Fracture and Trauma
Fracture and Trauma

The spectrum of cases Dr Punit treated ranges from patients with a single fracture to polytrauma with from multiple, life-threatening musculoskeletal injuries.

Due to changing nature of trauma-road side accident cases & severities of injuries, we make a strong team of Plastic Surgeon, Neurosurgeon, Vascular Surgeon, anesthetist and critical care experts, who are available 24 hrs to immediately manage any such injuries.. State-of-the-art techniques are used in the treatment of associated injuries to nerves and blood vessels and incidents involving soft tissue loss. Treatment plans are upto the international standards and AO principles are strictly followed in all cases.

Physiotherapy department at our setup is equipped with all modern, advanced machines and we always make a coordinated move in the rehabilitation of all our operated cases.

Significant attention is given to comprehensive evaluation and care of Geriatric patients with fractures. Our expert physician team is there to take care of attached co- morbidities with the geriatric patients. Late reconstructive procedures are commonly performed on such as Nonunion, Malunions, and Osteomyelitis etc.

Upper Limb Fractures

  • Clavicle Fractures :- Acromio-clavicular dislocation
  • Forearm Fractures :- Radial haed/neck fractures,galeazzi/monteggia fracture dislocation.
  • Humerus Fractures :- Proximal Humerus Fractures, Humerus Shaft Fractures
  • Elbow Fractures :- Olecranon Fractures, distal humeral fractures
  • Dislocation of the Elbow/ shoulder/ wrist/small joints of hand.
  • Stress and insufficiency fractures, pediatric fractures.
  • Distal Radius Fractures, Ulnar Fractures.
  • Scapula fractures
  • Sports injuries- biceps tendinits, tenni's elbow, golfer's elbow

Lower Limb Fractures

Lower Limb Fractures

Introduction
Lower limb fractures are mainly due to high energy traumas like- road side accidents except in elderly people or diseased bones. High energy trauma is most of the time associated with open, contaminated and comminuted fracture of tibia & femur. This fractures need urgent surgical intervention to stop bleeding, prevent spread of infection & to stabilize the patient.

Fractures of the lower limb are common especially in the elderly. They are often associated .with considerable morbidity and lengthy hospitalisation.

List of conditions / Surgeries we routinely perform :-

  • Hip fractures- Inter-trochanteric fractures, fracture neck femur
  • Fractures of femur (thigh bone)
  • Fractures of knee : Patella fractures, distal femur fractures
  • Fractures of ankle : Pott's, Pilon fractures, Tillaux fractures, Bosworth fractures, Weber fractures, Wagstaffe-Leforte fracture, Maisonneuve fracture etc.
  • Fractures of foot: Jones fracture, Lisfranc injury,avulsion of the 5th metatarsal, Calcaneal fracture, Lover's fracture, Aviator fracture, March fracture, Beak fracture.
  • Fracturs of tibia : Shaft fractures, Plateau fractures.

Pelvic Fractures

Pelvic fracture is a disruption of the bony structure of the pelvis, including the hip bone, sacrum and coccyx. They include pelvic ring fractures, acetabular fractures SI joint & pubic joint disruption, and avulsion injuries. The most common cause in elderly is a fall, but the most significant fractures involve high-energy forces such as a motor vehicle accident, cycling accidents or a fall from significant height. Diagnosis is made on the basis of history, clinical features and special investigations usually including X-ray and CT.

Many digestive and reproductive organs are located within the pelvic ring. Large nerves and blood vessels that go to the legs pass through it. The pelvis serves as an attachment point for muscles that reach down into the legs and up into the trunk of the body. With all of these vital structures running through the pelvis, a pelvic fracture can be associated with substantial bleeding, nerve injury, and internal organ damage.

These fractures are considered as Orthopedic emergency & need urgent stabilization & might need life support management.

Stable - In which the pelvis has one break point in the pelvic ring, limited bleeding and the bones are staying in place. This type is considered good prognosis with early recovery.

Unstable - In which there are two or more breaks in the pelvic ring with moderate to severe bleeding. This type is often associated with visceral injuries .Such cases are management by joint efforts from orthopedic surgeon & General surgeon.

Spine Fractures

Anatomy

The human spine is made of 24 spinal bones, called vertebrae. Vertebrae are stacked on top of one another to create the spinal column. The spinal column gives the body its form. It is the body's main upright support. The main section of each vertebra is a large, round structure called a vertebral body. Compression fractures cause this section of bone to collapse. When the fracture is due to osteoporosis, it usually occurs in the lower part of the thoracic spine, near the bottom of the rib cage.

A bony ring attaches to the back of each vertebral body. When the vertebrae are stacked on one another, the bony rings form a hollow tube. This tube, or canal, surrounds the spinal cord. The spinal cord is like a long wire made of millions of nerve fibers. Just as the skull protects the brain, the bones of the spinal column protect the spinal cord. Spinal fracture (or vertebral fracture) is a fracture affecting the bones of the spinal column. these are cervical, dorsal, lumber fractures & osteoporotic fractures. A spinal fracture is a serious injury.

Cause

Cervical fractures usually result from high-energy trauma, such as automobile crashes or falls. Athletes are also at risk. A cervical fracture can occur if :

  • A football player "spears" an opponent with his head.
  • An ice hockey player is struck from behind and rams into the boards.
  • A gymnast misses the high bar during a release move and falls.
  • A diver strikes the bottom of a shallow pool.

Any injury to the vertebrae can have serious consequences because the spinal cord, the central nervous system's connection between the brain and the body, runs through the center of the vertebrae. Damage to the spinal cord can result in paralysis or death. Injury to the spinal cord at the level of the cervical spine can lead to temporary or permanent paralysis of the entire body from the neck down.

Fractures of the thoracic and lumbar spine are usually caused by high-energy trauma, such as :

  • Car crash
  • Fall from height
  • Sports accident
  • Violent act, such as a gunshot wound

Osteoporosis, or weakening of the bones, can lead to painful vertebral compression fractures

Types of Spinal Fractures

There are different types of spinal fractures. Doctors classify fractures of the thoracic and lumbar spine based upon pattern of injury and whether there is a spinal cord injury. The three major types of spine fracture patterns are flexion, extension, and rotation.

Flexion Fracture Pattern

Compression fracture : While the front (anterior) of the vertebra breaks and loses height, the back (posterior) part of it does not. This type of fracture is usually stable and rarely associated with neurologic problems.

Axial burst fracture : The vertebra loses height on both the front and back sides. It is often caused by a fall from a height and landing on the feet.

Extension Fracture Pattern

Flexion/distraction (Chance) fracture : The vertebra is literally pulled apart (distraction). This can happen in accidents such as a head-on car crash, in which the upper body is thrown forward while the pelvis is stabilized by a lap seat belt.

Rotation Fracture Pattern

Transverse process fracture : This fracture is uncommon and results from rotation or extreme sideways (lateral) bending, and usually does not affect stability.

Fracture - dislocation : This is an unstable injury involving bone and/or soft tissue in which a vertebra may move off an adjacent vertebra (displaced). These injuries frequently cause serious spinal cord compression

Osteoporotic compression usually occurs in the lower part of the thoracic spine, near the bottom of the rib cage.

Minimal Invasive Surgeries

MIS is generally classified as any technique involved in surgery that does not require a large incision.

This technique benefits to the patient in terms of reduced post operative pain, increased post operative comfort, reduced hospital stay, quicker return to normal physical activities and ultimately a quicker return to work. Improved cosmesis and reduced wound complications associated with large scars are also major advantages associated with this technique.

Role of minimal invasive surgery in trauma & fractures or list of some of the minimally invasive surgical procedures we offer.

  • Fractures near the joint, particularly the knee (proximal tibia and distal femur) and ankle, are best treated with this approach
  • Simple fractures of the distal tibia are amenable to minimally invasive surgery
  • Obese patients may also benefit because open procedures in these patients require large incisions.
  • Works best in periarticular, communiuted fractures.
  • Patients needing particularly long plates are also good candidates for this type of surgery. The fracture needs to be able to be reduced without direct manipulation or visualization
  • Proximal femur fractures are also amenable to this type of fixation in some situations.
  • Percutanous fixation of small bones, like undisplaced greater tuberosity, undisplaced fracture lower end radius etc
  • Pediatric long bone fixation-TENS nailing in tibia, femur etc.
  • A minimally invasive plate osteosynthesis technique (MIPO) using a locking compression plate (LCP) has been used widely in trauma cases. Its advantages are that the MIPO technique does not interfere with the fracture site and thus provides improved biological healing and that the LCP has excellent angular stability, while open reduction and rigid fixation by classic plates in the is requiring large incisions with important deperiostation. Potential complications are infections, consolidation delays and nonunions.

Difficulties of using a minimally invasive approach to treating fractures?

The biggest problems we see are malreductions, particularly concerning length and rotation. Additionally, some more simple fracture patterns are not reduced or stabilized sufficiently to allow healing. Finally, these cases take longer and subject the patient and surgeon to more radiation that would occur in standard plating techniques.

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