Orthopaedic Emergencies
Most orthopaedic trauma does not require emergency management. Conditions that require urgent assessment and senior review include:
Fractures associated with vascular injury
Severely deformed fractures, high-energy or penetrating injuries and pelvic/acetabular fractures are often associated with arterial or venous injuries. If present, request senior review emergently whilst resuscitating the patient. Haemodynamically unstable patients may require rapid transfer to operating theatre or major trauma centre for management.
Assess for distal pulses and sensation - involve vascular surgeons if any doubt. For information on managing vascular injuries.
Compartment syndrome
Often seen in closed tibial fractures but may occur in any traumatic injury to a limb. Severe pain out of proportion to the injury and pain with passive movement of muscle groups crossing that compartment are indicative.
ALWAYS have a low threshold for requesting senior review if concerned about compartment syndrome.
Septic arthritis
Can rapidly destroy a joint and lead to overwhelming sepsis. A painful, swollen joint must be considered septic until infection is ruled out. Urgent blood tests and joint aspiration. If positive - URGENT joint washout is required. For more information on managing septic arthritis.
Open fractures
Always assess fractures for overlying skin defects. If present, document injury and neurovascular status of limb, start antibiotics, apply sterile dressings and splint the limb. Discuss with senior doctor urgently. For more information on managing open fractures.
Cauda equina syndrome and spinal cord compression
Patients with sudden onset saddle anaesthesia and bladder/bowel dysfunction or rapid onset of limb weakness (generally lower limb) must be reviewed urgently. If any suspicion of cord or cauda equina compromise urgent MRI and referral to spine or neuro surgeons.
Fractures associated with vascular injury
Severely deformed fractures, high-energy or penetrating injuries and pelvic/acetabular fractures are often associated with arterial or venous injuries. If present, request senior review emergently whilst resuscitating the patient. Haemodynamically unstable patients may require rapid transfer to operating theatre or major trauma centre for management.
Assess for distal pulses and sensation - involve vascular surgeons if any doubt. For information on managing vascular injuries.
Compartment syndrome
Often seen in closed tibial fractures but may occur in any traumatic injury to a limb. Severe pain out of proportion to the injury and pain with passive movement of muscle groups crossing that compartment are indicative.
ALWAYS have a low threshold for requesting senior review if concerned about compartment syndrome.
Septic arthritis
Can rapidly destroy a joint and lead to overwhelming sepsis. A painful, swollen joint must be considered septic until infection is ruled out. Urgent blood tests and joint aspiration. If positive - URGENT joint washout is required. For more information on managing septic arthritis.
Open fractures
Always assess fractures for overlying skin defects. If present, document injury and neurovascular status of limb, start antibiotics, apply sterile dressings and splint the limb. Discuss with senior doctor urgently. For more information on managing open fractures.
Cauda equina syndrome and spinal cord compression
Patients with sudden onset saddle anaesthesia and bladder/bowel dysfunction or rapid onset of limb weakness (generally lower limb) must be reviewed urgently. If any suspicion of cord or cauda equina compromise urgent MRI and referral to spine or neuro surgeons.
