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principles of diagnosis and management of fractures and soft tissue injuries
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includes: general principles, fracture description, fracture healing, fractures in children, diagnostic modalities, complications, subluxations and dislocations, treatment, soft tissue injury, management of orthopaedic injury

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  • December 21, 2023
  • 8
  • 2021/2022
  • Lecture notes
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1
Sunday, 16th January 2022
Week 1
Medicine
Principles of diagnosis and management of fractures and soft tissue injuries
Introduction
 Very common
 Often involve young, usually healthy individuals
 Accurate diagnosis, treatment, and documentation essential
General principles
 Predicted by knowing
o Chief complaint
o Age of patient
 Certain injuries more common for certain age groups
o Mechanism of injury
 Crush injuries
 Falls
o Amount of energy delivered
 Certain velocity
 Road traffic accidents
 Careful history
 Physical examination
 If a fracture is suggested but radiographic films appear negative the patient should
be treated as though fractures were present
 Criteria for adequate radiographic studies exist
 Should be performed before attempting reductions except when delay could cause
harm
o Presenting with dislocated ankle joint and patient is ischemic
 Neurovascular competence should be checked before and after any reductions
 Patients should be checked for safe mobility before discharge
 Should give written explicit aftercare instructions before discharge
 In multiple trauma it is important that orthopaedic injuries should only be diagnosed
and addressed after more life-threatening injuries
 All orthopaedic injuries should be described precisely and according to convention
o Conventions change from time to time and place to place
o Important for communicating efficiently with colleagues
Fracture description
 Precise language
o Enable accurate clear communication with others
 Fracture break in continuity of bone or cartilage
 Loss of function
 Pain
 Tenderness
 Swelling
 Abnormal motion
 Deformity
 Radiographic studies
o Xray
o CT scans

, 2
Sunday, 16th January 2022
Week 1
Medicine
o Usually confirm presence
 First – closed or open
o Closed – soft tissue intact
o Open – exposed to outside environment
o Can be difficult to determine if small wounds communicate with fracture
 Describing the fractures exact anatomic terms
o Name of bone
o Left or right
o Standard reference points along the bone
o Long bones divided into thirds
 Additional modifier
o Direction of fracture line in relation to long axis of bone
o Transverse – right angle to the long axis
o Oblique – oblique to long axis
o Spiral – rotational force, encircles shaft of bone in spiral
o Comminuted – more than two fragments
 Describe position and alignment of fracture fragments
o Described relative to normal position
 Any deviation from normal is displacement
o Distal described in terms of proximal
o Displacement can also be described quantitively
 Millimetres or percentage
 Alignment
o Relationship of longitudinal axis of one fragment to another
o Deviation is angulation
o Describe direction of angulation
 Complete or incomplete
o Complete both cortices
o Incomplete if only involves one
o Should be noted if a fracture extends into or involves articular surfaces
 Avulsion and impaction
o Avulsion – bone fragment pulled away from normal position due to
contraction of muscle or resistance of a ligament to a force
o Impaction – forceful collapse of one fragment of bone into another
 Pathology fracture
o Abnormal bone
o Seemly happens through trivial trauma
o Not used for the elderly when the fracture is osteoporotic
o Fractures in normal bone through trivial trauma should suspect abuse or
battering
 Stress fracture
o Repeated low intensity forces
o Hard to find in x-rays
o Picked up a week or two after the fact when CT or MRI is used

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