19. Principles of fracture management

Question 1

Complications of surgery

Answer 1

Loss of life
Loss of limb
Loss of function

General/Systemic
CVS,RS,GIT,GUS,NS
Specific/Local
Infection
Dislocation
Neurovascular damage
Fracture
Metalwork failure
Operation specific

Question 2

Trauma acute management

Answer 2

ATMIST
Age
Time
Mechanism
Injuries (top to toe)
Signs
Treatment

Question 3

Airway

Answer 3

With cervical spine control
Give oxygen

How do you control the cervical spine?

Question 4

Life threatening A&B problems

Answer 4

A ir Obstruction
T ension pneumothorax	
O pen pneumothorax
M assive haemothorax
F lail chest
C ardiac tamponade

Question 5

physiology of shock

Answer 5

Tachycardia
Decreased pulse pressure
Altered conscious level
Decreased urine output
Reduced BP (late)

assess urine output

Question 6

Save limb?

Answer 6

Only once life saved and patient stabilised
Vessels
Nerves
Bones
Soft tissue/muscles

Question 7

Compartment syndrome

Answer 7

Occlusion of venous outflow
Increasing pressure in an enclosed space
Venules damaged usually, pressure builds up
Present with: pain much more than expected
Treat with fasciotomy if severe
If miss it muscle contracts permanently and get Volkman’s ischaemic contracture

Question 8

History of fracture management

Answer 8

AMPLE
Allergies
Medications
Past Medical Hx
Last meal 
Environment/Event
	(incl Temp)

Question 9

Red flags with specific fracture history

Answer 9

Red flags
	• Vessels
	• Nerves
	• Soft tissues
		○ Viability
		○ Compartment
	• Children (safeguarding)

Question 10

Fracture examination

Answer 10

Start at the top, remember ATLS
Listen to the patient
Remember your anatomy
LOOK
FEEL (carefully)
MOVE (carefully)
SPECIAL TESTS (nerves and vessels)

Question 11

Fracture management

Answer 11

Relieve pain
Analgesia
Splint the bone
Avoid further damage
Reduce dislocations
Straighten bent limbs
Re-establish circulation
Relieve pressure on nerves close by
Open Fractures......?

Question 12

Fracture management - investigations

Answer 12

X-rays
• Two views
• Two joints
Two times?

Question 13

X-ray description

Answer 13

Which bone
Where in the bone
- Intra-articular
- Epiphysis
- Physis
- Metaphysis
- Diaphysis
What sort of bone
Normal, Pathological

Question 14

Fracture pattern description

Answer 14

Simple
Transverse, oblique, spiral
Comminuted
How many parts?
Displaced
Angulated, translated, burst
Special Types
Greenstick, avulsions

Question 15

Fracture management - the basics

Answer 15

1. Reduce
   
   2. Stabilise
   3. Rehabilitate

Question 16

management 1. Reduce

Answer 16

closed vs open
Correct:
- Length
- Alignment
- Rotation

Question 17

management 2. stabilise

Answer 17

External – sling, POP, external fixator
Internal – wires
intramedullary (nail)
extramedullary (plates)

Question 18

polytrauma care

Answer 18

Damage Control
Vs
Early Total Care

Physiological parameters
- Acidosis (Lactate<2)
- Hypothermia
- Coagulopathy
= terrible triad of trauma

Question 19

Non-union causes

Answer 19

Biological
hypovascular

Mechanical
poor frx stability

Question 20

Paget’s diseases

Answer 20

Pathological fracture – Pagets
Trabecular coarsening
Cortical thickening 
Deformity/bowing
Pathological fractures
Sclerosis

Question 21

Fracture management

Answer 21

Rehabilitation
Essential
Complications of surgery
Yes there are
KISS
…..again ‘Primum non nocere