Basics of fracture management Flashcards
What is external fixation
External fixation – putting pins into the bones with a frame on the outside
What is an external monolateral frame
frame on one side
What is an external circular frame
rings around the bone
What is internal fixation
opening up the fracture and putting a metal device in to hold the fracture in the right position
What is a IM nail and what is it used for
IM nail – intramedullary nail – bone placed in centre of femur – fracture heals and the rod keeps it in the right position as it heals – used in long bone treatments
What is plate fixation
Plate fixation – plates hold the bones in place as they heal
What is the management of a suspected fracture
immobilisation and then pain relief
Then assess the fracture and see if there is actually a fracture, if the circulation is fine, any nerve damage and if the skin is open or closed
Radiology is then done
What is an open fracture
A fracture where there is direct communication between the external envionment and the fracture
What is the prophylaxis in open fractures and what is the main thing it is trying to prevent
broad spectrum antibiotics - trying to prevent tetanus - tetanus boosters or tetanus toxoid can also be given
What is the management of open fractures
Clean the open fracture - high pressure water can be used
Do not close the wound if the would is not clean
Fasciotomies if patient is at risk of compartment syndrome
What is a stable fracture
A fracture that will not move under physiological loading conditions
What are examples of unstable fractures which are succeptible to shortening
oblique - potential to be stable if less than 45 degrees
spiral
comminuted
What is an example of a stable fracture
transverse fracture
When does a fracture have to be reduced
reduce a fracture If it is out of place and if it heals in that position, it will cause problems
What are examples of conservative fracture treatment which allow for mobilisation
strapping
brace
What are the conservative fracture treatments which allow for immobilisation
cast
functional bracing
traction
What is 3 point loading
Curved cast with 3 points of fixation of pressure which hold the bone in position to heal
What is hydraulics
A brace is put around the fracture site which constrains the muscles around it - as force is put through the muscle and bone environment, the pressure is pushed against the outside environment which stops sliding of the fracture
What does it mean for a bone to be sticky
When a bone heals , it produces callous which stops the bone sliding - can push around the fracture and it would not be painful but still at risk of sliding when pressure is applied through it
What are the complications of traction
Blistering skin and compartment syndrome
What are the indications for external fixaton
Fractures with poor soft tissue conditions - open fractures
What are the complications of external fixation
Neurovascular injury
Pin tract infection
Loss of fracture alignment
The frames are heavy and can cause stiffening of the joints
The frame can stop union of the two parts of the fracture
When is intramedullary nailing indicated
Long bone fracture - it has to be nailed above and below the fracture
When are plates good for healing fractures
Healing fractures that affect the joints
What is a compression plate
squeezes the bone together
What is a neutralisation plate
resists rotating factors (spiral fractures)
What is a butress plate
A fracture which goes into a joint - plate pushes the bone back
