39: Basics of Fracture Management

Question 1

what is an open fracture?

Answer 1

• a fracture in which there is a direct communication between the external environment and the fracture.
• usually through a break in the skin, but not always e.g. fragments of bone from a fractured pelvis penetrating the rectum

Question 2

what classification is used for open fractures?

Answer 2

Gustilo

Question 3

open fractures management

Answer 3

• tetanus and antibiotic prophylaxis within 1 hour
• image, cover and stabilise limb, remove and gross contamination, check and document neurovascular status
• surgical emergency e.g. if there is gross contamination/farmyard/sewage > all operations within 24 hrs
• definitive treatment in orthoplastics unit

Question 4

what is a stable fracture?

Answer 4

one that will not move under physiological loading conditions
- complete stability e.g. transverse fracture
- potential stability e.g. oblique fractures < 45 degrees

Question 5

what are the different types of fracture treatment?

Answer 5

Conservative:
- no immobilisation e.g. strapping, brace
- immobilisation e.g. cast, functional bracing, traction

Operative:
- pins
- external fixators
- intramedullary rods
- screws and plates

Question 6

what is functional bracing?

Answer 6

• used for long bones e.g. femur, tibia, humerus
• brace in which joints are left free to mobilise
• once bone ‘sticky’
• stops bending

Question 7

what is traction?

Answer 7

A method of applying axial force to the limb to:
- Immobilise it
- Reduce pain
- Minimise further soft tissue damage & blood loss
- Align the limb (or axial skeleton)
- Allow movement around bed
- Permit nursing care
- Minimise limb shortening

Question 8

list some common indications for external fixation

Answer 8

• fractures with poor soft tissue conditions inc. open fractures
• where distraction through the fixator may help with fragment reduction
• emergency pelvis stabilisation for haemorrhage control
• limb reconstruction

Question 9

list some complications of external fixation

Answer 9

• neurovascular injury
• pin tract infection
• loss of fracture alignment
• (joint contractures)
• (Tardy union)

Question 9

when is intramedullary nailing indicated?

Answer 9

long bone diaphyseal fracture

Question 10

what are the different plate types?

Answer 10

• compression: squeeze bone together
• neutralisation: resist rotating forces (spiral fractures)
• buttress: stop collapse
• strut/bridging: no opening fracture, more like external nail