29 April Flashcards
What are the 5 stages of fracture healing? Include a time scale.
- Haematoma
- Inflammation and proliferation (8 hours)
- Soft callus formation - woven bone in callus (6-14 weeks)
- Consolidation - woven bone replaced by lamellar bone
- Remodelling to normal structure - years
What are the indications for open reduction as opposed to closed?
Articular #
Avulsion #
Failed closed reduction
If operation needed anyway - first step before internal fixation
What is the advantage of healing by callus formation rather than direct union?
Ensures mechanical strength is built up
What are the causes of non-union?
Severe soft tissue damage Fragments separated Excessive movement Poor blood supply Abnormal bone Infection
What are the indications for internal fixation?
Articular #
Pathological #
AVN risk
Unstable and prone to re-displacing
What are the indications for external fixation?
Infection
Bone loss
Multiple severe #’s
What classification system is used for open fractures?
Gustilo-Anderson
1: <1cm and clean
2: 1-10cm and clean
3A: >10cm but enough soft tissue coverage
3B: >10cm and not enough soft tissue coverage
3C - All injuries with vascular injury
What extra management do open fractures require?
Remove gross contaminants Abx Tetanus Photograph wound Cover with saline gauze Surgical debridement and ORIF if needed.
What is the biggest risk of internal fixation?
Sepsis
What blood tests would you order for a patient presenting with an open #?
Baseline (FBC,U&E,CRP)
Clotting screen
Group & Save
List early local complications associated with fractures?
Visceral damage Vascular damage Nerve damage Haemarthrosis Compartment syndrome Infection Gas gangrene
Which vessels are at risk from which fracture?
1st rib: subclavian Shoulder dislocation: axillary Humerus supracondylar: brachial Elbow dislocation: brachial Pelvic #: internal iliac Femoral supracondylar: femoral Knee dislocation: popliteal
Which nerves are at risk from which fracture?
Shoulder dislocation:axillary Humeral shaft: radial Humeral supracondylar: radial + median Medial epicondyle: ulnar Elbow dislocation:ulnar Hip dislocation: sciatic Knee dislocation: perineal
What are the signs of compartment syndrome?
Pain disproportionate to injury Pain worse on passive movement Generalised muscle tenderness Paraesthesia in cutaneous nerve distribution If progression - 6 P's of ischaemia
What organism commonly causes gas gangrene?
Clostridium welchii
Anaearobic, dirty wounds, toxins destroy cell walls to spread rapidly. Brown discharge.
