Trauma Service

At the Department of Orthopaedic Surgery in Singapore General Hospital, our Trauma Service comprises a full service centre where patients can expect to receive the best diagnosis, treatment and rehabilitation from a highly-skilled professional team. The Trauma Service also provides full support to the hospital’s ‘Level 1’ Trauma Centre.

This service provides treatment for patients who have sustained a wide variety of injuries as a result of accidents. The care of these patients is carried out by a dedicated team who provides round-the-clock consultant-delivered service. People who suffer serious injuries require specialist care of the highest quality to ensure the best chances of survival and recovery.

State-of-the-art techniques are used in the treatment of associated injuries to nerves and blood vessels, as well as incidents involving soft tissue loss.

Conditions

Our specialists provide a complete range of orthopaedic services for the treatment of conditions consisting of the following:

Broken bones
Compartment syndrome
Complex long bone fractures involving the:

Femoral shaft
Tibial shaft
Humeral shaft
Compartment syndrome

Fractures of the lower extremities such as:

Hip fractures
Distal (supracondylar) femur fractures
Knee dislocations
Tibial plateau fractures
Tibial pilon (plafond) fractures

Fractures of the upper extremities such as:

Shoulder fractures and dislocations
Clavicle fractures
Scapula (shoulder blade) fractures
Elbow fractures and dislocations
Radial-head fractures
Olecranon fractures
Distal radius fractures/dislocations

Pelvic and hip socket fractures:

Sacroiliac fracture/dislocation
Pubic symphyseal injuries
Acetabular fractures
Hip dislocations
Tibial pilon (plafond) fractures

Peri-articular fractures including:

Shoulder fractures and dislocations
Fractures of the foot and ankle
Ankle dislocations
Talus fractures and dislocations
Calcaneus (heel bone) fractures
Lisfranc (midfoot) dislocations or fractures

Spinal fractures and dislocations
Polytrauma
Severe fractures of the upper and lower extremities including open and complex injuries surrounding the joint
Open fractures

They also have extensive expertise in the long-term treatment of debilitating post-traumatic sequelae including:

Chronic osteomyelitis (bacteria, viruses or parasites that causes an infection of the bone)
Nonunions (If a bone fracture fails to heal)
Malunions (If a bone fracture fails to heal with appropriate alignment)
Joint stiffness following trauma
Limb length discrepancy (one limb is shorter than the other)
Deformities (If a bone fracture heals improperly, it may cause chronic pain, restricted mobility, functionality or even disability)

Some of these conditions are explained in greater detail below:

1. Compartment Syndrome

Compartment syndrome occurs when excessive pressure builds up inside an enclosed muscle space in the body. It usually results from bleeding and or swelling after an injury. As a result, the dangerously high pressure in compartment syndrome impedes the flow of blood to and from the affected tissues.

When this happens, immediate surgery to relieve the pressure is required. If left untreated, compartment syndrome can lead to permanent tissue damage and loss of function.

2. Pelvic fractures and acetabular fractures

Pelvic fractures and acetabular fractures are among the most serious injuries treated by orthopedic surgeons. An acetabular fracture occurs when the socket of the hip joint is broken.

Often the result of a traumatic incident such as a motor vehicle accident or a bad fall, these fractures require rapid and precise treatment and, in some cases, one or more surgical procedures.

People of all ages are vulnerable to these injuries. In addition, some elderly patients with fragile bones due to osteoporosis develop pelvic fractures and fractures of the acetabulum with a lower impact fall.

3. Polytrauma

Polytrauma occurs when a person experiences injuries to multiple body parts and organ systems due to incidents such as blast-related events or motor vehicle accidents etc.

4. Soft tissue injuries

A severe high-energy fracture is associated with profound damage to the surrounding soft-tissue envelope. Open fractures and fractures with severe, closed soft-tissue damage are often associated with polytrauma.

5. Complex peri-articular fractures

Peri-artiular fractures occur around or immediately adjacent a joint, the points in the body where bones meet and are held together with ligaments and tendons.

6. Complex fractures

Fractures of the femoral and tibial shaft are common injuries. They exhibit a bimodal age distribution and are frequently associated with other injuries. The tibia, or shinbone, is the most common fractured long bone in your body. A tibial shaft fracture occurs along the length of the bone, below the knee and above the ankle. As it typically takes a major force to break a long bone, other injuries often occur with these types of fractures.

A femoral fracture is a bone fracture that involved the femur or thigh bone. Being the largest and strongest bone, the shaft requires a large amount of force to fracture. Femoral shaft fractures are severe injuries and are often associated with a high impact trauma mechanism, frequently seen in multiple injured patients. Humeral shaft fractures usually occur as a result of a direct blow to the upper arm (transverse fractures).

7. Open fractures

An open fracture, also called a compound fracture, is a fracture in which there is an open wound or break in the skin near the site of the broken bone. Most often, this wound is caused by a fragment of bone breaking through the skin moment of the injury at the.

Surgical Techniques

A huge percentage of surgical interventions for trauma patients are orthopaedic in nature. The orthopaedic trauma service works closely with physicians and specialists in emergency medicine and general surgery to provide the coordinated treatment of acute injury.

Our services for trauma include:

• Minimally invasive fracture fixation

• Computer-aided surgeries (e.g treatment of pelvic and acetabular fractures)

• Intramedullary nail fixation

• Osteoporotic fracture fixation

• Post-traumatic deformity and disability correction

• Trauma Navigation

• Skeletal Realignments

• Stabilizations using closed, percutaneous, external and internal fixation techniques

• Extremity reconstruction

• Limb salvage

• Malunion repairs

• Nonunion repairs

• Traumatic amputations

• Bone debridement (e.g. treatment of osteomyelitis)

Some of these techniques are further elaborated below:

Minimally invasive fracture fixation

The minimally invasive plate osteosynthesis (MIPO) technique is used for fracture fixation. With the MIPO technique, procedures could be performed with smaller incisions and thus with less soft tissue damage and a better preserved blood supply.

Patient Outcomes
The procedure is increasingly popular as surgical rib fixation improves outcome of patients with a flail chest or isolated rib fractures. Surgery time is shorter, with lesser blood loss. A smaller incision results in less scarring and is cosmetically more appealing and acceptable to female patients.

Computer-assisted Orthopaedic Surgeries

Computer-assisted orthopaedic surgeries (CAOS) are frequently used to treat pelvic and acetabular fractures.

Displaced acetabular fractures are among the most complex of all orthopaedic injuries. Keys to accurate reduction and improved outcomes are accurate imaging studies and a complete understanding of the nature of the fracture.

The expansion of the power and capabilities of three-dimensional (3D) computer reconstructions has been recognized as a useful adjunct in preoperative planning, with the ability to devise an accurate preoperative plan.

Computer-enabled tracking systems or robotic devices help to improve visibility to the surgical field and increase application accuracy in a variety of surgical procedures.

Patient Outcomes

Computer-assisted orthopaedic surgery (CAOS) has been shown to offer more accurate and reliable implant positioning compared to conventional techniques. CAOS is known to provide closer restoration to the neutral mechanical alignment and approximately double the cases of optimal alignment compared to conventional surgery.

Intramedullary nail fixation or plating

Intramedullary nail fixation has become the standard of treatment for both femoral and tibial shaft fractures, with reported union rates for the femur approaching 97%. Because of this success and the ease of intramedullary nailing, the indications for this procedure have been expanded to include the peri-articular portions of the long bones.

Patient Outcomes

Intramedullary nail fixation of these fractures may be less traumatic than conventional techniques, especially in critically ill patients, and can obtain similar outcomes. Union rates remain above 90%.

Limb Reconstruction

Complex injuries to the extremities require skilled physicians to reconstruct and salvage these limbs. Our orthopedic trauma team has the experience, expertise and knowledge to tell if a limb is at risk of losing any functionality or if it needs to be amputated. Limb preservation and reconstruction is needed for traumatic injuries to limbs or extremities, or conditions relating to infection or cancer.

Our orthopedic trauma physicians use a variety of specialized surgical techniques and procedures to salvage damaged limbs, giving each patient the best chance to have their damage limb return to everyday functionality.

Nonunion Repairs

A nonunion occurs when a fractured bone fails to heal after an extended recovery period.

Surgical procedures carried out include:

Removal of all scar tissue from between the fracture fragments
Internal or external fixation
The stabilization of broken bone fragments using metal plates, pins, screws and rods, which are driven into the bone.
Bone grafting

Patient Outcomes

After nonunion repair surgeries, elderly patients are able to heal at similar rates and in a similar time frame as younger patients. Improvement in pain scores is seen in all patients after surgery

Malunion Repairs

A malunion occurs when a fractured bone heals in an abnormal position. Surgical procedures can help realign severe cases of malunion, two of which are mentioned below:

Osteotomy
This technique is commonly used to restore the appropriate alignment of bones that have not healed properly.
Open Reduction and Internal Fixation (ORIF) Surgery
‘Open reduction’ is surgery to realign the bone fracture into the normal position, while ‘internal fixation refers to the steel rods, screws, or plates used to keep the bone fracture stable in order to heal the right way and to help prevent infection.

Patient Outcomes

A recent study has found that patients could safely bear weight shortly after undergoing open reduction and internal fixation (ORIF) surgery for an ankle fracture, regardless of the fracture pattern.

As for the treatment of clavicle (collarbone) fractures, ORIF surgery is shown to provide lower rates of nonunion and earlier return to normal activities for the patient, as compared to nonoperative treatment for certain fracture patterns. Depending on the type of incisions made, smaller scars lead to improved cosmetic results, hence increasing patient satisfaction levels.

Bone debridement

During this procedure, the surgeon cuts away dead or damaged bone tissue. He or she also washes the wound to remove any dead or loose tissue. Surgeons may eventually replace the removed bone with a graft, a small piece of bone taken from your hip or from a bone bank, which stores donated bone tissue. A skin graft may also be needed if the skin around the bone or joint is infected and doesn’t heal.

This procedure is recommended for people with Osteomyelitis, an inflammation of the bone caused by an infecting organism.

Patient Outcomes

Patient satisfaction after high-energy lower-extremity trauma is related to other outcome parameters. The most important seem to be physical function, less pain, the absence of depression and the ability to return to work within two years. These factors are important drivers of patient satisfaction regardless of the type of patient or injury, as well as the details of treatment.