Guide to Managing Orthopaedic Emergencies

Common Types of Orthopaedic Emergencies

Fractures: Fractures that constitute an emergency are typically serious fractures such as broken bones (i.e. not just a crack), especially open fractures where the bone protrudes through the skin. Visible deformities arising from bone fractures are also considered emergencies.

Dislocations: Severe joint dislocations, particularly those involving major joints like the hip or knee, can potentially cause nerve damage or blood vessel injury if not treated promptly.

Ligament Issues: In cases of complete ligament tears, prompt treatment is crucial to prevent the injury from worsening. Common signs of an acute ligament injury include joint instability, loss of mobility in the affected joint, and an audible popping sound at the time of injury.

Compartment Syndrome: Compartment syndrome is a buildup of pressure within a confined muscle compartment due to swelling from bleeding or inflammation. It can cause severe pain, numbness, and tissue death if not treated right away.

Tendon Ruptures: Tendon ruptures occur when a tendon, the tough tissue connecting muscles to bones, tears completely. This tear typically causes significant pain, swelling, bruising, and inability to use the affected limb.

How to Manage an Orthopaedic Emergency

Proper management is crucial in times of orthopaedic emergencies as a wrong move could potentially cause further harm to the injured area.

First Response

If you suspect any broken bone or head, neck, or spine injury, do not move the patient. Instead, call emergency services and let trained paramedics safely move them. Similarly, seek medical attention if you experience severe injuries like open fractures, dislocations with an obvious deformity, or uncontrollable bleeding.

Initial Evaluation

Before performing any interventions, the medical team will first conduct a thorough assessment of the patient’s breathing, circulation, and injuries. If the patient is not in a life-threatening situation, then treating their current injuries and preventing complications from arising becomes the next priority.

Emergency Procedures

Treatment procedures commonly performed in an orthopaedic emergency include:

Wound closure: Large, open wounds require cleaning, debridement (removal of dead tissue), and potentially stitches or sutures to close the wound.
Closed reduction: In some closed fractures or dislocations, the orthopaedic surgeon may attempt to manipulate the bones back into their correct position without surgery.
Open reduction and internal fixation (ORIF): This surgery involves surgically realigning bone fragments and fixing them with plates, screws, or wires.
Arthroscopy: This minimally invasive procedure uses a camera and small instruments to visualise and repair damage inside a joint.

Rehabilitation and Follow-Up Care

Following treatment, rehabilitation is key to facilitate a quicker and more complete healing. A physiotherapist will design a personalised plan of exercises to improve one’s strength, flexibility, and range of motion. You should also attend follow-up appointments with your orthopaedic specialist to monitor your healing progress and adjust treatment and rehabilitation plans as needed.

Dr Wang Lushun

Senior Consultant Orthopaedic Surgeon

MBBS (S’pore), MRCS (Edin), MMed (Ortho), FRCS (Ortho) (Edin)

Dr Wang is a Senior Consultant Orthopaedic Surgeon with more than 18 years of experience treating orthopaedic emergencies and caring for athletes. He was formerly the Head of the Hip and Knee Division at Ng Teng Fong Hospital; and has won several awards for superior patient outcomes, service quality and enhanced recovery programmes.