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Key Points

  • image The main principle of internal fixation for fracture care (most commonly intramedullary nails or plate and screw fixation) is to create a stable construct that will allow the fracture to heal in proper length, alignment, and rotation.

  • image In open fractures, early administration of intravenous antibiotics is important to avoid infection. An external fixator is used when the wound is grossly contaminated, and definitive treatment of the wound is delayed until the wound is sufficiently clean. Early wound coverage is important.

  • image Early diagnosis and treatment of compartment syndrome is important in order to prevent irreversible damage to the muscles and the nerves, which is time sensitive. Emergency fasciotomy by releasing the tight fascia is a limb-saving procedure.

  • image Fractures of the scapula are typically the result of a high-energy trauma with a high incidence of associated injuries that typically involve the ribs and the lungs.

  • image The shoulder is one of the most commonly dislocated joints, and most dislocations are anterior. Posterior dislocations may be missed and are typically associated with seizures or electric shock. Anterior-posterior and axillary views of the shoulder are necessary for the diagnosis.

  • image Isolated humeral shaft fractures are usually treated conservatively. The radial nerve spirals around the humeral shaft and is at risk for injury; therefore, a careful neurovascular exam is important. The patient should be checked for wrist drop.

  • image Hemorrhage from pelvic trauma can be life-threatening. An important first line of treatment in the emergency department is resuscitation of the patient with fluids, including blood, and the application of a pelvic binder or sheet that is wrapped tightly around the pelvis to control bleeding.

  • image In spinal injury, spinal stability must be assessed, and the patient should be immobilized until there is further understanding of the injury. A computed tomography scan is more reliable in assessing spine injury than plain radiographs.

  • image Spinal cord injuries can be complete or incomplete, and every attempt should be made to avoid further injury. Patients should be triaged to trauma centers since trauma center care is associated with reduced paralysis and improved outcome.

  • image According to the Centers for Disease Control and Prevention and the National Health Interview Survey, approximately 55 million adults have been diagnosed with some form of arthritis. This number is projected to grow substantially in the future.

  • image A combination of nonsteroidal anti-inflammatory medications, physiotherapy, and weight loss with the help of a dietary consultation, and physical therapy are typically the first line of treatment for knee osteoarthritis. Weight loss of as little as 11 lbs (5 kg) has been shown to decrease the risk of developing knee osteoarthritis in women by 50%.

  • image Minimally invasive surgical techniques improve cosmesis and allow for early rehabilitation. However, they may be associated with decreased visualization intraoperatively, associated risks of component malposition, intraoperative fracture, and nerve or vascular injury.


Every physician should be familiar with orthopedics and orthopedic surgery. Anyone who cares for patients in ...

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