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Distal radial fractures Extra-articular (type A) fractures of the distal radius may displace in a volar or dorsal direction. It is possible to reduce volar displaced fractures (Smith’s fracture) of the distal radius with a closed technique. However, they tend...

Examination An initial general examination, including vital signs and general assessment, should be conducted. Is this an isolated injury or do you need to start right at the beginning, considering the Achilles , the Greek hero, was the son of Peleus and Thet...

FRACTURE HEALING It is useful to review fracture healing, as it relates to treatment and outcome. Following a fracture, bone can heal in two di ff er - ent ways: direct (primary) bone healing or indirect (secondary) bone healing. One can conceptualise direct bo...

FURTHER READING Blom A, Warwick D, Whitehouse M. Apley’s system of orthopaedics and fractures , 10th edn. Boca Raton, FL: CRC Press, 2017. Bone LR, Johnson KD, Weight J, Scheinberg RJ. Early versus delayed stabilization of femoral fractures. J Bone Joint Sur...

Femoral shaft fractures It is possible to treat diaphyseal fractures of the femoral shaft non-operatively . The fracture can be reduced and held in position until union with traction; however, it takes 3 months. This is a long time to be in hospital and carri...

Forearm fractures (radius and ulna) Fractures of the diaphyseal shaft of the radius and ulna are technically , in the anatomical sense of the word, extra-articular. However, the forearm bones work together, being coupled at the proximal and distal radioulna...

Fractures of the proximal humerus In fractures of the proximal humerus consideration is given to the vascularity of the humeral head. The most common classification of the proximal humerus is the Neer classifica tion, which looks at the four individual pieces ...

Heal Time to fracture healing depends on several factors: patient comorbidities, the age of the patient, bone involved (upper limb or lower limb), patient factors (diabetes) and choice of treatment. Well-known factors that slow down bone healing include diabe...

History It is important to ascertain the mechanism of injury and the amount of force involved in the injury . Take time to gather su ffi cient detail in order to do this. The mechanism of injury gives an indication to the clinician of the energy and forces im...

Hold If the fracture fragments are in an acceptable position, or have been reduced into an acceptable position, they then need to be held in that position until they heal. When choosing a method to hold a fracture the aim is to: /uni25CF optimise the biologic...

Humeral fractures Fractures of the diaphyseal portion of the humeral shaft are extra-articular fractures and as such require mechanical alignment. Non-operative treatment with functional bracing will achieve union in an acceptable position within 12 weeks in...

Intra-articular fractures AO type B and type C fractures are intra-articular and as such the principles of treating intra-articular fractures need to be respected; namely , anatomical reduction of the articular surface and rigid stabilisation to allow early j...

Intracapsular femoral neck fractures Intracapsular fractures are further broken down into whether they are displaced or undisplaced. Undisplaced intracapsular fractures are generally stable and interruption of the blood supply to the femoral head is rare. The...

INTRODUCTION In several chapters the importance of life-threatening trauma is emphasised, but numerically for every patient who dies follow ing a traumatic event there are three who are left with a lifelong functional impairment. Extremity trauma can be thoug...

Investigations The mainstay of extremity trauma investigation remains radi - ography of the a ff ected limb to see if there is a bony injury . However, this is not the sole investigation available. - Haematological investigations Simple haematological inves...

Lateral condylar mass fracture of the elbow Lateral condylar mass fractures of the elbow are easily missed and often considered benign as there is often only a small flake of bone visible. This thin sliver of metaphyseal bone on the lateral side of the elbow ...

Learning objectives To gain an understanding of: How to identify whether an injury exists • The important injuries not to miss • The principles of the description and classi /f_i cation of • fractures Learning objectives To gain an understanding of: How to ide...

Metaphyseal fractures In the AO classification metaphyseal fractures are classified into A type – extra-articular, B type – partial articular, and C type – complete articular. In A-type fractures, joint congruity is not an issue and as such the principles of me...