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McRae's Orthopaedic Trauma and Emergency Fracture Management

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McRae's Orthopaedic Trauma and Emergency Fracture Management

Timothy O White | Samuel P Mackenzie | Alasdair J Gray

(2015)

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Additional Information

Book Details

ISBN
978-0-7020-5729-8
Edition
3
Language
English
Pages
464
Subjects
Surgical orthopaedics & fractures
Medical study & revision guides & reference material

Abstract

This book is derived from Ronald McRae’s Pocketbook of Orthopaedics and Fractures, a highly successful ‘survival guide’ for the trainee working in accident and emergency or orthopaedic departments. Retaining the underlying principles of the original editions this comprehensive rewrite and re-presentation provides complete coverage of orthopaedic trauma surgery as relevant to contemporary practice.

  • McRae's Orthopaedic Trauma and Emergency Fracture Management utilises a detailed descriptive and didactic style, alongside a wealth of illustrations all completely redrawn for this book.
  • The first section on general principles in orthopaedic trauma deals with basic terminology and classification, principles of closed and operative management of fractures, infection and complications.
  • The main section provides a regional review of specific injuries, each following a logical sequence describing emergency department and orthopaedic management, and outlining a safe and widely accepted management strategy. Each chapter begins with an overview of the relevant anatomy and principles of the examination of the patient.
  • The book provides a comprehensive overview of both surgical as well as conservative management of orthopaedic trauma injuries.
    • This book is a fully rewritten text based on a classic textbook by Mr Ronald McRae.
    • Now in a larger page size the book contains over 500 illustrations all drawn in two colours for this new edition.
    • Over 250 x-rays accompany the text, many of which are connected with the line drawings to ease interpretation.

    Table of Contents

    Section Title Page Action Price
    Front Cover cover
    Inside Front Cover ifc1
    Half title page i
    Ronald McRae (1926–2012) ii
    McRae's Orthopaedic Trauma and Emergency Fracture Management iii
    Copyright Page iv
    Table Of Contents v
    Preface ix
    Dedications and acknowledgements x
    Contributors xi
    1 General Principles 1
    1 Fractures and fracture management 2
    Orthopaedic terminology 2
    Fracture types and patterns 2
    Aetiology 2
    Traumatic fractures 2
    Pathological fractures (Fig. 1.1) 2
    Insufficiency fractures (Fig. 1.2) 2
    Fatigue (or stress) fractures (Fig. 1.3) 3
    Morphology 3
    Transverse and oblique fractures (Fig. 1.4) 3
    Spiral fractures (Fig. 1.5) 3
    Avulsion fractures (Fig. 1.6) 3
    Impaction fractures (Fig. 1.7) 4
    Paediatric fractures (Fig. 1.8) 4
    Severity 5
    Open fractures (see Fig. 3.1) 5
    Intra-articular fractures (Fig. 1.9) 5
    Comminution (Fig. 1.10) 5
    Joint dislocation (Fig. 1.11) 5
    Fracture-dislocation (Fig. 1.12) 6
    Sprains (Fig. 1.13) 6
    Location (Fig. 1.14) 6
    Displacement 7
    Displacement in length (Fig. 1.16) 7
    Displacement by angulation (Figs 1.17, 1.18) 7
    Displacement by rotation (Fig. 1.19) 8
    Displacement by translation (Fig. 1.20) 8
    Classification systems 10
    AO comprehensive classification system 10
    AO classification of shaft fractures (Fig. 1.22) 11
    AO classification of metaphyseal fractures (Fig. 1.23) 11
    Assessment of a fracture 12
    History 12
    History of injury 12
    Medical and drug history 12
    Social history 12
    Examination 12
    Look 12
    Feel (Fig. 1.24) 13
    Move 13
    Neurovascular assessment 13
    Radiological assessment 13
    Radiographs 13
    Ultrasound 14
    Computed tomography (CT) 14
    Magnetic resonance imaging (MRI) 14
    Aspiration 14
    Blood tests 14
    Principles of fracture management 15
    Reduce 15
    Direct reduction 15
    Indirect reduction 15
    Hold 15
    Stable fractures 15
    Unstable fractures 16
    Move 16
    Bone structure and healing 16
    Bone anatomy (Fig. 1.28) 16
    Fracture healing 17
    Secondary bone healing (healing with callus) (Fig. 1.29) 17
    Primary bone healing (Fig. 1.30) 18
    Assessment of healing 18
    How to present a radiograph 18
    Description of a distal radial fracture 19
    Description of an ankle fracture 19
    Description of a hip fracture 20
    2 Management of the injured patient 21
    Major trauma 21
    The anatomy of the trauma system and team 21
    The trauma system 21
    The trauma team 21
    Primary survey 21
    A – airway with cervical spine control 21
    B – breathing with 100% oxygen 21
    C – circulation with haemorrhage control 21
    Hypovolaemic shock 22
    D – disability 23
    E – exposure 23
    Secondary survey 23
    Tertiary survey 24
    Imaging in trauma 24
    Radiographs 24
    CT 24
    Intravascular fluid replacement in major trauma 25
    Blood 25
    Blood products 25
    Antifibrinolytic drugs 26
    Major haemorrhage protocols and packs 26
    Decision-making in trauma 26
    Response to resuscitation 26
    The lethal triad 26
    Disposition from the resuscitation room 27
    Orthopaedic decision-making: early total care and damage control orthopaedics 28
    Early total care 28
    Damage limitation surgery 28
    Early appropriate care 28
    The stress response to trauma 28
    The ‘second hit’ 29
    Management of the stress response, MODS and ARDS 29
    Anaesthesia and analgesia 30
    Types of anaesthesia 30
    Local anaesthetic agents 30
    Preparation for local anaesthesia 31
    Haematoma block 31
    Technique (Fig. 2.7) 31
    Regional nerve blockade 32
    Sensory nerve supply to the hand 32
    Ring block (digital nerve block) 32
    Technique (Fig. 2.8) 32
    Metacarpal block 33
    Technique (Fig. 2.9) 33
    Ulnar nerve block 33
    Technique (Fig. 2.10) 33
    Median nerve block 34
    Technique (Fig. 2.11) 34
    Fascia iliaca block 34
    Technique (Fig. 2.12) 34
    Regional intravenous anaesthesia 35
    Analgesia 35
    Trauma in the elderly 35
    History of the presenting complaint 35
    Past medical history 36
    Cognitive assessment 36
    Social history 37
    Drug history 37
    Examination 38
    Investigations 38
    Common medical problems 38
    Delirium 38
    Dehydration and electrolyte imbalance 38
    Cardiac dysrhythmias 38
    Myocardial infarction 39
    Infection 39
    Pathological fractures 39
    Postoperative management 39
    Analgesia 39
    Falls and fracture prevention 39
    3 Limb-threatening injuries 40
    Closed soft tissue injuries 40
    Contusion 40
    Haematoma 40
    Swelling 40
    Tenting 40
    Blisters 40
    Degloving 40
    Open fractures 41
    Classification 41
    Emergency Department management 41
    History 41
    Examination 41
    Treatment 42
    Orthopaedic management 42
    Emergency surgery indications 42
    Urgent surgery (<24 hours) indications 42
    Principles of surgery in open fractures 43
    1. Set-up 43
    2. Wound debridement 43
    3. Fracture stabilization 43
    4. Wound closure 44
    5. Repeated inspection and debridement 44
    6. Soft tissue reconstruction 44
    7. Bone defect reconstruction 45
    Compartment syndrome 45
    Aetiology 46
    Emergency Department management 46
    History and examination 46
    Treatment 46
    Orthopaedic management 46
    Pressure monitoring 47
    Technique (Fig. 3.7) 47
    Fasciotomy of the leg (Fig. 3.8) 47
    Neglected compartment syndrome 49
    Crush injuries 49
    Emergency Department management 49
    History and examination 49
    Investigation 50
    Treatment 50
    Orthopaedic management 50
    Nerve injury 50
    Anatomy (Fig. 3.9) 50
    Classification 50
    Neurapraxia 51
    Axonotmesis 52
    Neurotmesis 52
    Emergency Department management 52
    History 52
    Examination 52
    Nerve root levels: upper limb (Fig. 3.14) 52
    Nerve root levels: lower limb (Fig. 3.15) 54
    Nerve root levels: perineum (Fig. 3.16) 54
    Peripheral nerve assessment 55
    Treatment 55
    Fracture displacement/joint dislocation 55
    Indications for urgent senior review 56
    Orthopaedic management 57
    Vascular injury 58
    Emergency Department management 59
    Examination 59
    Treatment 59
    Orthopaedic management 60
    Vascular repair 60
    The mangled limb 60
    Signpost injuries 61
    4 Closed management of fractures 62
    Reduce: closed reduction 62
    Urgent reduction 62
    Definitive reduction 62
    Reduction manœuvres 62
    Disimpaction with traction 62
    Unlocking the fragments by exaggeration of the deformity 63
    Reduction with the aid of the periosteal hinge 64
    Assessment 64
    Positioning for cast application 64
    Hold: principles of cast management 64
    2 Specific Injuries by Region 127
    8 Shoulder girdle 128
    General principles 128
    Anatomy 128
    The clavicle 128
    The scapula 128
    The superior shoulder suspensory complex 129
    The proximal humerus 129
    Clinical assessment of the painful shoulder 129
    History 129
    Examination 130
    Look 130
    Feel (Fig. 8.4) 130
    Move 131
    Neurovascular assessment 132
    Radiological assessment of the painful shoulder 132
    Radiographs 132
    Shoulder trauma series 134
    CT 134
    Clavicle 134
    Classification 134
    Robinson (Edinburgh) classification 134
    Emergency Department management 134
    Clinical features 134
    Radiological features 136
    Closed reduction 136
    Immobilization and reassessment 136
    Inpatient referral 136
    Outpatient follow-up 137
    Patient instructions 137
    Orthopaedic management 137
    Complications of surgery 137
    Indications for surgery 137
    Surgical techniques 137
    Outpatient management 139
    Acromioclavicular joint 139
    Classification 139
    Rockwood classification 139
    Emergency Department management 141
    Clinical features 141
    Radiological features 141
    Closed reduction 141
    Immobilization and reassessment 141
    Inpatient referral 141
    Outpatient follow-up 141
    Orthopaedic management 141
    Non-operative 141
    Operative 141
    Surgical techniques 141
    Acromion fixation 141
    Coracoid fixation 142
    Outpatient management 142
    Sternoclavicular joint 142
    Classification 142
    Emergency Department management 143
    Clinical features 143
    Radiological features 143
    Closed reduction 143
    Immobilization 143
    Outpatient follow-up 143
    Inpatient referral 143
    Orthopaedic management 143
    Non-operative 143
    Operative 143
    Scapula 144
    Classification 144
    Ideberg classification 144
    Emergency Department management 145
    Clinical features 145
    Radiological features 145
    Closed reduction 145
    Inpatient referral 145
    Outpatient follow-up 145
    Orthopaedic management 145
    Operative 145
    Surgical approach 145
    Scapulothoracic dissociation 145
    Emergency Department management 146
    Clinical features 146
    Radiological features 146
    Immobilization 146
    Inpatient referral 146
    Orthopaedic management 146
    Anterior shoulder (glenohumeral) dislocation 146
    Anatomy of shoulder stability 146
    Static stabilizers 146
    Dynamic stabilizers 147
    Pathoanatomy of shoulder instability 147
    Emergency Department management 148
    Clinical features 148
    Radiological features 148
    Closed reduction 149
    Kocher’s technique (Fig. 8.21) 149
    Hippocratic method (Fig. 8.22) 150
    Milch’s technique (Fig. 8.23) 150
    Stimpson’s technique (Fig. 8.24) 150
    Immobilization and reassessment 150
    Inpatient referral 151
    Outpatient follow-up 151
    Patient instructions 151
    Orthopaedic management 151
    Non-operative 151
    Operative 151
    Urgent surgery 151
    Planned surgery 151
    Late presentation 152
    Posterior shoulder dislocation 152
    Emergency Department management 152
    Clinical features 152
    Radiological features 152
    Closed reduction (Fig. 8.28) 153
    Immobilization and reassessment 153
    Inpatient referral 154
    Outpatient follow-up 154
    Patient instructions 154
    Orthopaedic management 154
    Non-operative 154
    Operative 154
    Urgent surgery 154
    Surgery within 48 hours 154
    Planned surgery 154
    Inferior shoulder dislocation (luxatio erecta) 155
    Emergency Department management 155
    Clinical features 155
    Radiological features 155
    Closed reduction (Fig. 8.30) 155
    Immobilization and reassessment 155
    Inpatient referral 155
    Outpatient follow-up 155
    Patient instructions 155
    Orthopaedic management 156
    Rotator cuff tears 156
    Emergency Department management 156
    Clinical features 156
    Index 611
    A 611
    B 612
    C 613
    D 615
    E 617
    F 617
    G 620
    H 621
    I 622
    J 623
    K 623
    L 623
    M 624
    N 625
    O 626
    P 626
    Q 628
    R 629
    S 630
    T 632
    U 634
    V 634
    W 635
    Y 635
    Back Cover backcover

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