Basics of fracture management

Question 1

What does treatment depend on?

Answer 1

Stability
Patient factors
Closed vs open

Question 2

What are some patient factors to consider?

Answer 2

Fitness
Other injuries
Underlying conditions etc.

Question 3

What kind of fracture is completely stable?

Answer 3

Transverse

Question 4

What are unstable fractures?

Answer 4

Oblique
Spiral
Comminuted

Question 5

What is fracture stability?

Answer 5

How will the fracture deal with force applied longitudinally down the bone

Question 6

What are the 2 main differences for open fractures over closed ones?

Answer 6

Higher risk of infection

Higher risk of injury

Question 7

How are open fractures graded?

Answer 7

Gustilo

Type I-III

Question 8

How do we prevent bacterial growth in open fractures?

Answer 8

Tetanus and antibiotic prophylaxis

Photograph, cover and stabilise limb

Question 9

How are open fractures managed?

Answer 9

Infection prophylaxis
Excision and toilet
Leave wound open
Repeat wound review and toilet
Cover bone and skin over 5-7 days
Stabilise fracture

Question 10

What are the first considerations for treating fractures?

Answer 10

Immobilisation

Pain relief

Question 11

What are some conservative tactics for immobilisation?

Answer 11

Cast
Functional bracing
Traction

Question 12

What are some operative tactics for immobilisation?

Answer 12

Pins
External fixators
Intramedullary rods
Screws and plates

Question 13

What are some fracture managements which do not immobilise?

Answer 13

Strapping

Brace

Question 14

What are some cast principles?

Answer 14

Three point loading
Hydraulics
Rotational control

Question 15

What is three point loading?

Answer 15

Applying force in 3 places in order to correct alignment after a fracture

Question 16

How is skin traction given?

Answer 16

Applied via adhesive or non-adhesive tape

Question 17

What are some drawbacks of skin traction?

Answer 17

Blistering

Compartment syndrome

Question 18

How is skeletal attraction applied?

Answer 18

Pin or wire in bone

Femur and tibia common sites for skeletal traction

Question 19

What is a benefit of skeletal traction?

Answer 19

Allows greater force

Question 20

What are external fixators?

Answer 20

Pins or wires through skin and bone

Fixed to an external frame

Question 21

Why may external fixators be used?

Answer 21

Fracture with poor soft tissue conditions
Fragment reduction for distraction
Emergency pelvic stabilisation for haemorrhage control
Limb reconstruction

Question 22

What are some possible complications in external fixation?

Answer 22

Neurovascular injury
Pin tract infection
Loss of fracture alignment
(Joint contractures)
(Tardy union)

Question 23

When may intramedullary nailing be used?

Answer 23

Long bone diaphyseal fracture (tibia. femur, humerus, paeds)

Question 24

What are some advantages to IM nailing?

Answer 24

Incisions remote from fractures
Minimal fracture exposure
Joints free to move

Question 25

How do screws work?

Answer 25

Fix 2 pieces of bone together by compressing then fixing in position

Question 26

How do plates work?

Answer 26

Fixed to outside of bone with screws

Plate and bone share load

Question 27

What are some different kinds of plate treatment?

Answer 27

Compression - squeeze bone together
Neutralisation - Resist rotating forces
Buttress - stop collapse
Strut/bridging - No opening fracture