Trauma and orthopedic surgery

Last updated: February 16, 2022

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Fractures are common complications of trauma and often require surgical treatment. Orthopedic surgery aims to restore or preserve as much limb function as possible. Fracture care comprises the repositioning of the broken pieces of bone (reduction) and their immobilization and stabilization (fixation) in proper union until they have healed. Surgical fracture management permits more precise measures, a greater degree of stability, and better anatomical reduction than conservative fracture management, resulting in quicker immobilization. These advantages should always be weighed against the possible complications of surgery (e.g., wound infections, blood clot formation, blood loss, and compartment syndrome). Conservative treatment (e.g., closed reduction internal fixation) is indicated for most fractures in children because pediatric bones have greater remodeling capacity than adult bones. Osteosynthetic procedures are chosen on the basis of fracture type, fracture location, and the patient's general condition. If there is advanced joint damage, arthroplasty may be necessary to restore function. Follow-up treatment may involve orthopedic rehabilitation. In patients with bone misalignment (e.g., hip dysplasia), osteotomy may be necessary. Amputation may be indicated if the injured structure or its function cannot be restored and/or if there is a risk of complications (e.g., gangrene).

Internal fixation is a surgical method to fixate fractures and/or dislocations using rods, nails, plates, and/or screws placed inside the body.

Closed reduction internal fixation

Open reduction internal fixation

Lag screw fixation

  • Definition: the fixation of a fracture using lag screws either on their own or in combination with other devices (e.g., plates)
  • Indications: : most types of fractures (e.g., articular fractures, slipped capital femoral epiphysis)
  • Principles: fixation and compression of the fracture gap
  • Types of hardware involved
    • Cortical screws: fixation of the fracture gap
    • Cancellous screws: compression and fixation of the fracture gap

Plate fixation

  • Definition: a surgical procedure in which stainless steel or titanium plates are used in combination with screws for the fixation of a fracture
  • Indications: comminuted fractures (e.g., unstable articular fractures, osteoporotic fractures)
  • Principles: neutralization and stabilization of the malposition for quicker postoperative functional rehabilitation
  • Types of hardware involved
    • Buttress (antiglide) plates: compensate for shear forces
    • Compression plates: compress the fracture gap
    • Neutralization plates: neutralize bending, torsional, and shear forces
    • Tension-band plates: convert tensile forces into compression forces
    • Bridge plates: connect the intact bone ends of comminuted fractures or bony defects, bypassing the intermediate fracture zone

Dynamic hip screw fixation [1]

  • Definition: a surgical procedure for the fixation of certain types of hip fracture using an orthopedic implant consisting of a sliding lag screw, a stabilizing side plate with a barrel, and cortical screws
  • Indications: fractures in the trochanter region
  • Principle: When the patient places weight on the affected leg, the sliding lag screw moves through the barrel and enables fracture compression.
  • Types of hardware involved
    • Sliding lag screw: compression of the fracture gap
    • Side plate: stabilization and fixation of the fracture gap
    • Cortical screws: fixation of the side plate to the bone

Intramedullary nail fixation

Kirschner wire fixation

  • Definition: a surgical procedure that uses a wire for the fixation of bone fragments
  • Indications
    • Fractures of small bones
    • Fragment repositioning in multifragmentary fractures
    • Epiphyseal and/or metaphyseal fractures
    • Provisional fixation
    • Support of fractures that have been fixed with screws and/or plates
  • Principle: fixation of the fracture without compression

Tension-band wiring

General

Total arthroplasty [4]

Total arthroplasty is a surgical procedure in which a damaged musculoskeletal joint is entirely removed and replaced with an endoprosthesis.

Hemiarthroplasty [4]

Hemiarthroplasty is a surgical procedure in which the damaged portion of a musculoskeletal joint is removed and replaced with an endoprosthesis (e.g., hip hemiarthroplasty).

Resection arthroplasty

  • Definition: a surgical procedure in which a damaged joint is partially or completed removed to preserve as much function as possible
  • Indications

Corrective osteotomy

  • Definition: a surgical procedure to correct bone misalignment by transecting the bone and realigning and fixing it in a normal position
  • Indications: posttraumatic malunions, congenital or acquired valgus and varus deformities with the risk of osteoarthritis (e.g., severe hallux valgus or genu varum)

Hip osteotomy

  1. Kazley J, Bagchi K. Femoral Neck Fractures. StatPearls. 2021 .
  2. Hadeed A, Werntz RL, Varacallo M. External Fixation Principles and Overview. StatPearls. 2021 .
  3. Pajarinen J, Jamsen E, Konttinen YT, Goodman SB. Innate immune reactions in septic and aseptic osteolysis around hip implants.. J Long Term Eff Med Implants. 2014; 24 (4): p.283-96. doi: 10.1615/jlongtermeffmedimplants.2014010564 . | Open in Read by QxMD
  4. Lappalainen R. Hemiarthroplasty. Springer US ; 2013 : p. 1636-1638
  5. Müller M. Chirurgie für Studium und Praxis (2012/13). Medizinische Verlags- und Informationsdienste ; 2011
  6. Siewert JR. Chirurgie. Springer Verlag (2006)

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 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer