Clinical Management

  • Clinical Management

    Once the fracture has been reduced and fixed, it becomes possible to make a proper assessment of the soft tissue component of the injury, and carry out an initial excision of irreparably damaged tissue, skin, fascia and muscle. The criteria for assessing viability of skin have already been described, and the excision of damaged fascia […]

  • Role Of Periosteum

    The periosteum plays a crucial role both in the management of the fracture and in the provision of skin cover. In addition to providing an effective barrier to infection, a significant proportion of the blood supply to the superficial cortex of the bone reaches it through the periosteum. This explains why avascular necrosis of the […]

  • Degloving Injuries

    The distinguishing feature of a degloving injury is the flaying of the skin, the result of a severe shearing strain, as for example in the ‘running over’ of the limb by a pneumatic tyre. The plane through which the skin is detached is sometimes superficial, sometimes deep to the investing layer of deep fascia, and […]

  • Limb Trauma

    Limb trauma predominantly involves skin, muscle and bone. Infection does not loom large as a hazard if the skin is not involved, but it has to be added to the list of possible complications when there is a break in the skin barrier, and this can be particularly serious when a fracture is part of […]

  • Lschial Sores

    The cavity of the ulcer consists of the ischial bursa but, as the condition progresses and extends, the ischial tuberosity increasingly pro-jects into the cavity and becomes the seat of chronic osteitis. An advance in the treatment of this type of ulcer has been reduction of the prominence of the ischial tuberosity jointly with the […]

  • Tensor Fascioe Latae Flap

    In the lateral aspect of the thigh the fascia lata is markedly thickened to form the iliotibial tract, receiving into its upper part the insertions of glu-teus maximus behind and tensor fasciae latae further forward. As the tract passes distally it overlies vastus lateralis but there is no attach-ment between the two structures. Although the […]

  • Paraplegic Pressure Sores

    Although discussion of pressure sores in the paraplegic patient is confined to the problems of reconstruction, it cannot be emphasised too strongly that the procedures to be described for the various types of decubitus ulceration are only a small facet in the overall care of the paraplegic, and they must be regarded as merely providing […]

  • Vascularised Fibular Transfer

    The fibula derives its blood supply from branches of the anterior tibial and the peroneal vessels, but when it is transferred as a vascularised bone graft, the peroneal vessels are the sole perfusion source. The peroneal artery is described as a branch of the posterior tibial artery, arising just below the divi-sion of the popliteal […]

  • Scapular Flaps

    These flaps are perfused by branches of the circumflex scapular artery and its associ-ated veins. The artery is formed by division of its parent vessel, the subscapular, itself a branch of the axillary artery. The subscapular artery passes down on the posterior wall of the axilla for approximately 4 cm, where it divides into the […]

  • Pressure Sore Management

    NON-PARAPLEGIC PRESSURE SORES The usual sites of pressure sores in the non-para-plegic are the sacral area and heel, occasionally the iliac crest, and the background to their occur-rence is immobility of the patient. Although immobility is ultimately responsible for the local pressure being prolonged for sufficiently long to produce the local ischaemia which leads to […]