Basics of Fracture Management Flashcards
How stable are the following fractures:
- transverse
- oblique
- spiral
- communited
- oblique
- Complete stability
- Transverse
- No stability to shortening
- Oblique
- Spiral
- Communuted
- Potential stability
- Oblique
- <45 degrees, as they move towards transverse fractures
- Oblique
When is an oblique fracture considered stable?
- <45 degrees, as they move towards transverse fractures
What are the 2 main ways that open fractures differ from closed fractures?
- Higher energy of injury
- Higher risk of infection
What system is used to classify open fractures?
Gustilo grading
Describe Gustilo grading?
Describe the management of open fracture?
- Tetanus and antibiotic prophylaxis
- Photograph, cover and stabilise limb
- Surgical emergency
- All operations within 24 hours
- Some operations within 6 hours
- Wound excision, skin is left open to allow going back and reviewing, skin closed by 5-7 days, stabilise fracture definitively
Describe the general treatment of fracture?
- Initial
- Immobilisation
- Pain relief
- Assessment
- Clinical
- Fracture, circulation, neurological, closed vs open
- Radiological
- Clinical
- Definitive treatment
- No reduction required
- Reduction required
- LA, GA, other
- Maintenance of position
- Conservative
- No immobilisation
- Strapping
- Brace
- Immobilisation
- Cast
- Cast principles are three point loading, hydraulics (stops soft tissue bulging out by circumferential constraints) and rotational control by including joint above and below
- Functional bracing
- For long bones
- Stops shortening and bending, allowing joints to be free to mobilise
- Traction
- Applies axial force to tighten soft tissue and align bone, producing closed reduction
- Left on provides continuing maintenance reduction
- Usually done by skin traction
- Danger of blistering and compartment syndrome
- Can use skeletal traction to put more weight on
- Allows greater force
- Common sites are femur and tibia
- Cast
- No immobilisation
- Operative
- External fixation
- Means to fix bone from outside
- Uses pins or wires passed through skin and bone, attached to external frame
- Additional wires can be used to pin fragments together, not attached to frame
- Indications include
- Fractures with poor soft tissue conditions
- Where distraction through fixator may help with fragment reduction
- Emergency pelvic stabilisation for haemorrhage control
- Limb reconstruction
- Fixator types are unilateral, multilateral or circular
- Possible complications
- Neurovascular injury
- Pin tract infection
- Loss of fracture alignment
- Internal fixation
- Intramedullary nailing
- Indication is long bone fractures
- Usually used in tibia, femoral, humeral and some paediatric
- Technique is
- Patient positioned > fracture reduced > incision at entry point and x-ray guided wire inserted > canal reamed > nail passed > bone locked onto nail
- Indication is long bone fractures
- Screws and plates
- Used for bones other than long bones
- Different types of screws, cortical vs cancellous
- Different sizes of screws depending on bone size
- Plates are fixed outside of bone with screws, they load share with bone, initially taking more weight
- Different plate types includes
- Compression – squeeze bone together
- Neutralisation – resist rotating forces (spiral fractures)
- Buttress –stops collapse
- Strut/bridging
- Intramedullary nailing
- External fixation
- Conservative
Describe the initial treatment of fracture?
- Immobilisation
- Pain relief
What is fracture reduction?
Repairing the fracture to correct alignment
What are conservative options for maintanence of position in fracture management?
- Conservative
- No immobilisation
- Strapping
- Brace
- Immobilisation
-
Cast
- Cast principles are three point loading, hydraulics (stops soft tissue bulging out by circumferential constraints) and rotational control by including joint above and below
-
Functional bracing
- For long bones
- Stops shortening and bending, allowing joints to be free to mobilise
-
Traction
- Applies axial force to tighten soft tissue and align bone, producing closed reduction
- Left on provides continuing maintenance reduction
- Usually done by skin traction
- Danger of blistering and compartment syndrome
- Can use skeletal traction to put more weight on
- Allows greater force
- Common sites are femur and tibia
-
Cast
- No immobilisation
What can be used for maintanence of position that allows mobilisation?
- Strapping
- Brace
What can be used for maintenance of position but does not allow mobilisation?
Cast
Functional bracing
Traction
What are the cast principles?
- Cast principles are three point loading, hydraulics (stops soft tissue bulging out by circumferential constraints) and rotational control by including joint above and below
For what kind of bones is functional bracing used for?
- For long bones
- Stops shortening and bending, allowing joints to be free to mobilise
How does traction work?
- Applies axial force to tighten soft tissue and align bone, producing closed reduction
- Left on provides continuing maintenance reduction