Assessment of Fractures Flashcards
What are some types of fractures?
Complete, transverse, oblique, spiral, comminuted, incomplete, bowing, buckle, green stick, growth plate injuries, intra/extra-articular
Where may fractures occur in the bone and what are some ways displacement can occur?
Location = diaphysis, metaphysis, epiphysis Displacement = angulation, translation, rotation, distracted, impacted
Where is it common for there to be other fractures above or below the main fracture?
Forearm and ankle at the joint
What are some features of fracture documentation?
Legible and avoid acronyms, accurate description from patient, was it witnessed?, perceived external threats?
What are you looking for on examination?
Likely pattern of injury based on age and mechanism, look for distracting injuries, zone of injury, open or closed, skin integrity
What patient functions should be assessed?
General limb function, neural and vascular status
How can fractures be imaged?
Plain x-ray, CT, MRI
What does oNVD mean?
Patient has no neural deficit
What should be involved in a neurovascular assessment?
Understand peripheral innervation of upper and lower limbs, and examine sensation and motor for each main peripheral nerve
Why do you need to perform an examination?
Establish baseline function, identity potential for infection, assess for compartment syndrome and permanent loss of function
What causes acute compartment syndrome?
Interstitial pressure increasing in closed osseofascial compartments = causes micro vascular compromise
What are some common sites of acute compartment syndrome?
Anterior and deep posterior compartment of leg, volar compartment of forearm
At what pressure does significant muscle damage occur?
Compartment pressures > 30-40 mmHg or within 10-30 mmHg of diastolic
What are some causes of compartment syndrome?
Tibial fractures (especially in men aged 10-35), forearm fracture, IVDA, comatose prolonged lie, anticoagulation with trivial trauma, burns
What are some symptoms of compartment syndrome?
Disproportionate pain, pain on passive stretch of muscles in involved compartment, paraesthesia
How is compartment syndrome treated?
Immediate release of all dressings/cast to skin, don’t elevate, phone senior for help, theatre for emergency fasciotomy
How should open injuries be managed initially?
Stop haemorrhage and then splint extremities
What should be documented with an open injury?
Location and size of wound, nature incised wound or laceration, possible degloving, capillary refill, posterior tibial and dorsalis pedis pulses, tendon action
What are some examples of neck pain where the patient should be referred for cervical spine imagine?
Fall from > 1m or 5 stairs, axial load to head, high speed RTA (combined speed >60mph), roll-over vehicle RTA, age >65, injured >48hrs earlier, known vertebral disease
Patients with what score on the GCS should get cervical spine imaging?
Score <15 on assessment on ED or paralysis, focal neurological deficit or paraesthesia in extremities
What blood pressure and respiratory rate qualify a patient for cervical spine imaging?
Systolic BP <90 mmHg
Respiratory rate outside of range of 10-24 breaths/minute
What are flexion distraction injuries?
Uncommon injury caused by spine failing in tension = fall from height, RTA, 2 point seatbelt restraint
What are some features of flexion distraction injuries?
Disruption of PCL, horizontally orientated fracture pattern, grossly unstable, bony or ligamentous, high rate of GI injuries
What occurs in flexion distraction injuries?
Middle and posterior columns fail under tension = anterior column under compression
How are flexion distraction injuries treated?
Operative stabilisation = posterior short segment stabilisation, pedicular screws in compression/fusion
What are the aims of surgery for flexion distraction dislocations?
Restore stability, correct deformity and optimise neurological recovery
