Trauma

What is trauma ?

Orthopedic trauma is a special branch of orthopedic surgery specializing in problems related to the bones, the joints, and the soft tissues (namely muscles, tendons, and ligaments) or the entire body following a recent trauma. The main aim of this specialized area in the field of orthopedics is the resetting and healing of the fractured alignment of the joint and its surfaces to allow for recovery and return to maximum movement and function.

Treatment options :

All fractures do not require special care, certain complex fractures may always benefit from care provided by a trauma specialist. Many orthopedic Hospitals and clinics are using leading and cutting- edge surgical techniques in the treatment of trauma patients such as minimally invasive surgery, advanced external fixation, and procedures such as the bone graft or bone protein therapy.

Nonsurgical treatment of trauma injuries :

Some fractures and dislocations such as the clavicle, scapula, humerus, wrist, hand, and foot, can be treated without the need for an operation. Depending on the severity and intensity of the fracture the physician may treat the injury without the need for surgery using the external fixation method. This method usually involves the use of splints, casts, braces, and other devices on the outside of the injury to stabilize and repair the fractured portion of the bone.

Surgical treatment of trauma injuries :

In a surgery, a physician usually performs surgery to place pins or wires or screws, and plates of the bone to repair the fracture at the damaged area as the situation demands. Severe injuries may require more complex surgeries such as bone grafting, limb lengthening, and complex reconstruction procedures.

Minimally invasive orthopedic options :

Minimally invasive surgery is certainly preferred over an open procedure for its advantages such as

• Speedy recovery
• Less pain
• Complications are less
• Inflammation in the area is less

However, Surgery may be required to fix certain types of broken bones back into their places. Internal fixation (metal rods or pins located inside the bone) or external fixation devices (metal rods or pins located outside of the body) are used to hold the bone fragments in place while they heal back to normalcy.

Fractures may take many days or months to heal as broken bones bind back or join together when new bone is formed between the broken parts.

Minimally invasive procedures and techniques are :

External fixation : External fixation involves the placement of pins into the bones and then connecting those pins to bars placed on the outside of the skin. This is often temporary and used only when it is unsafe to perform definitive surgery immediately. An example is in the case of periarticular fractures (those in dand around joints), where soft tissue gets inflamed and may prevent early surgery from being done due to the risk of latent infections. Other types of external fixators (small wire fixators) are used for certain fractures (non-union’s and mal-unions) and bone transplant as and when necessary.

Intramedullary rodding : Intramedullary rodding is most commonly used for fractures of the femur and tibia. This procedure is done with small incisions and often patients are allowed to bear weight on the extremity immediately after the surgery. The rod is placed inside the canal of the bone and then screws are placed through the rod and bone to maintain alignment of the limb in the position required. Additional casting is not required.

Plates and screws : Plates and screws are most often used when a bone break is in or near a joint, which includes certain fractures involving the shoulder, elbow, forearm, hip, knee and ankle. The bones are moved back into their proper and original position and a plate with screws is used to hold the fracture in place unit it takes the time to heal. Most often, additional casting is not required and patients are allowed to begin moving their joints soon after surgery.

The orthopedic trauma team at KIMS specializes in the expert care of the most complex fractures and related problems, such as non-unions, mal-unions, post-traumatic arthritis, deformity correction, pelvis/hip reconstruction and foot and ankle reconstruction. The ultimate goal is to help patients recover from their injuries faster and return to their day to day routines.

What are the benefits of minimally invasive trauma surgery ?

The main benefits are :

• Smaller incisions and not a big one
• Less muscle dissection which allows muscles to repair themselves
• Less disruption of blood supply to the bone, and less disruption of fracture hematomas.
• Less blood loss
• These benefits make the fracture healing and patient recovery quite faster.

Which patients benefit most ?

• Patients who have had fractures near a joint that are not feasible to intramedullary nailing or have been subject comminuted fracture gain the best benefit.
• Certain simple fractures of the distal tibia are amendable by minimally invasive surgery.
• A section of surgeons’ feels that obese patients may also benefit from open procedures in these patients require large incisions. Unfortunately minimally invasive surgery in these patients is difficult to perform

Which fractures are best treated through a minimally invasive approach ?

• Minimally invasive or percutaneous plating work their best in periarticular or communiated fractures. Patients needing really long plates are also good candidates for this type of surgery.
• Fractures near the joint, particularly the knee (proximal tibia and distal femur) and the ankle, are best treated under this approach.
• Proximal femur fractures are also treated using minimally invasive procedures

What are the difficulties of using a minimally invasive approach to treating fractures ?

• The procedure is performed under fluoroscopic guidance, and this has some inherent problems associated with it.
• The greatest problems we see are maledictions, particularly concerning length and rotation. In certain cases, some simple fracture patterns are not reduced or stabilized sufficiently to allow their healing. Finally, these cases take longer and subject the patient and surgeon to more radiation that would occur in standard plating technique.

What surgical advances have led to the success of minimally invasive trauma surgery ?

The greatest advancement has been the evolution of an anatomically contoured locking plate. They fit the bone better than the older generation plates, which allow the plates to be inserted without seeing the contours of the bone. Locking plates also provide more stability when spanning over longer fracture segments.

Most current plate systems have targeters inserted that assist in proper screw placement.

Bone grafting :

A bone graft is a surgical procedure done to fix problems with bones or joints. Bone grafting or transplantation of bone tissue is beneficial in fixing bones that are damaged from trauma, or problem of the joints. It is also useful for growing bone around an implanted device, such as a total knee replacement. A bone graft may fill a void where bone is absent or help provide structural stability for the patient to walk better and feel better.

The bone used in a bone graft can come from your own body or a donor or it can be entirely man-made. The bone graft can provide a framework where new living bone can grow if it is accepted by the body.

The two most common types of bone grafts are :

An allograft uses bone from a deceased donor or a cadaver that has been cleaned and stored in a tissue bank. An autograft comes from a bone inside your bodies, such as your ribs, hips, pelvis, or wrist.

Risks of the surgery :

All surgical procedures involve risks of bleeding infection and reactions to anesthesia. Bone grafts carry these risks and other risks such as pain, injuries to the nerves, rejection of the bone graft by your body, inflammation, swelling or redness or risk of the graft being reabsorbed.

What to do to prevent fractures ?

• Most fractures are caused accidentally, such as if you fall, or any other unexpected injuries while playing any sport. But there are some things you may be able to do to decreases your risk of bone fractures, for instance :
• Follow a healthy diet that includes vitamin D and calcium to keep your bones strong enough
• Do weight-bearing exercises help strengthen your bones
• Tobacco and nicotine increase the risk of bone fractures and interfere with the healing process of the fractures hence avoid tobacco completely.
• Osteoporosis is the most common cause of fractures in the elders aged over 50 years.
• When to call a doctor :
• You should see a doctor anytime you think you may have a broken bone or start feeling heavy
• An open fracture (one in which the bone comes through the layers of the skin so you can see it or a deep wound that exposes the bone through the skin) is considered a medical emergency. Get medical attention right away for this type of fracture.
• Any injury to the bones of your spine is also a medical emergency. These cause severe back pain and may cause nerve problems, such as numbness, tingling, weakness, or bowel or bladder problems while passing urine or motion.

Recovery : Recovery varies from person to person. Lack of activity may stiffen your muscles this is called muscular atrophy. Hence, you have to follow the physical therapist in doing exercises; you should not over exercise at the same time. Good diet and suggested exercises is a key to faster recovery.

KIMS Hospital, secunderabad is the best orthopedic hospital in the twin states of Andhra and Telangana. It has the best orthopedic surgeons, eminent trauma care specialists who have treated innumerable trauma cases with optimal results. KIMS Hospital Secunderabad has the Best Trauma Care centre with the best equipment, experienced trauma care specialists who work 24*7 to treat victims of trauma in all possible emergency situations.