A3: Grafting, fractures, ESF Flashcards
Why are open fractures more common on distal limbs?
Little soft tissue coverage
What is a grade 1 open fracture?
A small wound created by a fragment from the inside, no bone protruding
What is a grade 2 open fracture
Outside to inside, soft tissue damage and contusion, but reversible muscle damage and minimal tissue loss
What is a grade 3 open fracture?
More severe wound with lots of skin, soft tissue and bone damage
How can you further categorise grade 4 fractures?
By soft tissue, periosteal and vascular injury
What is the initial first aid for an open fracture?
Stop bleeding, cover with sterile dressing, support the fracture, take radiographs
What do you NOT do to an open fracture?
Leave the wound open or manipulate the fracture
In how many fractures is bacterial isolation successful?
Below 50%
Where do you take the bacterial culture from?
Deep tissue after lavage
Which bacteria cause post-traumatic osteomyelitis?
staphs
What do you use to lavage?
Large volumes of sterile isotonic fluid
What do you use to debride?
Scalpel blade
What’s the advantage of wet to dry dressings?
Provide debridement and encourage granulation tissue
What are the advantages of a stable environment for the bone?
Better healing, reduced SSI risk
What are the indications for internal fixation?
Grade 1, articular fracture, multiple orthopaedic injuries, ESF not possible, poor healing potential
What are the advantages of external fixation?
Preserves the soft tissue and haematoma which have important growth factors
Why do you use hanging leg preparation in orthopaedic surgery?
Can help align the fractures
How do you perform countertraction to reduce a fracture?
Slow force, muscles stretch and fracture reduces
How can you reduce a fracture that is overriding?
Use toggling (V shaped contact) for reduction
What’s the disadvantage of toggling?
Can cause fissures
How do you do Levering of a fracture?
Use a Hohman retractor to lever it and reduction forceps
What’s one final way to reduce a fracture?
A pusher pin with a plate on top
Where must the pins in an ESF engage?
Must engage two cortices
What are the three types of ESF frames?
Linear, circular or hybrid
How thin must transfixation pins be?
Below 33% bone diameter
What types of transfixation pins are there?
Smooth, threaded, negative profile (Ellis), positive profile (end threaded or centre threaded)
Where is the weak point of a negative pin?
Where the thread starts - must be inside the bone
What are two types of connecting clamps?
Kirschner-Ehmer or SK
What is a type Ia frame?
Unilateral and uniplanar
What is a tied-in IM pin?
Unilatera, uniplanar, with an IM pin tie-in
What is a type Ib frame?
Unilateral, but biplanar
What kind of pins do unilateral frames have?
Half pin as unilateral
What is a type 2b ESF?
Bilateral, uniplanar
What kind of pins do bilateral frames have?
Full pin as bilateral
What is a type 3 ESF?
Bilateral, biplanar
When do you use a circular frame (Ilizarov ring)?
Angular limb deformities
What are the three types of bone graft you can use?
Synthetic, autograft, allograft
What are the indications for a bone graft?
Complex fractures, poor healing potential, filling of bone defect, arthrodesis, intervertebral fusion, delayed or non-union
What are the advantages of doing a cancellous bone graft?
Provides matrix, releases growth factors, recruits stem cells
Where do you take bone grafts from?
Pelvis, distal femur, proximal tibia etc
When do you take the bone graft?
At the point in surgery you need it
What are the two types of autografts?
Vascularised (with the artery and vein) or non-vascularised
What are the three types of union?
Bone, clinical or radiographic
What is apposition?
The fracture fragments
What is alignment?
Bone and joints
What is apparatus?
The implants used
What is activity?
Evidence of healing
What is a clinical union?
No pain and can use normally
What is a radiographic union?
Evidence of mineralisation
