General Indication of Surgery

General indication of surgery in athopedic : imp hip fracture ②fracture of femur in adults & addescent ③ fracture of tibia in adults 4 open fractune external fixation ⑤ Intra articular fracture كصور في جوینت External fixation Complicated by traumatic arthritis ⑥fracture associated with Arterial injury eximedial malulus ⑦fracture of ankle type C @Pathokgical fractune @failure of (Conservative) close reduction Type 3 supracondylar fractune. fracture of radius & ulna (4 arm) (12) non union (>6m) un healed Greated or not treated) 13( Poly trauma pt with fractuکبر اتنی بودا م اعضاء مؤثرة )multiple systems( + 14 m X Ray ID ② anatomical part + View (AP and lateral) ③ Pathokgy (fracture or Dislocation) Site ④ long bone. Proximal third middle Type Distal A Transverse -oblique -spiral-Comminuted angulation -Sigmatal sslocation Q -MC posterior Q 馬 Shoulder Ant or posterior Do lateral view xray ➡to see if ant Ant Dislocation Shortening &, fallen & Externally rotated, abducted QQfest - flexion adduction & internally rotated & hoster *examo ins Palpation ROM Power nurological exam Special test *note: Complication rate in dislocation is 3-5 7. Qsiatic nerve injury A Vascular necrosis in Dislocation Close reduction (after sedation & analgesia) No Surgery needed" Hip fracture (head) Blade from Capsule → to head neck Icuminance *Capsule start from acetabulum to the base of neck of femur Q any fracture in capsule (intracapsular) Can Cause ay scular necrosis) hip replacment femur hood اغفیر - prosthetic Joint Differ out of in blood arthroplasty = لانو الدم حال يوصل بعد الكسر capsule (extra Capsular) (intertrochanteric) Supply so diff treatmet Reduce & fix بالمسامير تتصلح Q Short - fallen leg pathognomic fer hip fracture ex rotat tiba 3-6 m humerus 4-6 w Adult Fomur ✱ Femur fraderne - Tibial fractane. 5-6m Intramedullary nail ← Cause gröth arrest (so only in adult) - adult Surgery fixation (screws) and open reduction - Adolescent flexible nail -Children thick periosteum hip spica جي )because children has thick pericstecum & Rich in blood supply) *Tibial fractune intra medallary nail (like femur) Complications: Bleeding + Sciatic nerve injury + compertingat syndrome non union + fat embolism note: multiple fractures plates and screws (cant be trended with intramedullary nail) nall Ankle fracture Avultion fracture (cut of delteid ligament) Evaltion -abduction & external rotection of foot (Causes) affected medial matutus and fibula A * fracture below level of join Type A B* fracture of lateral malulus -in level of joint Surgery Type B C *fractune above Sindesmosis up te fibula. medicul malakar + Fibula lig betwsen tibia &, fibula Sever - Typ C Surgery Sindesmosis Screw - Type open reduction because it is intra articular - Type C Sindesmosis Screw -Type A, B No surgery AP #order 3 xray views laterad mortise Q Shalder Disslocation Due Abduction & external rotation to know if it ant or post Axillary view xray head albone head belau glenoid glenoid Flat Shoulder Q ant MC Q Posterior hend is Disslocaled (Down of Deltoid muscle) Prominace of acromioun apparent longer hand Palpation tender - bony prominance - limited ROM & paunfell unkinked glenoid )فراغ( Complication nurological axillary nerve moter Delterd injury Sensory skin over deltoid recarrance * -musculoskeletal (motorbiceps sensory s Tx (close reduction( MC Cause of failure of reduction is pain so imp to selet ime abduction + externa click put hand in intermat rotation → sling 4-6 w (for capsule healing) + physiotherapy * Successed return to normal #normal exam + Post reduction xray *Recuriance rate is 80% if didn't put sling. if recurriant it will need surgery. names of Reduction techniques ** 3-5% approach Consideration Stimson manuver Scapular manipulation External rotation -Traction Contraction axiled Traction milch technique humerus fractanc healing in 4-6 weeks in adults to exculte Hematoma and Callous close مجلس •reduction + Cast wonder follow uf every week (Pray) →if after 1w is good and started te heal + Post reduction x ray Come after 2 w Do cadiological union & clinical cpion (Xray) (No pain in fraclared area) *ife failed close reduction (Conservative) Surgery -Complication : radial nerve injury (wrist drap) Pathological fracture Cancer breast (example) bone osteolytic by ⇒ bone try to heal osteoblast So in x ray pathological fracture Surgery Special types of forearm fractures: G M monteggia: fracture of proximal ulna with Radial head Dislocation Ru + Proximal Radio ulnar joint injury (energy from back of focarm) adult sofen reduction + Internal fixation (OR) Galeazzi fracture of distal Radius with ulnar dislocation of distal Radic ulnar - Complications Pedia close redaction & Immobilization posterior interosseas nerve injury -Radial head instability/disiccation - Radio winar synestesis (fusion) (DRUJ) Due to fell on outstretched hand (pronated or Direct wrist trauma. RxGR+IF + check fer DRuj Stability shablete + disruption Stable splint 10-14 days →OR+IF/Percutancus Pmning Joint →Cast Supra Condilar fracture -Common in children due to falling MC (hond protective) out stretched elbow hand Gartend lat view →lack at Ant nemoral ina Types 1: non displaced + fal pod sign" fractune TX Posterior Slap Q Cabore elbow Cost fer 4w)@ in examinatin angulated/ Dreplaced fracture with fes intact posterior Cortex Very imp Tx close reduction & posterior slap to assess 3 Complele displaciment with No Contact beteveen Fragment Palse Radial - Imp due to presence of artery (brachial artery) →ischemia in 4-6 h No Q - 3-5%. of brachial artery cut or injury. pulse 3-57% only, closed reduction Do -TX closeal reduction ER in + Percutanous pening OR if returned not ② Pulse returned Emergency absolute (call vascular) Complication: Radial/median nerve Injury (wrist-drop) Describe the radiographs * first I have to identify pt name & age *This is an (AP/Lateral view) of an X-ray of (UL/LL showing ... bone of Rt/Li side) * There is (fracture / dislocation) of ... bone at (proximal/mid/distal 1/3) ***The fracture - Type (open/close/*complete*/incomplete/extra/intra articular/Avulsion) - Orientation (Transverse/Oblique/Spiral/segmental/Comminuted) "TOSS" - Alignment (Displaced/Angulated/Rotated/Impacted) "DARI" Alignment = relation of distal to proximal eg: Ant/post displacement (L view) or M/L displacement (AP view)