Advanced Trauma

Trauma surgery is a surgical specialty that utilises both operative and non-operative management to treat traumatic injuries, typically in an acute setting and normally focuses on the abdominal area along with any given ‘Emergency’ field they may be required to serve upon. Trauma surgeons generally complete residency training in general surgery and often fellowship training in trauma or surgical critical care. The trauma surgeon is responsible for initially resuscitating and stabilising and later evaluating and managing the patient. The attending trauma surgeon also leads the trauma team, which typically includes nurses and support staff as well as resident physicians in teaching hospitals.

Upper Limb

1. Clavicle Fracture :

The clavicle bone is a shape bone that serves as a strut between the shoulder blade and the sternum. Clavicle is the most commonly fractured bone. It is easily fractured due to impacts to the shoulder.

Allman classification for fracture clavicle

Group I -> Middle 1/3 (80%)
Group II -> Lateral 1/3 (12-15%)
Group III -> Medial 1/3 (5-6%)

Treatment options

Conservative management

Figure of 4 bandage
Arm Sling
Clavicle brace

Close Reduction & internal fixation

K wire
TENS
Tension band wire

Open Reduction and Internal Fixation

Anatomical locking plate
1/3 Tubular plate
Reconstruction plate

2. Hamerus :

Hamerus is a long bone in the arm that runs from the shoulder to the elbow. It has a rounded head, narrow neck, two tubercles, the body, shaft and lower end. Any hard blow or injury to your arm can result in a humerus fracture. High impact collisions, Such as a car accident or football tackle can cause distal humerus fracture.

Types

Proximal
Mid-shaft
Distal

Treatment

Conservative : Patient given arm sling & above elbow high slab
Plating : Most of the humerus fracture is treated with open reduction & internal fixation using a locking plate.
External Fixation : In open around injury external fixation done for temporary management.

3. Shaft Radius/Ulna :

The forearm bones also articulate with each other. Proximally, the head of the radius forms a joint with the radial notch of the ulna, and distally, the head of the ulna forms a joint with the ulnar notch of the radius.

Fractures of the forearm can occur at different levels

Distal : Near the wrist end of the bone.
Middle : Middle of the forearm.
Proximal : At top end of bone.

Mode of Injury

They fracture due to direct blow or indirect injury fall on outstretched.

Treatments :

Non Operative

A stable, simple & isolated fracture of ulna can be treated with cast for six weeks.

Surgical Treatments

Close reduction & internal fixation using a rush nail.

Open reduction & internal fixation using plates & screws.

4. Wrist :

Wrist is a complex joint between the five metacarpal bones of hand and radius & ulna bones. Wrist is Composed of eight small bones roughly arranged in two rows.

Wrist Functions

moving hand back of forth & side to side.
Transferring forces from arm to hand.

Wrist pain

It has a number of causes including carpal tunnel syndrome, ganglion cyst, tendonitis, osteoarthritis.

Broken wrist (colles fracture)

Colles’ fractures are very common, they are the most frequently broken bone in the arm.

It is also called “dinner fork deformity”

Cause

Fall on an outstretched arm.

Treatment

Conservative

Splint : Use for initial few day while swelling goes down.
Cast : Applied for 6 to 8 weeks.

Operative

Close reduction Of internal fixation using k wires.
Open reduction & internal fixation using plates.

5. Hand Injury :

The orthopaedic surgeons at Naveli hospital are experts at evaluating, diagnosing, and treating traumatic hand injuries and upper extremity injuries. We use the latest techniques and tools to treat injuries and restore function to each patient’s hand, wrist, arm, or elbow.

The hand and upper extremities are vital for all kinds of everyday activities, both at work and at home. Our goal at Naveli Hospital is to accurately diagnose injuries of the hand, wrist, arm, and elbow and provide personalised care to enable our patients to regain their quality of life as soon as possible.

Lower Limb

1. Hip fracture

What is a hip fracture?

If you have fractured your hip, you have broken the top of your thigh bone, most likely between the main part of the bone and the ball part of the hip socket joint. Sometimes the bones don’t separate after breaking, which makes the fracture hard to diagnose. This is called an occult (hidden) hip fracture.

Hip fractures are more common in older people, particularly those with osteoporosis. Some medications, balance problems and poor vision (leading to trips and falls) increase the risk of hip fractures.

A hip fracture is a very serious condition. It can cause you to be immobile for a long period of time, leading to complications such as blood clots, pneumonia, urinary tract infections, bed sore and loss of muscles. Around half of the people who have a hip fracture can’t return to independent living afterwards.

About one in 5 people who fracture their hip will have another hip fracture within 2 years.

What are the symptoms of hip fracture?

The symptoms of hip fracture are:

severe pain in your groin or front of your hip
being unable to bear weight on the affected leg
swelling, stiffness and bruising of your hip
the affected leg appearing shorter than the other one
being unable to get up after falling

Hip fracture surgery

The type of surgery needed depends on the location and severity of the fracture, and on your general health and age. Options include:

repairing the fracture with metal screws to hold the broken parts together
partial hip replacement, where your surgeon removes the top of the thigh bone including the ball part of the hip socket joint and replaces this with a metal implant (prosthesis)
total hip replacement, where both the ball and the socket part of the hip joint are removed and replaced with prostheses

Rehabilitation starts soon after surgery (usually the next day) to help get you moving and shorten the length of time you are immobile.

2. Distal femoral fractures

What are distal femoral fractures?

A distal femoral fracture is break in the thighbone (femur) just above the knee. Distal femoral fractures occur due to:

weak bones (in older people)
a fall from a height
car/motor bike accidents

What are the symptoms of a distal femoral fracture?

Symptoms of a distal femoral fracture include:

pain, especially when trying to bear weight on the leg
swelling and bruising
deformity (eg the leg may be at an odd angle or appear shorter than the other)
inability to bear weight
inability to move your lower limb
numbness or tingling in your shin, ankle, foot or toes

How are distal femoral fractures treated?

Treatment depends on the severity of the fracture and on your general health and age, which affect your healing ability.

Some fractures will heal with conservative therapy. This typically involves stabilising the placing the leg in a cast or brace and taking pain medications. The cast or splint will usually be worn for 4–6 weeks.

Surgery is usually needed if the bones are displaced. During surgery, the bones are realigned and held together. The bones may be held together with internal pins or nails or screws and plates.

It can take many months of rehabilitation to return to normal activities after a distal femoral fracture.

3. Knee fractures and dislocations

What are knee fractures and dislocations?

A knee fracture is a break (or crack) in any of the parts of the bones that make up the knee joint: the femur (thighbone), the tibia (shin bone) and the patella (kneecap). Because of its location at the front of your knee, the kneecap is the most frequently fractures knee bone. The most common cause is a fall onto the kneecap.

Other parts of the knee may be fractured during car/motor bike accidents, jumping sports, falls from a height and when other injuries happen (eg ACL ligament rupture).

A knee dislocation is a rare injury where the bottom of the thighbone and the top of the shin bone come apart. Due to the strong supportive structures around the knee, this type of dislocation requires a lot of force. It tends to occur during a high-impact trauma such as car or motor bike accident or a severe fall. Note that a knee dislocation is not the same as a patella dislocation, which is a common injury.

What are the symptoms of knee fractures and dislocations?

Symptoms will vary with the location and severity of the fracture or dislocation. Dislocated bones often go back into place by themselves, but the injury tends to cause significant damage to soft tissues, meaning that symptoms remain. General symptoms include:

pain, especially when trying to straighten or stand on the leg
swelling and bruising
deformity
inability to bear weight or move the knee/lower leg

The knee may become very swollen if there is bleeding into and around the joint.

How are knee fractures and dislocations treated?

Treatment depends on the type and severity of your injury, as well as factors such as your age and general health.

The aims of any treatment are to realign the bones, stabilise the joint, preserve blood vessels and nerves and to control pain. Some injuries will be able to be treated conservatively, with casts or splints and pain medication. Other injuries will require surgical treatment.

4. Tibial and fibular fractures

What are tibial and fibular fractures?

Tibial and fibular fractures are breaks in the bones of the lower leg: the tibia and the fibula. Knee fractures are more common in children than in adults tibia (or shin bone) is the major bone in the lower leg and is the one that bears weight. Tibial fractures are typically caused by:

a fall onto the shin (tibial shaft)
a direct blow to the shin bone
violent twisting injuries (eg contact/impact sports)
intense training leading to a stress fracture (eg runners, ballet dancers)

The fibula is well covered by soft tissue, so tends to be protected from direct injury. The vast majority of fibular fractures occur at the same time as the tibial fracture. Fractures of just one of the two bones may occur in children.

Displaced tibial fractures are often complicated by blood vessel and nerve damage.

What are the symptoms of tibial and fibular fractures?

The symptoms of tibial and fibular fractures include:

severe pain immediately after the injury
swelling and bruising soon after the injury and can be severe due to damage to the soft tissues as well as the bones
deformity (eg the lower limb having an odd bend in it or appearing shorter than the other one)
inability to bear weight on the limb
weakness, numbness or tingling in the foot and toes

It is not uncommon for these fractures to be associated with broken bones poking through the skin. This is called a compound fracture.

How are tibial and fibular fractures treated?

Treatment for these fractures depend on which bone is fractured, how severe the fracture, the degree of soft tissue damage and your age and general health.

Most cases in adults require surgery to realign the bones and hold them in place, typically with screws and metal plates. You will generally wear and cast for 6 weeks after the surgery, during which time you won’t be able to bear weight on the leg.

Prompt specialist treatment reduces the risk of complications such as serious/permanent blood vessel and nerve damage, infection and arthritis.

5. Ankle fractures

What is an ankle fracture?

An ankle fracture is a break (or crack) in one or more of the three bones that make up the ankle joint: the tibia, the fibula and the talus. The bony bump on the outside of your ankle is the end of the tibia and the one on the inside is the end of the fibula. The talus is the bone that joins the shin to the foot.

Ankle fractures may involve just the bones or they may involve the joints where bones meet.

Ankle fractures are usually caused by rolling or twisting the ankle during high impact jumping sports or falling.

What are the symptoms of an ankle fracture?

The symptoms of an ankle fracture are:

pain
swelling and bruising
deformity, which may be severe (eg the foot facing in the wrong direction)
inability to stand on the leg
inability to move the foot

In some cases, a piece of broken bone may poke out through the skin. This is called a compound fracture.

How are ankle fractures treated?

Treatment depends on the location and severity of the fracture, as well as your age and general health, which affect your ability to heal.

If the bones are not displaced and the ankle is stable, conservative therapy may be used. This typically involves a cast or splint and pain medication. Surgical treatment is needed for unstable and displaced fractures. Surgery involves realigning the bones and holding them in place with screws and plates. Your ankle is then immobilised in a splint or cast.

You’ll need to keep weight off your ankle for some weeks. Most people manage with crutches, but some may need a wheelchair. Your doctor will also recommend physiotherapy to help restore strength and flexibility to the ankle.

6. Foot and toe fractures

What are foot and toe fractures?

Foot and toe fractures are breaks (or cracks) in one or more of the 26 bones in the foot and toes. Each foot has:

7 tarsal bones where the foot joins the ankle
5 metatarsal bones that make up the main part of the foot
15 phalanges or toe bones

The foot can be divided into three areas:

the hindfoot, which consists of two of the tarsal bones (the talus and the calcaneus, which is the heel bone)
the midfoot contains the rest of the tarsal bones
the forefoot consists of the metatarsals and the phalanges.

There are two main causes of foot and toe factures: high-impact trauma such as a fall from a height or a motor vehicle accident, or overuse leading to a stress fracture.

What are the symptoms of foot and toe fractures?

Symptoms will vary with the location and severity of the fracture. General symptoms include:

pain
swelling and bruising
deformity
inability to bear weight
inability to move the foot or toes

Stress fractures may have more subtle signs.

How are foot and toe fractures treated?

Treatment depends on the location and severity of the fracture, as well as your age and general health, which affect your ability to heal.

If the bones are not displaced, conservative therapy may be used. This typically involves a cast or splint and pain medication. Surgical treatment is needed for unstable and displaced fractures. Surgery involves realigning the bones and holding them in place with screws and plates. Your foot is then immobilised in a splint or cast.