CASE FILES-orthopedics-4th edition:
The transition from textbook learning to the application of information in a specific clinical situation is one of the most challenging tasks in medicine. It requires retention of information, organization of the facts, and recall of a myriad of data in precise application to the patient. The purpose of this book is to facilitate this process. The first step is gathering information, also known as establishing the database.
This includes taking the history; performing the physical examination; obtaining selective imaging, such as plain x-rays; and ordering laboratory studies. Of these,the historical examination is the most important and useful. Sensitivity and respect should always be exercised during interactions with patients.
Acute trauma: In acute, high-energy traumatic situations, it is essential to carefully follow Advanced Trauma Life Support (ATLS) protocol to optimize patient survival and minimize morbidity. In many hospitals, traumatic scenarios are managed by emergency department physicians and trauma surgical teams. Orthopaedic surgeons play a vital, if supportive, role in acute life support management.
After ensuring stability of the patient’ s airway, breathing, cardiovascular system, cerebral perfusion, and environment, the orthopaedist must work to stabilize major fractures, reduce dis-locations, attenuate bleeding, provisionally irrigate contaminated lesions,and assess neuro vascular deficits.Mechanism of injury: In traumatic situations, whether low-energy falls from standing height or high-energy motor vehicular collisions (MVC), orthopaedic physicians must make special note of the mechanism of injury.
Both the patient’s positioning during injury and the direction of forces acting on the patient play a key role in the classification, treatment, and prognosis of many different types of orthopaedic injuries. In fact, several fracture classification systems are based on the very mechanism of injury, including high-energy,high-mortality pelvic fractures and comparatively lower energy “everyday”ankle fractures.
For patients injured in MVCs, note whether the patient was wearing a seat belt. Likewise, was the motorcyclist wearing a helmet? Does the patient recall the accident, or did he or she lose consciousness? In the elderly especially, a hip fracture may represent more than just a broken bone. Such patients often fall as a result of syncope or presyncope, secondary to underlying cardiac and/or neurologic conditions. The fall may be the first presentation of uncontrolled atrial fibrillation or Alzheimer dementia.