++
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 alignment.
Often, in open fractures, definitive treatment of the fracture is delayed until the wound is sufficiently cleaned and healthy soft tissue is available to cover the fracture.
When compartment syndrome is suspected, emergent fasciotomy must be performed in which the overlying tight fascia is released through long incisions. These must be done as soon as possible because the damage to muscles and nerves will result in irreversible necrosis and contractures causing severe loss of function.
Fractures of the scapula often result from significant trauma and can be associated with injuries to the head, lungs, ribs, and spine.
The shoulder is one of the most commonly dislocated joints and most dislocations are anterior. Posterior dislocations are associated with seizures or electric shock.
Humeral shaft fractures occur from direct trauma to the arm or from a fall on an outstretched arm, especially in elderly patients. The radial nerve spirals around the humeral shaft and is at risk for injury, therefore a careful neurovascular exam is important.
Hemorrhage from pelvic trauma can be life threatening. An important first line treatment in the emergency room is the application of a pelvic binder or sheet that is wrapped tightly around the pelvis to control bleeding.
In spinal injury spinal stability must be assessed, and the patient immobilized until his spine is cleared. CT scan is more reliable in assessing spine injury than plain radiographs.
Spinal cord injuries should be triaged to trauma centers since trauma center care is associated with reduced paralysis.
According to the CDC and the National Health Interview Survey approximately 50 million adults (22% of the US population) have been diagnosed with some form of arthritis. This number is projected to grow to an astounding 67 million adults by 2030 (or 25% of the U.S. population).
Weight loss of as little as 11 pounds has been shown to decrease the risk of developing knee osteoarthritis in women by 50%. Similarly, patients who engage in regular physical activity have been found to have lower incidence of arthritis.
Smaller incisions come with the disadvantage of decreased visualization intra-operatively and associated risks of component malposition, intraoperative fracture and nerve or vascular injury. The only documented benefit of minimally invasive techniques appears to be improved cosmesis.
++
Orthopedic surgery is a specialty with which every physician should be familiar. Anyone who cares for patients in an outpatient or emergency room setting will find that the majority of presenting complaints involve the musculoskeletal system. A basic understanding of musculoskeletal anatomy is assumed, and understanding the principles of care for musculoskeletal trauma is essential.
++
For physicians, the field of orthopedics offers an array of subspecialties with such diversity that it seems that “there ...