AO_chapters Flashcards
preop management of fx patient
ABCDairway, breathing, circulatory, other disabilitiesSPO2, auscult, IV access/fluids, imaging, full ortho neuro PE
benefits to pain mgmt for fx patient
decrease anxiety/stress and it’s associated hormonal and metabolic derrangementsprovide patient comfort
most effective analgesic time period
PRIOR to onset of pain (surgery)
advantages of multimodal pain therapy
selectivity to target multiple sites of pain pathadditivite/synergismreduced dosingreduced toxicity
define neuroleptanalgesia
combo of neuroleptic drug (ace) and analgesia (opioid)
infection rate of CLEAN ortho procedures
2.5-4.8%
most common isolate causing ortho infxn
Staph intermedius
host risk factors for sx infection
age (>8yrs) obesitydistant infection, endocrinopathyinadequate skin prepprolonged axpropofol
intraop risk factors for sx infection
sx > 90 mexcessive electrocauterybreak in asepsisbraided/multifilament sutureimplants
use of periop prophy Ab decreases rate of infxn_______
use of periop prophy Ab decreases rate of infxn 4 fold in clean procedures.
traditional recommendation for prophy Ab in clean procedure
in clean procedures generally NOT indicated UNLESS>90m surgerymetal implants usedextensive ST damagecefazolin–bactericidal given IV 30 min prior to sx
AO fracture classification
1 humerus2 RU3 femur4 tib/fib1=prox2=shaft3=distalA= single fxB= wedge/butterflyC=complex
open fracture classification
I. bone penetration thru skin (small puncture hole/laceration < 1 cm); CLEANII. > 1cm laceration with fracture communicating with skin; mild ST traumaIII. A severe comminution; hi energy, ST flaps but available for wound coverageIII. B severe comminution; hi E; bone exposure; periosteum strippedIII. C severe comminution; hi E; bone exposed with damage to arterial blood supply
physeal fracture classification
Salter HarrisI growth plate II growth plate metaphysealIII growth plate epiphyseal (intraarticular)IV metaphyseal/epiphyseal (intraarticular)V compressionVI asymmetric compression
objectives for fracture repair
reduction/alignmentrigid stabilization/immobilizationmaintain blood supplyearly return to normal function
mechanical and biological factors for fractures
mx: fx configuration, reconstruction or not, concurrent ortho injurybx: age, fracture location, ST injury
pros/cons to open vs closed reduction of fx
open: visualization, bone grafting, anatomical recon BUT incr sx time and ST injury/blood supplyclosed: preserve ST/blood supply, decr contamination BUT at the expense of fracture alignment/recon
Three ways of fracture planning
direct overlaybone specimenintact contralateral bone
major benefit of fully reconstructed boney column
shares the wt bearing load of the limb during fx healing
review of post op radiograph criteria
4 AsA=appositionA=alignment (50% is necessary to prevent delayed union)A=apparatusA=activity
rehabilitation goals
prevents musculoskeletal disabilitydecreases healing timefacilitates restoration of normal function
rehab includes
cryotherapy–ICE in acute < 72 hr period; vasoconstrict, min fluid/edema, decr nerve conduction, encourage muscle relax; w compression decr temp by 27 deg Cheat therapy– > 72 hr period, vasodil (NOT in nerve patient); incr metabolismmassage–incr local circulation, decr muscle spasm, attentuate edema, brkdown scar tissuetherapeutic exercise–pROM; maintain normal joint motion, sensory awareness, blood flow improvement; build strength, agility/coordinationtherapeutic US–treats chronic scare and adhesions NM stimulation–creates artificial contraction
types of massage
EFFLEURAGE–superficial/light strokingPETRISSAGE–kneadingTAPOTEMENT–percussion/tapping
biological fracture healing goals
flexible fixationeliminate anatomic reconstructioncreate axial alignmentless surgical traumaindirect bone healing w calluspreserve blood supply