"#$ 4 >8 ?$CF$18+$- ?

1. Life preservation

2. Limb preservation

3. Avoidance of infection

4. Functional preservation

5$"I AJ.1878 Volkmann ./ mortality rate K)+ 38.5% 5$LM 2"N('BEFLM 2"N$>('BEF/B=!2F3. 4(B"$!"T UF$>F+P= *+9":4":F3 (contamination)4. degree of soft tissue injury

5. "B;!3=$!P2$!:EF1 !P2$"B;P(,':8+6(4/8$,)49:2


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Open Fractures

111

Classification of open fracture (Gustilo and Anderson 1984)

5D2!"#$9$


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Open Fractures

112

Type III C. 3- major arterial injury BG


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Open Fractures

113

4(BX84"B;8 ?$CF$6(4 superficial structure :+0" deepstructure

1. Skin P@ ('B8/ puncture wound 'BEF low velocity gunshot wounds 4(BC819CG+>F/9L:9:; irrigation 4V!.-O+.F 03G3-AF+ bone diameter 'BEF


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Open Fractures

114

bone fragment A2F,- *

!DE *FKEF0123(4,- *P71Tendon 6;3-!OE *F5P/(+'7 23FOM G!B-O4M1 periosteum FF46(44B;1M4Q1O03G6@ (!"#$4. Bone 4B;1M4D= ?$!:V4Y,- *03G3- soft tissue attachment 'BEF contaminate 3(4 A


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Open Fractures

115

Stabilization of fractures

'3(OK)+4(B6815'24B;1M4FOM G54:2!A-O+48/ anatomic position 3(4,- *P71 !.E *F,- *6;,@ (wound management 9:; early function 012

4(B681 alignment ,- *1-6;DG) ?$ $F46(4$- ?O8+DG2F!P-O 6)+A


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Open Fractures

116

External skeletal fixation (External fixator)

"%667/8$ external fixation !"#$2F1->F+ external fixation devices1. ,@ (012AGF$>2(++G(O9:;BF+4:2(3!$E ?F

3. K2(5PG external fixator $($Y Q1O!\.(;5$B(O,- *5'2 non weight bearing 6;,@ (5'2!4=1 delayed union 'BEF nonunion 012

External fixator 03G$=O35PG,- * humerus 9:; femur !$E *F+6(4C2F+5PGLG($4:2(3!$E ?F 9:;5$LM2"NF+ open fracture humerus 9:; femur grade I, II4V03G012!.=*3 rate >F+ infection !$E *F+6(44B;1M4,8 ?+ 2 $- ?3-4:2(3!$E ?FA:730121-

FOG(+0B4VC(3 5$ open fracture type III ,- *3- soft tissue injury 3(4 external fixator 4VO8+!"#$


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Open Fractures

117

2. Massively traumatized limbs 5$LM 2"N) ?$ 4VP(3(BK,@ ( internal fixation 012 !DG$non-reamed intramedullary nailing 5$ open fracture femur type III 5$LM2"N


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Open Fractures

118

4B;1M4QL:G /B=!


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Open Fractures

119


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Fractures and Dislocations for General Practitioner

120

!""# $ 9 Fractures and Dislocations for General Practitioner ---------------------------------------------------------------------------------------------------------------------------------------

!"#$%&'()*+,-./#0*123 454),4+(*+67+849:;'?9:;'


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121

4. Acromio - clavicular joint dislocation (AC joint)

Type I, II 0*+84./#$?P K/' arm sling $=)>?( distal clavicle type I H( Type III 5#4?4'T)4+NJ@(H=XJ!" #BG@')*+,-.)J?'4+!J4E*/ N4)4050*+84K/' arm sling $AJ(+*( 9O-2@09(-(3 4!" #BG@'$0> F?P

deformity ;& F,-)&?'" J 9EJ)*+,-.)J)&BYX=4=4+.)J;3 4P4(=(*+refer - H( type III 2(=(TJ)N4@;& F'*PE#?PHA#P4(=(*+ 9(-(3 4H=#!J4E*/

5. Anterior shoulder dislocation

0*+84./#$?PK/';3 4 closed reduction HA# Zero position =0>? traction counter traction9O#@9EJ2@4)5(*/ H(2(?4'T(#?'B0-)4R 15-35 B[)&K?+4N%#?=OT/U3 S 4./#N"P ,7P2@09(-(3 4H=#HNJarm sling 9O-10D=40+O#4)$(> S?0?1%#?.=OJH=#9%WP90P =#4) abduction 9O- external rotation %#?.=OJ H(2(N"P?4'TU7 FP?4,,-:1 greater tuberosity fracture 0J@)/#@' +WHA#@DL& reduction $=)>?(+*(9O-AD S(+0-/"+ greater tuberosity )*+,-+O*1$%#4;& F$/D) H=# sling .@#B0-)4R 2 N*B/4= F?B\?P+*(%#?.=OJED/

refer - reduce .)J$%#4 =0>? AD S( greater tuberosity .)J+O*1$%#4;& F- recurrent dislocation $BQ(1J?'9O-)&BYX=4H(+40HA#P4(

6. Fracture proximal humerus

Non displaced 9O- impacted fracture :1H(2(N"P?4'T 0*+84./#$?PK/' arm sling 1-2

N*B/4= F?=4'$,W1H=#$0D F) pendulum exercise K/'E#?PHNJ arm sling %R-10D=40%#?.=OJ =O*P,4+3 N*B/4= F?+0-/"+$0D F)ED/ ,7P5?/ arm sling exercise ROM ./# ;T+;D6;4P &'()*++,*-. H(impacted fracture .)JE#?P;3 4 reduction $:04-=4+/7P+0-/"+,-;3 4H=#0?'=*+=OT/,4++*(./# 9O-E#?PH=# arm sling 0*1(3 S 4=(*+9%(;* SP=)/10D$@R%#?6?+$:> F?B\?P+*( distraction force

refer - displaced fracture ;T+04' +J?( refer HNJ arm sling $:> F?O/?4+40$,W1B@/ ?4,H=#'40-P*1B@/0J@)/#@'

7.

Fracture shaft of humerus

H( transverse fracture )*+,- reduction ./#'4+ =4+$BQ( spiral =0>? comminutedfracture N4)405/7P9O-HNJ U-slab K/'E#?P@*/2@4)'4@H=#:?/& 2@4)'4@%?P$]?̂+$0D F)@*/,4+/#4(H(%?P0*+90#?#?)NJ@(%#?6?+??+.B/\4(%#4P,(%7 S(.B2OT) acromion process :*( elastic H=#+0-A*1(*/E0@,U3S 4/"$]?̂+H(N*B/4=


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122

refer - transverse fracture ;& F reduction .)J./#- =O*P reduction )& radial nerve palsy- HNJ$]?̂+9O#@+0-/"+.)JED/ (nonunion)

8.

Fracture distal humerus

H(!" #BG@'NJ@(H=XJ ,-$BQ( displaced fracturerefer - $:> F?;3 4+40!J4E*/

9. Fracture olecranon

H( non displaced fracture ;& F$=W(0?'0#4@+0-/"+.)J$2O> F?(E4) criteria H(1;;& F 3 HNJposterior long arm slab H(;J4 slightly pronation B0-)4R 2 N*B/4= F?=4'$,W1H=# exercise flexion, extension,pronation 9O- supination !"#BG@')*+,-)&BYX=4 limit fully extension B0-)4R 5-10 ?P64 U7FP:1./#1J?'9EJ,-.)J)&BYX=4H(+40HA#P4(

refer - reduce .)J./#- )&+0-/"+=*+0J@)/#@' $AJ( radial neck, radial head- )& ulnar nerve palsy

%%. Fracture shaft of radius and ulnar Monteggia fracture, Galeazzi fracture

Displaced Night stick fracture

+0-/"+=*+10D$@R forearm ;T+?*(;& F+OJ4@)4(& S $)> F?:1H=#;3 4 reduction $;J4;& F,-;3 4./# =0>?

92J,*/ alignment H=#E0P HNJ posterior long arm slab 9(-(3 4!" #BG@'H=#!J4E*/ +OJ4@2>?E#?P refer "56+07

%2. Non displaced Night stick fracture

0*+84./#$?PK/'$%#4$]?̂+ long arm cast H(;J4 neutral 4 N*B/4=


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123

• Fractures and dislocations of the hand and wrist

%. Distal radius fracture

Colles fracture H(2(N"P?4'TN4)4050*+84$?P./#/*P;& F$%&'(04'O-$?&'/ H(1;;& F 4 %#?N3 42*X 2>? ?'J4;3 4H=#$+D/ complication )4++@J4$/D) $AJ( HNJ$]?̂+'4@$+D( MP joint ;3 4H=#!" #BG@'+3 4.)J./# )>?9%WP=0>?$]?̂+=(*+)4+,(;3 4H=#!" #BG@''+9%(10D=40%#?.=OJ.)J./#

Non displaced distal radius fracture, Chauffeur’s fracture 0*+84K/'$%#4$]?̂+ shortarm cast 4-6 N*B/4=<

refer - Smith’s fracture (;T+04')& displacement)- Barton’s fracture ;* SP dorsal 9O- volar (;T+04')& subluxation %?P radiocarpal

joint)

- Displaced radial styloid fracture

- Displaced intraarticular fracture ?> F( V $AJ( lunate load fracture, comminutedfracture

2. Scaphoid fracture

non displaced fracture HNJ thumb spica cast 8 N*B/4=<

refer - Displaced fracture )4++@J4 1 )).- .)J9(JH,@J4)& fracture =0>?/" displacement .)JA*/$,(- fracture scaphoid 0J@)+*1 fracture 10D$@RH+O#$2&'P $AJ( radial styloid

3. Distal phalangeal fracture

0*+84./#$?PK/'HA# aluminium splint 4 N*B/4=


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124

5. Fracture of proximal and middle phalange

H( non displaced fracture H=#/";& F plane %?P$OW1=4+.)J)& malrotation 9O-$)> F?+3 4)>?9O#@(D S@;T+(D S@A& S.B;& F scaphoid tubercle ('+$@#(=*@9)J)>?) 0*+84K/' buddy splint 4 N*B/4=<

refer - displaced fracture ;& F reduce .)J./# =0>? reduce 9O#@)& deformity

6. Metacarpal neck fracture (Boxer’s fracture)

H( Boxer’s fracture 10D$@R neck %?P 4th =0>? 5th metacarpal 0*+84K/' AP slab ./#$?P57P9)#,-)& angulation 1#4P NJ@(H=XJ,-.)J$+D( 40 ?P64 U7 FP accept ./# +40HNJ AP slab 9!J( slab/#4( anterior E#?P?'" J.)J$+D( MP joint 2>? E#?PH=#!" #BG@'P? MP joint ./# 9!J( slab /#4( posterior =0>? dorsal HNJ57P PIP joint K/'P? MP joint 70-90 ?P64 %#?)>??'" JH(;& F dorsiflex B0-)4R 15-20

?P64 HNJ$]?̂+.@# 4 N*B/4=<refer - angulation )4++@J4 40 ?P64 =O*PHNJ$]?̂+ AP slab

- !"#BG@';& FE#?P+40 anatomical reduction 9O- cosmesis

7. Benett’s fracture

refer ;T+04' $:04-E#?P reduction 9O- percutaneous K-wire fixation

8. PIP joint dislocation

H( simple dislocation N4)405 reduce ./#$?P HNJ splint .@# 1-2 N*B/4=<refer - complex dislocation ;& F/7P.)J$%#4

9. MP joint dislocation

H( simple dislocation :'4'4) reduce E4)@DL&;& F$%&'(.@#H(1;;& F 4 E#?P0-@*P.)JH=#$BO& F'(,4+ simple $BQ( complex dislocation HNJ splint .@# 1-2 N*B/4=<

refer - complex dislocation U7 FP)*+$+D/,4+ volar plate .B%@4P E#?P!J4E*/

• Fracture and dislocation of lower extremity

%. Fracture of the pelvis

+0-/"+=*+10D$@R(& S;& FN4)4050*+84K/' conservative treatment 2>?- fracture ;& F.)J$+& F'@%#?P+*1 pelvic ring ./#9+J fracture ischium, ilium- open book ;& F symphysis 9'++*((#?'+@J4 2.5 U).- pubic rami fracture .)J@J4,-$BQ( 2 rami =0>? 4 rami

H=#(?(:*+1($E&'P H=# NSAIDs =0>?'40-P*1B@/H(AJ@PN*B/4= F?!"#BG@'AJ@'E*@$?P./#+WH=#$0D F)OT+(* FP =*/$/D(K/'HA#.)#23 S 4'*( =0>? walker


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125

major injury %?P fracture pelvis ?4,,-;3 4H=#!" #BG@'$N&'$O>?/./#)4+ 2@0,-H=# fluidresuscitation =0>?HA# elastic bandage 6 (D S@ 2 )#@( :*(0?1 pelvis 9O- 1 )#@(:*(10D$@RE#(%4$:> F?1&1 pelvis $%#4=4+*( AJ@'O/+40$N&'$O>?/H($1> S?PE#(./#

refer - fracture pelvis with vital sign unstable =O*P,4+ resuscitation- Open book injury ;& F symphysis 9'+)4++@J4 2.5 U).- Vertical shear fracture

2. Fracture acetabulum

0*+84./#$a:4- non displaced fracture K/'HNJ skin traction .@# 3-4 N*B/4= F?:1!" #BG@'$?+U$0'? acetabular labrum %@4P

H(%#?


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126

3. Fracture of proximal femur

=)4'57P fracture neck of femur, intertrochanteric fracture 9O- subtrochantericfracture

H(2(=(T J)N4@)*+$+D/,4+ high energy trauma U7 FPH(+OTJ)(& SE#?P0*+84/#@'+40!J4E*/ ,7PE#?Prefer ;T+04'

H(2(N"P?4'T;& F)& osteoporosis =4+N_4:!" #BG@'+J?(;& F,-)&+0-/"+=*+'*PN4)405$/D(./# +400*+84+W2@0,-=@*P@J4!" #BG@',-+O*1.B$/D(./#$AJ($/D) U7 FPE#?PHA#@DL&0*+84K/'+40!J4E*/ ?'J4P.0+WE4)!" #BG@'H(+OTJ)(& S+W)&K?+4N$N& F'PEJ?_4@-9;0+U#?(,4++40!J4E*/ U7 FP9:;'? +0-/"+=*+10D$@R(& S.)J@J4,-$BQ( non displaced =0>? displaced 2@0,-

!J4E*/;T+04'5#4N_4:0J4P+4'!" #BG@'9%WP90P

4. Fracture shaft of the femur

Supracondylar fracture

+0-/"+=*+10D$@R(& S$+>?1;T+04',- displace 2@0,*//7P+0-/"+H=#./#9(@;& F/& HNJ Thomassplint, resuscitation 5#4!"#BG@'$N&'$O>?/)4+,4+10D$@R;& F=*+ 9O#@ refer ;T+04'

5. Fracture of the patella

H(+0R&;& F$BQ( non displaced $=W(0?'0#4@ N4)4050*+84./#$?PK/'HNJ cylindrical cast H(;J4P?$%J4B0-)4R 10-15 ?P64 $:> F?B\?P+*($]?̂+$O> F?(OP.B+/%#?$;#4 HNJ.@# 4 N*B/4= F?;3 4 ORIF

6. Knee dislocation

=4+:1!" #BG@';& F)& knee dislocation 5>?@J4$BQ( Orthopaedics emergency ;& FE#?P0&1;3 4reduction $:04-)&K?+4N$+D/ popliteal vessel injury K/';3 4 longitudinal traction +0-/"+)*+,-+O*1$%#4;& F./# 9O-E#?PB0-$)D($N#($O>?/=O*P,4+/7P+0-/"+$%#4;& F$N)? HNJ splint 9O#@ refer ;T+04' .)J@J4,-)& vascular injury =0>?.)J $:> F?B0-$)D(+40a&+%4/%?P$N#($?W(9O-@4P9!(+400*+84EJ?.B

7. Fracture of the tibial plateau

0*+84./#$?PH(+0R& non displaced fracture =4+.)J9(JH,$?+U$0'


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127

8. Fracture of the tibia

0*+84./#$?PH(+0R&;& F$BQ( non displaced fracture, displaced transverse =0>? shortoblique fracture ;& F reduction 9O#@N4)405 accept alignment ./#E4) criteria K/'HNJ long leg

cast 6 N*B/4=


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128

%3. Fracture of toe

N4)4050*+84K/' buddy splint 2-3 N*B/4=S?PE#( +OJ4@2>? +40@D(D,a*' +40'7//4)+0-/"+ (splint) 9O-+40H=#'4B\?P+*( secondary corddamage H(04';& F)& spinal cord injury +40HNJ;J?AJ@'=4'H,H(!" #BG@';& F.)J0" #N7+E*@=0>?)&14/9!O10D$@RH1=(#4:7P0-O7+$N)?@J4 !" #BG@'?4,)& cervical spine injury H=#HNJ/#@'2@4)0-)*/0-@*P

E0@,@D(D,a*'?'J4PO-$?&'/ $)> F?:1@J4!" #BG@')& spinal cord injury _4'H( 8 A* F@K)P E#?P0&1H=#high dose methyl prednisolone 30 mg./kg. IV bolus dose H( 15 (4;& 9O- IV drip EJ??&+ 5.4mg./kg. H( 23 A* F@K)P '4(& S$BQ('4;& F2@0,-)&.@#H(K0P:'414O9O-'*P?'" JH(1*XA&'4=O*+9=JPA4ED

+400*+84!" #BG@' spinal injury ,3 4$BQ(E#?PHA#$20> F?PAJ@':'TP =0>? spinal brace /*P(* S(,7PE#?P

refer !"#BG@'$:> F?)40*1+400*+84EJ?H(K0P:'414O6"('?K0P$0&'(9:;'<,4+B0-N1+40R


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129

• Fractures and dislocations in children

+0-/"+=*+9O-%#?$2O> F?(H($/W+;& F:11J?' 9O-9:;'?$0> F?P cubitus varus 57P9)#,-0*+84?'J4P.0+WE4)+W)&K?+4N$+D/%7 S(./# 5-10%

3. Fracture lateral condyle of humerus

H( non-displaced fracture HNJ posterior long arm slab 4 N*B/4=


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130

NE4P2?,*1=" (full flexion elbow) ;3 4H($@O4;& F0@/$0W@ =O*P/7P$%#4;& FH=#0?N*+ 5-10 (4;& 5#4$BQ(B+ED+WH=#$/W++O*11#4(./#

5. Fracture of the forearm

5.1

Torus fracture =4+$,W1)4+HNJ short arm slab .)J$+D( 1 N*B/4=?H=#$/W+=O*19O#@+WHA#90P/*/+0-/"+H=#E0PK/'/"9%(/#4(E0P+*(%#4P$B0&'1$;&'1 HNJ$]^?+ long arm cast 9O-/*/H=#)& over correction $OW+(#?' $:> F?B\?P+*( recurrent deformity

5.4 Complete fracture of radius and ulnar 0*+84K/' closed reduction HNJ$]^?+ long

arm cast @DL& reduction ;3 4./#K/' longitudinal traction H(;J4P?6?+ 90 ?P64 =O*P,4+(* S(:*($]?̂+ %R-;& F$]^?+H+O#9=#PH=# mold $]^?+K/'+/1&110D$@R0?'=*+:?B0-)4R H(9(@=(#4-=O*P 2O#4';3 4$]?̂+H=#$BQ(0"B@P0& $:> F?1&19'++0-/"+ radius 9O- ulnar ??+,4++*( =#4)1&190P,($]^?+'T1=0>?;3 4H=#$O>?/.=O$@&'(.)JN-/@+ HNJ$]?̂+.@# 4-6N*B/4=?(+*(2>? reduction radial head=0>? DRUJ +J?( K/'H=# forearm ?'"JH(;J4 full supination $%#4$]?̂+ long arm cast$?+U$0'


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132

3. Fracture stabilization +0R&;& F+0-/"+)&+40!D/0"BA*/$,( =O*P,4+;3 42@4)N-?4/14/9!O9O#@:*( compressive bandage $:> F?=#4)$O>?/ 9O#@,7PHNJ splint /4)9O#@2J?':*(9%(=0>?%4+*1splint ?&+20* SP=(7 FP * &'(@AB=C0B"# $=!?B'!4(7 D * 9O-$BQ(?*(E04'+*1!" #BG@' 2>? $)> F?;3 4

2@4)N-?4/14/9!O$N0W,+WHNJ splint 9O#@HA# elastic bandage :*( splint +*19%(=0>?%4 /*P(* S(,7P.)J$+D/ compression $:> F?=#4)$O>?/ !" #BG@',-$N&'$O>?/./#)4+H(%R- refer

Open fracture "# $+-6E0?B'F(.

1. Fingertip injury )&?'" J 2 +0R& 2>?

1.1 Non exposed bone ;& F)&%(4/14/9!O%(4/$OW++@J4 1 E404P$U(ED$)E0 2@00*+84K/'+40 wet dressing =0>?HA# silver sulfadiazine cream dressing ;T+ 3-4 @*( =O*++40

0*+84K/'@DL&(& S2>? %?19!O,-)&+40=/E*@ 9O-)& epithelium P?+2OT)10D$@R9!OK/'0?1(creeping epithelialization) HA#$@O4 2-4 N*B/4=??&+@DL&=(7 FP 2>? $'W1BM/9!O5#4;3 4./# =4+14/9!O)&%(4/H=XJ+@J4 1 E404P$U(ED$)E0 2@0HA# full thicknessskin graft

1.2 Exposed bone )&+400*+84 2 @DL& 2>? skin flap U7 FP9:;'? short bone to close 911(& S;3 4./#PJ4' 9!O=4'$0W@ 9:;'?+@DL&H/;& F$=)4-N)

2.

Toe injury +0R&;& F)& traumatic amputation =0>? severe open fracture %?P toe $)> F?./#H=#%#?)"O;& F$=)4-N)9+J!" #BG@'9O#@ +40;3 4 amputation, short bone to close =0>? primary closureN4)405;3 4./#=4+14/9!O.)JA?+A3 S 4=0>?N+B0+)4+ =4+.)J9(JH,H=#$BM/9!O.@#+J?(9O#@;3 4delayed primary wound closure

=(#4;& F%?P9:;' F?=#4)$O>?/,/4)+0-/"+H($1> S?PE#(3. Antibiotics prophylaxis and treatment

4. 9(-(3 4!" #BG@'9O-X4ED57P9(@;4P+400*+845. $E0&')!"#BG@'H=#:0#?)N3 4=0*1+40!J4E*/ $AJ( NPO !"#BG@', NJP film )4:0#?)+*1!" #BG@'


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133

3+58

H(1;(& S./#:'4'4)0@10@)%#?)"O,4+9:;'


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Complications of fracture

134

!""# $ %0 Complications of fracture----------------------------------------------------------------------------------------------------------------------

Complication !" #$%&'()*+,-./0/,1234 '5678%-90:+;20 0HL(@.G%&'/" D5M:$'

$&:/G


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135

I:+.30/H &$


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136

$'


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137

&'(')*67&'(')*+,-=+$(&' systolic bloodpressure 26+/6 D/;C&5($G'@;HG


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138

2. Stability of fracture 5('CC6 #/5+=$9'@C"$$='+3&(/G'@;H G & 4 %6$?J- 5M:Torsion wedge, Comminuted, Defect 8%- Atrophic (H!" # 10.2 )

)89"# $ %0.% Hypertrophic nonunion )9"# $ %0.2 Atrophic nonunion


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orthopaedic trauma อ.ธีรชัย

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