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  • Print publication year: 2006
  • Online publication date: December 2009

22 - Musculoskeletal system


This chapter describes common orthopaedic conditions with heavy emphasis on the relevant clinical details that should be elucidated on history and examination. With a firm grasp of the principles of clinical orthopaedic assessment, a differential diagnosis can be formulated and appropriate investigations performed subsequently.


Fractures can be divided into the following types:

Green stick fractures: These occur in children. One cortex is splinted and the other is intact.

Closed fractures: There is no communication between the fracture haematoma and the environment outside the integument. The skin and soft-tissue envelope remain intact.

Open (‘compound’) fractures: There is breach of the integument and soft-tissue envelope surrounding the fracture such that the fracture haematoma communicates with the outside environment. These fractures are associated with an open wound and there is increased risk of deep infection, which may have catastrophic consequences for the healing of bone and soft tissues and subsequent usage of the affected part. Therefore, such fractures invariably require surgical treatment and constitute an orthopaedic emergency. Compound fractures may also be associated with delayed union.

Pathological fractures: These occur in bone weakened by a pre-existing disease, for example metastatic deposits or a generalized bone disease such as osteoporosis. Therefore, the resultant force required to fracture the bone is less than that required to fracture normal bone.


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