1: Principles Of Fracture Management Flashcards
What is a fracture
partial or complete disruption in continuity of the bone
What are 3 classes of fracture
- Stress
- Traumatic
- Pathological
What are stress fractures
Multiple low velocity injuries results in several hairline fractures to the bone
What is a pathological fracture
Abnormal bone (eg. malignancy or osteoporosis) that fractures on minimal trauma
What are 6 risk factors for poor healing
- Old age
- Diabetes
- Smoker
- NSAIDs
- Corticosteroids
- Osteoporosis
What is an oblique fracture
Fracture lies obliquely to the long bone
What is a comminuted fracture
When there are more than two fragments
What is a segmental fracture
When there are more than two fractures in a long bone
What is a transverse fracture
Fracture lies horizontal to long bone
What is a spiral fracture
Severe oblique fracture. With rotation along the long axis
What is an open fracture
Fracture where a fragment of bone breaks through skin
What is a Colle’s fracture
Fracture of the wrist that has 3 features (can be remembered by ‘TOD’)
Transverse fracture of the radius
One initial proximal to the carbo-metacarpal joint
Dorsal displacement and angulation of the distal radius fragment
What is a Smith’s fracture
Transverse fracture of the radius with volar angulation and displacement
What is a Monteggia’s fracture
Dislocation of the PROXIMAL radio-ulna joint and associated fracture of the ulna
What is a Galeazzi’s fracture
Dislocation of the DISTAL radio ulna joint with associated radial shaft fracture
What is a Bennet’s fracture
Fracture of the first carpo-metacarpal joint
What is a Boxer’s fracture
Fracture of the 5th MCP joint
What is a Pott’s fracture
Bi-malleolar fracture
What is Barton’s fracture
Fracture of the distal radius wit radio-carpal dislocation
What is an open fracture
Disruption in cortex of the bone associated with an overlying laceration
What system is used to classify open fractures
Gustillo-Anderson
In the Gustillo-Anderson classification, what is Grade I
- Low energy trauma
- Less than 1cm laceration
In the Gustillo-Anderson classification, what is Grade 2
- Low energy trauma
- More than 1cm laceration
In the Gustilo-Anderson Classification what is Grade 3A
- Adequate soft tissue coverage
In the Gustilo-Anderson Classification what is Grade 3B
- Inadequate soft tissue coverage
In the Gustilo-Anderson Classification what is Grade 3C
- Associated arterial injury
What Gustily-Anderson classification will an open fracture caused by high energy trauma be
Grade 3 (automatically)
How should a fracture be managed (General principles)
- Antibiotics for all open injuries
- Reduce
- Hold
- Rehabilitate
If a high-energy traumatic fracture how should it be managed (General principles)
- Resuscitate (ATLS)
- Reduce
- Hold
- Rehabilitate
What is reduction of a fracture
restoring the anatomical alignment of a fracture or dislocation
What is the aim of reducing a fracture
- Reduce pressure on soft-tissues (reducing swelling)
- Reduce pressure on nerves that could lead to neuropraxia
- Reduce pressure on blood vessels that may cause ischaemia
- Reduce tamponade of bleeding at fracture site
- Promote healing
How is reduction achieved (General principle)
Apply force equal and opposite to the force which caused the fracture
What are the two types of reduction
Open reduction
Closed reduction
In an emergency what type of reduction is often used
Closed reduction
What is open reduction
Taken to operating theatre. Fracture is visualised and internally reduced with instruments
What should be given prior to reduction
Analgesia
What is the preferred method of analgesia for reduction of fractures
Local nerve block
What does ‘hold’ refer to in general principles of fracture management
Immobilisation of the fracture to enable healing
What are the most common methods to immobilise a fracture
- Plaster cast
- Splint
What is a rare (old-fashioned) method to immobilise a fracture
Traction
When may traction be required in ‘holding phase’ of management
If an unstable fracture (eg. muscles pull on fracture sites causing it to be unstable) - subtrochanteric fracture, pelvic fracture
What type of cast should be applied in the first 2W of a fracture and why
Back-slab. (NEVER apply a circumferential cast in the first two weeks)
What will happen if a circumferential cast is applied within the first 2W following fracture
oedema and expansion of the tissues will be compressed in the cast and may lead to compartment syndrome
How is the ‘length’ of a cast decided
- If risk of axial instability (fracture can rotate along long-axis) then joint above AND below
- If no risk, just the joint distal to the injury
What has replaced traction
Internal and external fixation
In which population may traction be used
cHILDREN
What fractures are repaired by open reduction and internal fixation (ORIF)
fractures involving joint articulations
What are 6 indications for ORIF
- Articular fractures
- Unstable fractures
- Open fractures
- More than two fractures in one limb (segmental fracture)
- Identical bilateral fractures
- Failed medical management
What are 4 methods of internal fixation
- Intra-medullary nails
- Kirschner wires
- Plates
- Screws
What is the benefit of plates
Provide strength and stabilise fractures involving articular fractures
What are intra-medullary nails
screw into the medulla of bones
What are Kirschner wires
flexible stabilisation wire used as a temporary measure in internal fixation before definitive fixation
When are external fixation used
when there is soft-tissue damage to the trauma site (burns, loss of skin, loss of bone) as they are less disruptive
How is external fixation achieved
Pins/Wires/Rods are placed away from the zone of injury in various configurations to provide stabilise. Pins/Wires are placed through bone and connected using rods and clamps
What does rehabilitation involve
Need for patients to undergo PT and progressive loading following a fracture
What are 5 immediate complications of a fracture
- Organ injury
- Internal bleeding
- External bleeding
- Nerve or skin injury
- Vessel injury causing secondary ischaemia
What are 4 local late complications of a fracture
- Skin necrosis
- Pressure sores
- Infection
- Delayed union
What are 4 general late complications of a fracture
- Fat embolism
- PE
- Pneumonia
- Arthritis
Where to fat emboli occur from
Bone marrow
What day do symptoms from fat emboli often present
2-3d
What type of injury is neuromuscular disruption common
Knee dislocation
What is the most common complication of fractures
Infection
What is delayed union
When a fracture has not healed within the expected time frame
What is non-union
No evidence of fracture healing
What is mal-union
When a fracture has not haled in expected anatomical alignment increasing the risk of contractures, loss of function and increased risk of secondary OA
What are 3 common fractures in the elderly
- NOF
- Colle’s
- Vertebrae (wedge)
