ORT - Wk3 - General # and LL # Short Q

• pathological breakage

  • with localized bone weakness

  • break even in normal stress

• fragility #

  • with generalized bone weakness

  • common in old age people

• sudden & excessive external force

  • direct impact: in contact

  • indirect contact: force transmitted

• repetitive stress or loading

  • fatigue / stress #​

​Feel

• swelling & bruising​

• open wounds at / other part)

• deformities (length / angulation / rotation)​

• colour change at distal​

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​Look

​Move

• tenderness (at / surrounding)

• skin temp. (local / distal)

• pulses

• sensation at distal​

• change / loss of normal active movt

• abnormal movt at fragment

• crepitus at # site​

​2. sub-periosteal & endosteal cellular proliferation

• blood contribute various growth factors

​

​1. haematoma

​3. callus formation

• at periosteum & medullary canal, more cells to repair

• with osteoblasts laying down intercellular matrix, soft callus can be formed

• not to take weight at this stage​

​4. consolidation

• osteoblast and osteoclast activity to transform soft callus into hard bone

• start to take weight at this stage​

​

​5. remodalling

• united bone to be strengthened along lines of stress

• extra bone will be absorbed​

​

• ​reduction = to restore the normal alignment

• immobilisation

  • to retain / hold the reduction

  • to promote healing

    • to prevent re-displacement

    • to prevent unwanted movement

    • to relieve pain

    • to control swelling​

• open #

• multiple #

• shaft #

• comminuted #

• pathological #

• associated nerve & vessels damage

• non-union #​

• cannot achieve acceptable alignment with CR

• ​involve articular surface

• complicated with nerve / vessels / extensive soft tissue damage​

​

• multiple injuries with severe bleeding

• extensive soft tissue damage​ requiring repeated access

• infected #​

• severe swelling around # joint​

​

• post-injury symptoms control (swelling / pain)

• promote healing (bone)

• improve physical ability (jt. range​ / muscle control)

• regain functional independence (ambulation / bed mobility)

• handle associated complications​ (nerve injury)

​

​long term

• vascular injuries

  • ischaemia

  • compartment syndrome

• nerve injuries

  • peripheral

  • spinal cord​

• viscera injuries

​

​urgent

• skeletal problem (malunion / nonunion / AVN)

• joint (intraarticular adhesion / OA / stiffness / instability)

• failure of surgery​​ / refracture

• fat embolism syndrome (long bone #)

• complex regional pain syndrome

• myositis ossification