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Olecranon fractures Olecranon fractures may be displaced or undisplaced. Undisplaced fractures with <2 /uni00A0 mm gap or step at the articular surface can be treated non-operatively . In displaced fractures the extensor mechanism is interrupted and the articu...

Open fractures Any fracture with an overlying wound should be considered an open fracture. The term previously used was a compound fracture. Open fractures require particular mention because adequate stabilisation of the bony injury and appropriate managemen...

Osteoporotic fractures Osteoporosis is a condition characterised by low bone mineral density and reduced strength. Osteoporotic bone is liable to fracture with low-energy injuries (e.g. a fall from standing height). Treatment of lower limb osteoporotic fractu...

Patellar fractures Similar to olecranon fractures, undisplaced fractures in which the extensor mechanism is intact can be treated non-operatively . - A simple assessment of this is if the patient can straight leg raise to test the extensor mechanism, but bew...

Pathological fractures When abnormal bone fails under normal load this is referred to as a pathological fracture. Depending on the cause of the pathological fracture the bone may not heal and consideration should be given to a load-bearing device not load-sha...

Peripheral nerve injury Seddon classified nerve injuries into neurapraxia, axonotmesis and neurotmesis: /uni25CF Neurapraxia – no loss of nerve sheath continuity or periph eral Wallerian degeneration. If the pressure is removed from the nerve, recovery potent...

Proximal femoral fractures The blood supply to the femoral head is a prime consideration in treating femoral neck fractures. The blood supply comes via the hip capsule and although vascular anatomy is variable - it is chiefly through the medial and lateral bran...

Reduce The first thing to consider is the degree of displacement of the fracture fragments. It is useful to ask the following question: if the bone were to heal in this position, would it be compatible with optimum function in the short and long term? In gener...

SPECIAL CONSIDERATIONS Special consideration needs to be given to osteoporotic and pathological fractures, for example the ability to hold the frac ture until union. Furthermore, open fractures require urgent appropriate treatment to ensure bone healing in the...

SPECIFIC PAEDIATRIC INJURIES Distal radial fractures Fractures of the distal radius are very common in children. The bone either fails at the physis, leading to Salter–Harris type 2 fractures of the distal radius, or the metaphysis fails. The treatment princ...

SPECIFIC PAEDIATRIC INJURIES Distal radial fractures Fractures of the distal radius are very common in children. The bone either fails at the physis, leading to Salter–Harris type 2 fractures of the distal radius, or the metaphysis fails. The treatment princ...

Slipped upper femoral epiphysis A slipped upper femoral epiphysis classically occurs in a child approaching puberty . It is easily missed as symptoms may be mild and the predominant symptom may be knee pain referred from the hip. A history of trauma may be o ...

TO TOE) Scaphoid fracture The blood supply to the scaphoid enters distally and supplies the scaphoid in a retrograde fashion. As such, a displaced waist of scaphoid fracture interrupts the blood supply to the proximal pole, leading to avascular necrosis. An u...

TREATMENT BY FRACTURE LOCATION In general, the principles of treatment described above are dependent on the fracture location: diaphyseal, metaphyseal and intra-articular. Table 32.11 outlines some indications for operative stabi - lisation. TREATMENT BY FRAC...

TREATMENT OF FRACTURES IN THE SKELETALL Y IMMATURE The treatment principles that were described for the adult are equally applicable to the child (i.e. reduce, hold, heal, rehabilitate). A major di ff erence to consider is that in extra-articular fractures ther...

TREATMENT The main principle of extremity fracture management builds on the classical concept of reduction and stabilisation of the fracture. Treatment can be considered under the following headings (see Apley’s system of orthopaedics and frac - tures [Furt...

Talus fracture The talus consists of a head, neck and body . The most common injury is a talar neck fracture. This is caused by forced dorsiflexion of the forefoot (aviator’s astragalus). The blood supply to the body of the talus is interrupted in displaced ...

Tarsometatarsal (Lisfranc) joint injuries Injuries to the midfoot are associated with significant morbidity ranging from a midfoot sprain to complete rupture of the liga - ments connecting the forefoot to the midfoot. Injury classically follows forced plantar...