Introduction

The aim of this chapter is to introduce the reader to orthopaedic surgery. Core training in orthopaedics has four key topics, all concerned with trauma rather than elective surgery. This chapter will cover the topics:

1. Simple fractures and dislocations

2. Soft tissue injuries, including open fractures and compartment syndrome

3. Ankle fractures

4. Proximal femoral fractures in the elderly.

Fracture healing

Fracture healing is a complex physiological process, and unlike other tissues that heal by the formation of connective scar tissue of poor quality, bone is regenerated and the pre-fracture properties are usually restored.

Fractures can heal by:

• primary direct bone healing

• secondary (callus formation) bone healing.

The vast majority of fractures heal by secondary bone healing, which proceeds in five distinct stages:

• stage 1: tissue damage and haematoma formation

• stage 2: inflammation and cellular proliferation

• stage 3: callus formation

• stage 4: consolidation

• stage 5: remodelling.

Tissue damage and haematoma formation

Bleeding occurs from the medullary cavity, the periosteum, as well as adjacent soft tissue and muscle. This results in the formation of a haematoma within and around the fracture site. The disruption of the Haversian systems leads to death of the osteocytes at the fracture surface.