2: Simple Practical Procedures Flashcards
What are the 3 principles of fracture management
- Reduce
- Hold
- Rehabilitate
What is reduction of a fracture
Fractures are re-aligned
What is immobilisation
A joint or bone is held in place using a splint, cast or brace
What is the purpose of immobilisation
To protect damaged structures and prevent further damage
What is the most common method of immobilisation
Splint or plaster cast
What type of cast should not be used in the first 2W following a fracture and why
Circumfrential cast
What type of case should be used in the first 2W
Back-slab cast
When is a total hip replacement indicated
OA of the hip
What structure are approaches for total hip replacement referenced to
Gluteus medius
What are the approaches for total hip replacement
- Anterior
- Anterolateral
- Lateral
- Posterior
What is the most common approach for total hip replacement
Posterior
What is the main advantage of posterior approach
Does not disrupt the hip abductors and therefore enables quick recovery
What is the main disadvantage of the posterior approach
Increased risk of damaging sciatic nerve
What are the main advantages of the anterior approach
Avoids abductor muscles permitting quick recovery
What is the main disadvantage of the anterior approach
There is a 10% risk of loss of sensation over distribution of the lateral femoral cutaneous nerve
Explain what happens in the anterolateral approach
The abductors are removed and excessive adduction to expose the acetabulum
What is the advtange of the anterolateral approach
It does not disrupt the superior reticular vessels and therefore reduces risk of avascular necrosis
What are disadvantages of anterolateral approach
Slow recovery
Risk of damage to superior gluteal nerve
What is the advantage of lateral approach
Lower dislocation rate
What is the main disadvantage of the lateral approach
Abductors are disrupted - resulting in longer recovery
Explain approach of total knee arthroplasty
There is a cap approached to femur and tibia with a plastic space between
What is arthroscopy
small incision is made in the joint and endoscope used to visualise within the joint
What procedure can arthroscopy be used for
meniscectomy
How can a tear in the outer 1/3 of the meniscus be repaired
sutured - due to being highly vascular
How can a tear in the inner 1/3 of the meniscus be repaired
trimmed - due to being avascular
How can a tear in the middle 1/3 be repaired
sutured or trimmed
Explain ACL reconstruction
Surgical tissue graft is used to replace the ACL ligament. Native ACL can either be removed (more common) or the graft can be sewn inside
What is used to perform an ACL reconstruction
Arthroscopy
What can be used as autografts for ACL repair
- Patella ligament
- Hamstring tendon
What can be used as allografts for ACL repair
Following from a cadaver:
- Patella ligament
- Tibialis anterior tendon
- Achilles tendon
When is a reverse shoulder replacement indicated
If the rotator cuff muscles are torn (or rotator cuff arthropathy)
What is wound debridement
surgical removal of devitalised tissue
What is carpal tunnel decompression
flexor retinaculum is cut releasing pressure on the median nerve
What are 5 complications of carpal tunnel syndrome
Infection Trigger thumb Scar Nerve damage Incomplete decompression
What is open reduction
Fracture fragments are surgically exposed by dissecting tissues and reduced. Often accompanied by internal fixation
When is open reduction with internal fixation performed
- Open Fracture
- Pathological Fracture
- Fracture w/neurovascular compromise
What are 3 risks of ORIF
- Infection
- Neurovascular injury
- Malunion
What is closed reduction
Manipulation of fragments without surgical exposure
What are 3 advantages of closed reduction
- Lower risk of infection
- Removes skin tension and reduces swelling
- Quick healing
What are 2 disadvantages of closed reduction
- Neurovascular injury
- VTE
What are kitschier wires
Thin flexible wires used to hold fracture fragments together as a temporary measure of open reduction and internal fixation
What are plates
Internal splints that hold parts of broken bone together. May be left in place or removed following healing.
What is intra-medullary nailing
A metal rod is nailed into medullary cavity following long bone fracture
What are the 5 types of complete fracture
- Transverse
- Oblique
- Spiral
- Comminuted
- Segmental
What is a transverse fracture
complete fracture horizontal to the long axis
What is an oblique fracture
fracture oblique to long axis of the bone
What is a spiral fracture
severe oblique fracture with rotation along the long axis
What is a comminuted fracture
fracture into more than 2 segments
What is a segmental fracture
More than two fractures within a long bone
What is a salter-harris fracture
Fracture of a growth plate
What are 3 types of incomplete fracture
- Greenstick
- Bowing
- Buckle
What is bowing
bending of a bone
What is buckle fracture
fracture on concave aspect of bone
What is a green-stick fracture
fracture on convex aspect of bone
