Evaluation

The ABCs of assessment and resuscitation per the ATLS protocols always come first. Standard to all trauma evaluations are the cross-table C-spine, AP chest, and AP pelvis x-rays. As the patient is examined, any gross deformity should be noted and suspected long bone injuries should be x-rayed with two views 90° angulated from each other. To insure associated injuries are not missed, the joint above and below must be included in the x-ray evaluation of a long bone fracture. Any soft tissue wound should be evaluated for possible open fracture or joint arthrotomy. Further evaluation modalities can include appropriate CT scans, MRI, or ultrasound studies. Repeated exams throughout evaluation and treatment are very important in any trauma situation to ensure that no injuries are missed. With the constellation of factors in the polytraumatized patient, 5-20% of patients have unrecognized injuries after the initial evaluation.

There are many fracture classification systems in use to describe closed long bone fractures. The most important issue is to be able to accurately describe the bones involved and their related fractures. Fractures are described naming the involved bones and then describing the fracture site in terms of angulation, displacement, rotation, comminution, and finally whether it is open or closed. Displacement is always used to describe the distal fragment in relation to the proximal fragment.

Orthopaedic emergencies that must be identified and addressed include pelvic injuries, open fractures, compartment syndrome, and joint dislocations.

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