Orthopedic Traum a I have nothing to disclose. David Miller - PDF document

3/7/2018 Orthopedic Traum a I have nothing to disclose. David Miller Memorial Trauma Symposium 2017 James Black, MD Mercy Orthopedic Trauma - Springfield 10/ 27/ 2017 Objectives W hat is Orthopedic Traum a? • What is orthopedic trauma? • The role of the orthopedic traumatologist • Quick review of hip fractures • Lower extremity and pelvis examples W hat is Orthopedic Traum a? Orthopedic surgery subspecialties • Arthroplasty • Spine Orthopedics: • Sports medicine • Shoulder Surgical specialty dealing with • Hand/Upper extremity disorders of the musculoskeletal • Oncology system – bones, muscles, tendons, • Foot/Ankle ligaments… • Trauma 1

3/7/2018 Orthopedic Traum a Orthopedic Traum a  Acute injury to the musculoskeletal system after an accident Orthopedic Traum a Orthopedic Traum a Orthopedic Traum a Orthopedic Traum a 2

3/7/2018 Orthopedic Traum a Orthopedic Traum a Orthopedic Traum a Orthopedic Traum atologist • Acute care management of fractures and musculoskeletal trauma Historically, all orthopedic surgeons are trained in fracture care, so what makes the orthopedic trauma surgeon • Managing injuries in a polytrauma different? patient • Resuscitation, ICU care • Temporary versus definitive fracture fixation • Specialized fixation techniques Orthopedic Traum atologist Orthopedic Traum atologist • Understanding of how MSK injuries, and the required fixation, affects the Fracture Specialist ! mortality and morbidity in a multiply injured patient Take the “worst of the worst” and put • Team player in multidisciplinary them back together to maximize trauma care recovery and future function. 3

3/7/2018 Orthopedic Traum atologist Orthopedic Traum atologist Complex extremity fractures Complex extremity fractures • Peri-articular Orthopedic Traum atologist Orthopedic Traum atologist Complex extremity fractures Complex extremity fractures • Peri-articular • Peri-articular Orthopedic Traum atologist Orthopedic Traum atologist Complex extremity fractures Complex extremity fractures • Peri-prosthetic • Peri-prosthetic 4

3/7/2018 Orthopedic Traum atologist Orthopedic Traum atologist Complex extremity fractures Complex extremity fractures • Open fractures • Open fractures Orthopedic Traum atologist Orthopedic Traum atologist Complex extremity fractures Complex extremity fractures • Segmental or comminuted fractures • Segmental or comminuted fractures Orthopedic Traum atologist Orthopedic Traum atologist Soft tissue injuries Pelvic and Acetabulum Fractures Mangled extremities Traumatic amputations 5

3/7/2018 Orthopedic Traum atologist Orthopedic Traum atologist Pelvic and Acetabulum Fractures Fracture Complications • Nonunion • Malunion/ deformities • I nfection Proxim al Fem ur Fractures Let’s see som e broken bones! The spectrum of hip fractures… 6

3/7/2018 Fem oral Head Fractures Fem oral Head Fractures Fem oral Head Fractures Fem oral Head Fractures Fem oral Head Fractures Fem oral Neck Fractures 7

3/7/2018 Fem oral Neck Fractures Fem oral Neck Fractures Fem oral Neck Fractures Fem oral Neck Fractures The Young Fem oral Neck Fracture The Young Fem oral Neck Fracture 8

3/7/2018 The Young Fem oral Neck Fracture The Young Fem oral Neck Fracture The Young Fem oral Neck Fracture The Young Fem oral Neck Fracture Older patients? Total hip arthroplasty 9

3/7/2018 Hem iarthroplasty I ntertrochanteric Hip Fractures I ntertrochanteric Hip Fractures I ntertrochanteric Hip Fractures I ntertrochanteric Hip Fractures I ntertrochanteric Hip Fractures 10

3/7/2018 I ntertrochanteric Hip Fractures Pelvis and Acetabulum 11

3/7/2018 3 6 yo fem ale, m otorcycle accident Acetabulum Cases 3 6 yo fem ale, m otorcycle accident 12

3/7/2018 7 5 yo m ale, fall off ladder 7 5 yo m ale, fall off ladder 13

3/7/2018 2 9 yo m ale, m otor vehicle accident 2 9 yo m ale, m otor vehicle accident 14

3/7/2018 2 5 yo m ale, m otor vehicle accident Pelvis Cases 2 5 yo m ale, m otor vehicle accident In Binder Pelvic Binder 15

3/7/2018 1 5 yo m ale, peds vs auto 1 5 yo m ale, peds vs auto 16

3/7/2018 3 months postop 3 months postop 3 4 yo m ale, m otorcycle accident 17

3/7/2018 3 4 yo m ale, m otorcycle accident In Binder 18

3/7/2018 4 months postop 4 months postop 4 months postop Other w ays to fix a fem ur… 19

3/7/2018 6 9 yo fem ale, standing level fall 6 9 yo fem ale, standing level fall 20

3/7/2018 6 weeks postop 2 2 yo m ale, GSW to distal fem ur 2 2 yo m ale, GSW to distal fem ur 21

3/7/2018 I&D, bullet removal from quad tendon, ORIF distal femur Tibias! 6 0 yo m ale, m otor vehicle accident 6 0 yo m ale, m otor vehicle accident 22

3/7/2018 s/p In External Fixator 23

3/7/2018 2 0 yo m ale, m otor vehicle accident 2 0 yo m ale, m otor vehicle accident 3 1 yo m ale, fall off balcony 24

3/7/2018 s/p In External Fixator 25

3/7/2018 4 0 yo m ale, MVA polytraum a Not everyone show s up w ith just one fracture… 4 0 yo m ale, MVA polytraum a Right distal tibia facture Right medial femoral condyle fracture 26

3/7/2018 Right tibia Left distal femur, tibial plateau fractures Right tibia Postop Right medial femoral condyle Right medial femoral condyle 27

3/7/2018 Postop Left distal femur and proximal tibia Thanks! Postop 28