Common Adult Orthopaedic Injuries
General Rules about Fractures
1- When you suspect a fracture, order 2 views at 90° to one another and always include the joints
above and below the broken bone.
2- Always x-ray other sites “in the line of force” (e.g., lumbar spine for someone who falls and lands
on the feet, hips in a patient who has been in a motor vehicle accident with force of knees against the
dashboard).
3- Closed reduction is the answer for fractures that are not badly displaced or angulated.
4- Open reduction and internal fixation is the answer when the fracture is severely displaced or
angulated or cannot be aligned.
5- Open fractures (the broken bone sticking out through a wound) require cleaning in the OR and
reduction within 6 hours from the time of the injury.
6- Always perform cervical spine films in any patient with facial injuries.
7- Always worry about gas gangrene in any deep penetrating or dirty wounds. Three days later, the
patient will be septic with a tender, swollen injury site with gas crepitus. Treatment is large doses of
IV penicillin and hyperbaric oxygen.
Fractures
There are 5 main types of fractures, all of which present with pain, swelling, and deformity.
- Comminuted fractures: a fracture in which the bone gets broken into multiple pieces
• Most commonly caused by crush injuries - Stress fractures: a complete fracture from repetitive insults to the bone.
• Most common stress fracture is of the metatarsals.
• describe an athlete with persistent pain.
• X-ray does not show evidence, so a CT or MRI must be conducted in order for diagnosis.
• Treatment is with rehabilitation, reduced physical activity, and casting.
If persistent, surgery is indicated. - Compression fractures: a specific fracture of the vertebra in the setting of osteoporosis
• Approximately one-third of osteoporotic vertebral injuries are lumbar, one-third are thoracolumbar,
and one-third are thoracic in origin. - Pathologic fracture: a fracture that occurs from minimal trauma to bone that is weakened by disease
• Metastatic carcinoma (e.g., breast or colon), multiple myeloma, and Paget disease are a few
examples of diseases that cause brittle bones.
• An older person fractures a rib from coughing.
• Treatment is surgical realignment of the bone and treatment of the underlying disease. - Open fracture: a fracture when injury causes a broken bone to pierce the skin
• An open fracture is associated with high rates of bacterial infection to the surrounding tissue
• Surgery is always the right answer