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British Medical Books Health Issues Computerized Tomography

General information & definition

  • age group at risk
  • incidence
  • risk of associated injuries

Mechanism of #’s

  • trauma
    • direct - tapping, crushing, pulling
    • indirect - bending, torsion
  • stress or fatigue
  • pathological

Classification of #’s

Clinical features

  • symptoms
  • signs

Investigations

  • X rays
  • special imaging (tomo’s, CT, MRI, isotope)

Treatment

  • ABC + 1° survey
  • 2° survey

Principle of management:

  • reduce, maintain reduction, rehabilitate
  • must consider soft tissues as well:

Tscherne classification of closed injuries:

  • grade 0: simple, minimal or no soft tissue injury
  • grade 1: with superficial abrasion or contusion of skin & sub-cut tissues
  • grade 2: more severe with deep soft tissue contusion & swelling
  • grade 3: threatened compartment syndrome

Conservative

  • reduce - analgesia, sedation, anaesthetic
  • maintain - POP, traction, functional bracing

Operative

  • indications
  • ORIF, external fixation

Open fractures

4 principles:

  • immediate wound cleaning & sterile cover
  • prophylactic antibiotics & ATT
  • early debridement
  • stabilization

Gustillo classification of open fractures:

  • type 1: < 1cm, little ST injury & contamination
  • type 2: > 1cm, no skin flap, moderate ST injury & contamination
  • type 3: extensive ST injury & contamination
    • 3a = can cover bone with ST
    • 3b = periosteal stripping
    • 3c = arterial injury
  • Incidence of infection correlates to ST injury
    • < 2% for type 1
    • 10% in type 2

Complications of fractures

General

  • shock, DIC & respiratory dysfunction - usually within 1st 24 hours
  • crush syndrome
  • DVT & pulmonary embolism
  • fat embolism
  • tetanous
  • gas gangrene

Local

  Early Late
Bone Infection AVN
Malunion
Delayed or non - union
Infection
Soft tissues Blisters
POP blisters
Muscle & tendon injury
Vascular injury
Compartment syndrome
Nerve injury
Visceral injury
Bed sores
Myositis ossificans
Tendinitis & tendon rupture
Nerve compression & entrapment
Volkman’s contracture
Joints Haemarthrosis & infection
Ligament injury
RSD
Instability
Stiffness
RSD
Osteo-arthritis