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Orthopaedic Trauma and Emergencies

Orthopaedic emergencies include fractures, dislocations, and joint infections. In the event of traumatic events such as a fall, one may be unable to engage in physical activity, or only able to walk with a limp. Walking with a limp may be a sign of a possible fracture which needs urgent assessment. Musculoskeletal trauma is a form of orthopaedic trauma and occurs as a result of musculoskeletal injuries that are injuries to the bone, tendon, muscle and ligaments. Fractures, sprains and dislocations can cause musculoskeletal pain or joint pain. Arthritis, bursitis, and tendinitis are common forms of musculoskeletal trauma and include symptoms of joint pain, stiffness and swelling.

What are the signs of a fracture?

Signs of fractures include pain, swelling, sudden deformity, an inability to use the limb as one did before the traumatic event. Severe multiple trauma victims are often found in motor vehicle accidents, especially those on motorcycles. When these occupants experience injuries to more than one long bone, they are termed "polytraumaquot; patients. Depending on the severity and the number of injuries, they may first require "damage control surgery" to temporarily stabilise their fractures while they recover in ICU. This fracture management allows for later definitive fixation after thorough planning while the patient recovers in ICU. These patients are often too unwell to allow for lengthy operations and definitive fixation immediately following polytrauma.

A hip fracture can have life-threatening consequences for people over the age of 65. Bones likely weaken as the risk of falling increases with age, leading to a break in the upper part of the thigh bone known as a hip fracture. Arthritis and bursitis are common hip injuries. Inability to walk, severe hip pain and bruising around the hip area are all symptoms of a hip fracture. Bone healing or fracture healing is a physiological process that helps with the repair of a bone fracture. Fracture treatment involves the application of splints, braces, plaster casts, traction and the surgical insertion of metal rods and plates to hold pieces of the bone together.

bone fractures

What does "damage control orthopaedics" involve?

In certain instances, the orthopaedic injuries take place over the head, chest, and abdominal injuries, which need treatment first to ensure survival. Damage control orthopaedics often involves the insertion of intramedullary metal rods/devices in long bones called "nails". Other options include external fixations which consist of external rods and clamps which are attached externally to the bone via pins which are drilled into the bone itself. They are most often used for open fractures. Open fractures occur in the presence of a wound which communicates with the fractured bone ends. This wound allows potentially dangerous bacteria to gain entry to the body and bones and may result in severe infection and osteomyelitis. Emergency cleaning and decontaminating of the wound with stabilisation of the fracture is required to reduce the chances of complications. Some polytrauma victims may sustain a fracture of the pelvis which connects the legs to the abdomen and body. These patients often require external fixation of the pelvis to reduce internal bleeding. Other pelvic injuries include fractured hip sockets (acetabular fractures) and hip fractures (proximal femur fractures). The treating orthopaedic surgeon will recommend fixation or replacement depending on many factors, including the fracture pattern.

What other forms of trauma can occur?

Other simpler forms of musculoskeletal trauma like ankle and wrist fractures, may require surgery to put the bone pieces back into place, before fixing them with small screws and plates made of high-tech metals. None of the implanted materials in orthopaedics rust and most may be left in the body permanently without further or later complication. Since the metal is deep within the body, metal detectors like those in airports, will not alarm. Although fractures may be fixed with surgery, this does not mean that they are healed. Bones still take between 6 to 12 weeks on average to unite, open fractures and severe musculoskeletal trauma may sometimes take longer. After the bone fuses, most people return to their previous activities and sports.

Not all traumatic injuries are fractures. Sometimes a joint may move out of its regular place and become dislocated. Most often, it involves the shoulder. When this happens, a medical practitioner needs to replace the joint in position as soon as possible to prevent further complications.

x-ray    x-ray

What causes joint infections?

Joint infections occur when bacteria travel through the bloodstream, or a wound, into a joint. A joint infection leads to bacterial infection symptoms of pain, swelling, fever at times, and the inability to move the limb. A bacterial infection is an emergency, as joint infection leads to the production of enzymes that destroy cartilage – the joint lining. A joint infection may result in severe stiffness and arthritis if not urgently treated by surgery to open the joint and wash out the infected material and bacteria, together with the administration of intravenous antibiotics.

Fungal arthritis is a type of fungal infection that is caused by the spread of fungus through the bloodstream. Pain, heat, swelling, redness and reduced range of motion are fungal infection symptoms. A hospital infection as a result of surgery or puncture from a drug injection near the joint will increase the chances of the development of a bacterial infection. Surgical debridement is the removal of infected tissue to improve the healing potential of the remaining healthy tissue. The debridement procedure is used to treat septic arthritis caused by fungal, viral or bacterial infections. Surgical debridement aims to reduce the bacterial or fungal load within the joint. Joint infections are most often seen in children and those with weak immune systems.

child hip septic

DR PREYEN NAIDU

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Netcare Blaauwberg Hospital,
Waterville Crescent
Sunningdale,
Cape Town
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