JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications...
-
Upload
treyton-sheldon -
Category
Documents
-
view
218 -
download
3
Transcript of JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications...
![Page 1: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/1.jpg)
JMS
August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and
Workshop
Complications in Orthopaedic Trauma
Michael S. Bongiovanni, M.D.
Scripps Mercy Hospital
San Diego, California
August 4, 2012
![Page 2: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/2.jpg)
JMS
Disclosures-none
Thanks=AONA archives and Jeff Smith, MD
![Page 3: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/3.jpg)
JMS
Objectives
1. Recognize goal in Orthopaedic Trauma decision making is prompt diagnosis and treatment of musculoskeletal injuries
2. Post-operative mobilization3. Discharge planning needs4. Describe different weight bearing types5. Case examples-discussion6. Concept changes7. Ortho technologist importance
![Page 4: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/4.jpg)
JMS
Orthopaedic Emergencies
1. Open fractures/joints
2. Unstable pelvis injuries
3. Compartment syndrome
4. Injuries with neurovascular compromise
5. Certain infections
![Page 5: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/5.jpg)
JMS
But I have a full office!
![Page 6: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/6.jpg)
JMS
Patient Evaluation
ATLS approach
ABCDE
Systematic
Team approach
Other injuries
![Page 7: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/7.jpg)
JMS Orthopaedic trauma diagnosis
1. History
2. Physical exam
3. Studies-xrays, CT scans, and/or MRI
![Page 8: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/8.jpg)
JMS
Patient Factors
Age
Mech of injury
Assoc. injuries
comorbidities
![Page 9: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/9.jpg)
JMS
Mechanism of Injury
Patient hx
Paramedic hx
Scene description
Witnesses
![Page 10: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/10.jpg)
JMS
Physical Examination
Begins with ATLS primary survey
AirwayBreathingCirculationDisability (neurological)Exposure(undress)
![Page 11: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/11.jpg)
JMS
Open Fractures
![Page 12: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/12.jpg)
JMS
New concepts
-timing to Or?
-antibiotic length
-negative pressure wound therapy
![Page 13: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/13.jpg)
JMS
Type I
![Page 14: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/14.jpg)
JMS
Type II
![Page 15: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/15.jpg)
JMS
Type III
![Page 16: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/16.jpg)
JMS
Open Fracture: Type IIIA
Significant soft tissue injuryMuscle coverage of bone
unnecessarySTSG over muscle7% Infection Rate
![Page 17: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/17.jpg)
JMS
Open Fracture: Type IIIB
Significant soft tissue loss
–Requires Soft Tissue Coverage
–10–50 % Infection Rate
![Page 18: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/18.jpg)
JMS
Open Fracture: Type IIIC
Associated vascular injury that requires repair for limb salvage
25-50% Infection Rate ?
50 % Amputation Rate ?
![Page 19: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/19.jpg)
JMS
Identify Associated Injuries
What other interventions does the patient need?
What degree of extremity intervention will the patient tolerate?
![Page 20: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/20.jpg)
JMS
First aid: pre-hospital care
Emergency room care-ortho tech
Operating room: definitive care-ortho tech
Rehabilitation-ortho tech
Management Stages
![Page 21: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/21.jpg)
JMS
Control bleeding/ open woundDirect pressureCover wound with sterile
dressingtourniquets
Realign and splint decreases further soft tissue
damage and neurovascular compromise
comfort
First Aid
![Page 22: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/22.jpg)
JMS
First aid if not already given
Remove gross debris/ irrigate/dress/image/ splint
Tetanus prophylaxis - if necessary
Antibiotics!!!!!!!!!!!!!!
Emergency
![Page 23: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/23.jpg)
JMS
Open Fracture Management
Open fractures go to the OR
For a formal debridement
Followed by stabilization of the fracture
Continuation of IV antibiotics for treatment not prophylaxis
![Page 24: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/24.jpg)
JMS
Debridement
Layer by layer
Remove all devitalized and contaminated tissue (including bone)
![Page 25: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/25.jpg)
JMS Fracture Stabilization: Why?
Limb:Prevents further soft tissue injuryAllows mobilization of the involved limb for
dressing changes/ wound checks on the floor
Patient:Reduces painLong bone stabilization decreases
activation of the immune system/ inflammatory cascade
Allows mobilization of the patient
![Page 26: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/26.jpg)
JMS Temporizing or Definitive: VAC
-125 mm Hg pressure applied to an open cell sponge
Stimulates cell division and blood vessel in-growth
Sealed system placed in OR
Can be used to shrink wound size
![Page 27: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/27.jpg)
JMS
Wound Closure/CoverageOptimally by 3-7 days
Principles1 Durable coverage2 Well vascularized
soft tissue envelope
for bone3 Fill dead space
![Page 28: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/28.jpg)
JMS
Amputation vs Limb Salvage
![Page 29: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/29.jpg)
JMS
Factors Favoring Amputation
Warm ischemia time > 8 hrs
Severe crush
Chronic debilitating disease
Severe polytrauma (life before limb)
Mass casualty Complexity of reconstruction
![Page 30: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/30.jpg)
JMS
![Page 31: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/31.jpg)
JMS
New Concepts
-seeing more GSW
-similar principles
-rapid rehab
![Page 32: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/32.jpg)
JMS The ProblemDeaths from Firearms increased
60% since 1968.
For every death there are 3 Non-Fatal Injuries.
80% of the cost is paid by the Taxpayers.
![Page 33: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/33.jpg)
JMS
Antibiotics and Tetanus Prophylaxis
same as Open Fractures
![Page 34: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/34.jpg)
JMS Internal vs External Fixation
Low / High / ShotgunClose Range.Pts. General Condition.Soft Tissue Injury.Fracture Pattern.
![Page 35: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/35.jpg)
JMS Fxs. With Vasc. Injury
Shunt the Artery.
Irrigation and Debridment.
Definitive Fracture Fixation.
Final Vascular Repair.
![Page 36: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/36.jpg)
JMS
![Page 37: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/37.jpg)
JMS
![Page 38: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/38.jpg)
JMS
Unstable Pelvis Fractures
![Page 39: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/39.jpg)
JMS
In trauma center, 13-18% of pelvic injury patients present with unstable, high energy injuries
Associated injuries Mortality High rate of early and late morbidity
![Page 40: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/40.jpg)
JMS
Open Pelvic Fracture
Aggressive debridement of open wounds
Colostomy / urinary diversion nearly always
![Page 41: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/41.jpg)
JMS New Concepts
-less traction
-early mobilization
-minimally invasive surgical techniques
-binders/pelvis sheets
![Page 42: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/42.jpg)
JMS
Pelvis binder
![Page 43: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/43.jpg)
JMS Pelvic Binder
![Page 44: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/44.jpg)
JMS
Binder
![Page 45: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/45.jpg)
JMS
High Energy Injury Assessment
Beware of Associated Injuries
More extensive exam in polytrauma
Thorough distal neurovascular exam
![Page 46: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/46.jpg)
JMS
Associated Injuries
Massive energy input required to cause unstable pelvic injuries
Energy causes injuries to other organsHeadChestAbdomen
![Page 47: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/47.jpg)
JMS
Associated Injuries
Major vascular, neurological, gastrointestinal, and genitourinary structures pass through pelvis
Frequently involved with pelvic injuries
![Page 48: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/48.jpg)
JMS
Physical
Musculoskeletal Pelvic Exam
Inspection
Palpation
Function (Stability)
![Page 49: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/49.jpg)
JMS
Radiographic Evaluation
![Page 50: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/50.jpg)
JMS
Reduction and stabilization of pelvic ring
Emergent external fixation
• Decreases intrapelvic volume
• Minimizes motion at fracture site
• AP pelvis to determine if injury amenable to external fixation
Emergent Management
![Page 51: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/51.jpg)
JMS
Emergent Management
Open Surgery
Primarily reserved for failure to respond to ex fix or angiography
Occasionally coincident with emergent ex lap
Open packing usually preferred over ligation
![Page 52: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/52.jpg)
JMS
Early Management
Temporizing measures
External fixation
Binders/sheets
Longitudinal traction distal femur
• Very important with vertical shear injury
![Page 53: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/53.jpg)
JMS
External Fixation
-resusitation
-temporary
-definitive
-”damage control”
![Page 54: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/54.jpg)
JMS
O R I F
Symphysis
![Page 55: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/55.jpg)
JMS
ORIF
Iliac Fracture
![Page 56: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/56.jpg)
JMS
Compartment Syndrome
1. Elevated compartment pressure
2. Painful!!
3. Early diagnosis
4. Early treatment
5. Examples
![Page 57: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/57.jpg)
JMS
Compartment syndrome
1. Neurovascular exam
2. Possible pressure measurements
3. Surgical decompression
![Page 58: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/58.jpg)
JMS
Neurovascular exam
1. circulation-motor-sensory
2. Pulses-palpation or doppler
3. Capillary refill-nl less than 2 seconds
4. Sensation-present, diminished, absent
5. Motor-specific movement-present, diminished, or absent
![Page 59: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/59.jpg)
JMS
Compartment syndrome
1. Pain out of proportion
2. Pain with passive stretch
3. Paresthesias,(sensory changes)
4. Paralysis,(weakness)
5. Pulse(usually present, absent late finding)
![Page 60: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/60.jpg)
JMS
Compartment Syndrome
1. Loosen dressing, splints, wraps
2. Bivalve cast down to skin
3. Elevation controversial
4. Emergency notify surgeon
![Page 61: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/61.jpg)
JMS Deep Venous Thrombosis-prevention
1. ambulation-out of bed
2. Pharmacology-heparins/coumadin
3. Mechanical devices( SCD’s/Foot pumps)
4. IVC filter can help prevent PE in high risk patient
![Page 62: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/62.jpg)
JMS Deep Venous Thrombosis-diagnosis
1. leg and/or chest pain2. Fever3. Tachycardia4. Leg swelling(unilateral)5. Doppler ultrasound6. Chest CT scan7. Pulmonary angiogram
![Page 63: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/63.jpg)
JMS Deep Venous Thrombosis-treatment
1. Medical-heparin infusion-coumadin
2. Mobilization
3. Further surveys
![Page 64: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/64.jpg)
JMS Orthopaedic trauma-treatment
1. Age2. Other injuries3. Injury pattern4. Soft tissue injury5. Osteopenia6. Comorbidities7. Activities of daily living
![Page 65: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/65.jpg)
JMS Orthopaedic trauma-treatment
1. Closed,(cast,splint,brace)
2. Open,(plates/screws, external fixation, intramedullary implants, joint prosthesis, and/or pins)
3. Therapy-mainstay for recovery
![Page 66: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/66.jpg)
JMS
Casting
-fiberglas/plaster
-short/long/muenster/PTB
-molding
-Neurovasc check
-xray check
-listen to your patient
![Page 67: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/67.jpg)
JMS
Skin Traction
1. Example Buck’s traction
2. Comfort
3. Minimize further injury
4. Hip and knee dislocation
5. Hip fractures
6. 5-10 lbs.
7. Helpful?
![Page 68: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/68.jpg)
JMS
Skeletal Traction
1. Weight directly thru bone
2. Pelvis fractures, dislocations
3. Acetabular fractures
4. Femur fractures
5. External fixation
6. Temporary versus definitive
![Page 69: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/69.jpg)
JMS
Pre-op Planning
Minimize OR time
Minimize blood loss
Proper equipment
Minimize exposure
![Page 70: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/70.jpg)
JMS
Pre-op Planning
Table/position
C-arm
Equipment
Implants
![Page 71: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/71.jpg)
JMS
The Tools
Radiolucent table
C-arm
Pelvic reduction clamps
Pelvic instruments
Oscillating drill
• 3.5 mm / 4.5 mm pelvic reconstruction plates
• Large and small fragment screws
• 7.3 mm fully and partially threaded cannulated screws
• Large external fixator
![Page 72: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/72.jpg)
JMS
ORIF
Indications
Presence of significant associated injuries (Polytrauma)
![Page 73: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/73.jpg)
JMS
ORIF
Complications
Infection (4%)
Loss of reduction / fixation (5%)
DVT / PE (4%)
Nerve palsy (3%)
Matta, Tornetta 1982 -1991
![Page 74: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/74.jpg)
JMS
Post-Op Management
Stable fixation
Early mobilization
Weightbearing as tolerated unaffected side
Non or partial weightbearing affected side 8 - 12 weeks
![Page 75: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/75.jpg)
JMS
Post-Op Management
Unstable or incomplete fixation
Bedrest
Longitudinal traction on unstable side
Duration individualized, but caution to avoid deformity
Non-weightbearing 3 months
![Page 76: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/76.jpg)
JMS Weight bearing-lower extremities
NWB-non weight bearing
TDWB-touch down weight bearing
PWB-partial weight bearing(% or lbs.)
FWB-full weight bearing
WBAT-weight bear as tolerated
![Page 77: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/77.jpg)
JMS
Weight bear examples
Joint fractures-TDWB
Hip hemiarthroplasty-WBAT
Femur/Tibial shaft IM nails-TDWB-WBAT
Joint dislocations-TDWB-WBAT
![Page 78: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/78.jpg)
JMS Weight bearing upper extremity
Full, partial, or non-weight bearing
Platform crutches/walker
Casting
Splints
Bracing
![Page 79: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/79.jpg)
JMS
A Team Approach
![Page 80: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/80.jpg)
JMS
RK
43 yo male
Fell 40 feet from tree
ETOH
Combative,confused
Bone sticking out of thigh
![Page 81: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/81.jpg)
JMS
RK
Moving all four extremities
Rapid sequence intubation(airway control)
Hemodynamic stable
Past history negative-possible psych issues
![Page 82: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/82.jpg)
JMS
Closed Head Injury
Small Subdural Hematoma
![Page 83: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/83.jpg)
JMS Distal Femur SC/IC fracture open
5 cm lateral wound
![Page 84: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/84.jpg)
JMS
Distal Femur Fracture
![Page 85: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/85.jpg)
JMS
Distal Femur Fracture
![Page 86: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/86.jpg)
JMS Distal Radius Fracture, closed
![Page 87: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/87.jpg)
JMS
Treatment
Femur sterile dressings, hare traction splintAntibiotics(Cephalosporin, aminoglycoside)Tetanus toxoidRapid completion CT scansImmediate Neurosurgery consultationTo operating room, emergently for DCONS-’rapid ortho procedure so early repeat head ct
scan done’
![Page 88: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/88.jpg)
JMS
Debridement
![Page 89: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/89.jpg)
JMS
Intraop
![Page 90: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/90.jpg)
JMS Images
![Page 91: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/91.jpg)
JMS
Post-op
IV ABS, dressing changes, resuscitation
Head CT stabilized
Definitive treatment at 96 hours-
Wound re-debride, distal femur LISS, wound closure over drain
Wrist external fixation and pinning
![Page 92: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/92.jpg)
JMS Helpful Orthopaedic information
1. Npo status
2. Pain scale
3. Vital signs
4. Surgical drainage amount
5. Neurovascular exam
6. Labs –most recent
![Page 93: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/93.jpg)
JMS
Discharge planning
1. Begins immediately
2. Home, SNF, Rehab, Hospice
3. Team approach,(Nursing, orthopaedist, ortho tech, therapist, case manager, patient/family)
4. Resources/managed care
![Page 94: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/94.jpg)
JMS
QUESTIONS?
![Page 95: JMS August 2012 ASOPA/NAOTOrthopaedic Technologists Symposium Conference and Workshop Complications in Orthopaedic Trauma Michael S. Bongiovanni, M.D.](https://reader038.fdocuments.in/reader038/viewer/2022103111/5516951a550346f0208b482e/html5/thumbnails/95.jpg)
JMS