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MrAnjan K Banerjee
A Cook’s Tour
 Fractures


 Infection


 Back Pain & Sciatica


 Complications
Fractures
   Hand/Wrist
   Forearm
   Elbow
   Humerus
   Shoulder
   Foot
   Ankle/Tibia
   Knee
   Femur
   Hip
   Spine
Wrist & Hand
 Colles
 Smith’s
 Barton’s
 Perilunate dislocation
 Metacarpals
 Fingers
Fingers
Metacarpal
Metacarpal
Scaphoid
Scaphoid
Perilunate




             Capitate   lunate
Colles
Barton’s
Styloid
Forearm
                         Radial styloid




Isolated ulna #          Radial head
“Nightstick #”
From a direct blow to
the mid forearm.
(Night stick is an old
name for a police
truncheon)
Galeazzi #




             Needs ORIF
Monteggia #

Radius should line
up with the
capitellum.

“MonteggiaMore
Medial” (than
Galezzi) (if patient’s
arms where sticking
out)

                         Capitellum
Supracondylar fractures


Gartland I & II
Gartland II & III
Ankle – Images I should not see
Ankle – Images I should not see
Cervical Spine
 Canadian Rules.


 Always Consider the mechanism.
Cervical Spine
Remember Collar & Blocks
Lumbar Spine
Direct Axial Compression
Thoracic Spine
Salter-Harris



 S Slipped SH1
 A Above SH2
 L beLow SH3
 T Through SH4
 ER er, the mnemonic falls apart. Squashed SH5
 Usually worse as you go down the list.
Extracapsular Hip Fractures
aka Proximal Femoral Fractures
Intracapsular Hip Fractures
Management
 Assessment.


 Analgesia.


 Immobilize Limb (Where Possible).


 Be Aware of the Risk of Compartment Syndrome.
Open Fractures
 Tetanus.


 IV Augmentin/ Cefuroxime.


 Blood Loss?
Infection – Septic Arthritis
 Fever including Rigors/ Swinging Fever.


 Pseudoparalysis / unable to move joint due to pain.


 Hot swollen tender joint.


 Can affect any joint.
Infection - Ix
 FBC, CRP, Blood Cultures & Aspirate.


 X-rays.


 ESR/ Plasma viscosity.


 Urate
Infection - Pitfalls
 Psuedo/ GOUT.


 Transient Synovitis.


 Implants.
Cellulitis
 Upper limb & Hand.


 Lower Limb & Foot.


 Peripheral arterial foot problems – Gen Surg.


 Diabetic Foot with microvascular disease – Gen Surg
 then Ortho.
Tendons
 Tendo-Achilles/ Calf Tear.
    TA may require surgery (or cast in dorsal slab or full
     equinus cast)

 EPL/FPL.

 Quadriceps.

 Hamstrings.
Back Pain & Sciatica
 Red Flags
    Cancer, steroids, IVDU, weight loss, fever, night pain,
     age > 50, significant trauma, pain worse on lying down.


 MRI/ X-ray?


 Treatment.
Not All Back pain is Like This!
Complications


 DO NOT TREAT PERIPROSTHETIC INFECTION
 IN THE COMMUNITY!
Complications
 Fractures in POP can still displace


 Re-X-ray after applying a cast with Manipulation.


 Re-Xray if represents with increasing pain.


 If metal in-situ, Re-X-ray & Inflammatory markers.
Not All Ortho Registrars
     are like this!
Questions?
Tibial plateau
 Sometimes difficult to see
 fracture line
   May just have one plateau lower
    than the other or
   One plateau wider than the
    femur
   Typically from a blow to the
    lateral knee eg from a car
    bumper
   Tender over proximal tibia.

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Orthopaedics for the emergency department