Basic orthopaedic principles Flashcards
What are the 3 broad principles of orthopaedics
improve pain
reduce disability
improve function
What are the 4R’s of fracture treatment?
Resuscitate - ABC, blood, pelvic binder, power tourniquet
Reduce - realign the fracture back to it’s normal position (retract and then realign fracture)
Retain - externally or internally stabilise the joint. Cast is the main option for retaining. Can perform internal retaining with plates/screws
Rehab - promote healing through a good bone environment by applying the correct force as force increases bone turnover and stability.
Name some ways we can stabilise a joint
- Sling, cast, splint
- Screws, plates, nails
- Bed rest until bone becomes ‘sticky’
- Wires, halo (neck fractures), frames, intramedullary rod.
What are the ABCs of orthopaedic x-ray?
A - alignment - look for dislocation
B - bone - look for fractures.
C - cartilage - look for widened joint
If there is a fracture away from the growth plate in a child, is there a good or bad chance it will heal?
Good chance
If it is close to the growth plate, there is a worse chance of it healing
What is the difference between a transverse, oblique and spiral fracture?
A transverse fracture occurs when a bone breaks at a 90-degree angle to the long axis of the bone.
Oblique fracture: angled pattern more likely in elderly
Spiral: one part of the bone has twisted at the breaking point - more common in young patients.
Difference between comminuted, segmental and impacted fractures?
Comminuted - bone shattered into multiple pieces - indicates higher force and takes longer to heal
Segmental - fracture composed of at least two fracture lines that together isolate a segment of bone, usually a portion of the diaphysis of a long bone.
Impacted - An impacted fracture occurs when two pieces of a fractured bone are driven into each other. Because it involves more than a break in the bone, it is more serious than a simple fracture.
What is meant by angulation, shortened, translated and rotated fractures?
Angulation: bone ends pointing in opposite directions (breaking stick in half)
Shortening: Proximal migration of the distal fracture component results in shortening of the overall bone length
Translated/translocation: describes the movement of fractured bones away from each other.
Rotation: where there has been a rotation of the distal fracture fragment in relation to the proximal portion.
4 stages of bone healing?
Resting
Resorption - osteoclast resorb
Formation - osteoblast form
Mineralisation
Callus formation
- Injury causes bleeding
- Soft callus
- Mineralisation of soft callus - bony callus - more stable (6wks to 6months)
- Remodelling of bony callus
What things are required for direct bone healing to occur? Do we achieve absolute stability or relative stability?
- Gap <1mm osteoclasts and blasts can heal bone
- Absolute stability achieved
- Simple fracture
- Bone compression using screws etc
- No callus formation
When does indirect bone healing occur? Do we achieve relative or absolute stability?
- Most common way most fractures heal
- Usually for more serious, high impact fractures with multiple segments
- Achieve relative stability and limited movement to encourage soft callus formation into bony callus.
Factors which affect bone healing
- patient
- injury
- surgical
- post op
patient factors
- age, PMH, frailty, drug hx - corticosteroids
- NSAIDs, smoking (bones heal 7x slower), nutrition (vit c)
Injury factors
- High energy vs low energy
- Pattern of the fracture
- Open fractures and risk of infection
- Multiple injuries or neurovascular involvement
Surgical technique
- asepsis
- blood supply and soft tissue
- choice of fixation or stability
Post op
- Physiotherapy
- Complications: infection, implant failure and bone failure.
