Basics of fracture management Flashcards
What does treatment depend on?
Stability
Patient factors
Closed vs open
What are some patient factors to consider?
Fitness
Other injuries
Underlying conditions etc.
What kind of fracture is completely stable?
Transverse
What are unstable fractures?
Oblique
Spiral
Comminuted
What is fracture stability?
How will the fracture deal with force applied longitudinally down the bone
What are the 2 main differences for open fractures over closed ones?
Higher risk of infection
Higher risk of injury
How are open fractures graded?
Gustilo
Type I-III
How do we prevent bacterial growth in open fractures?
Tetanus and antibiotic prophylaxis
Photograph, cover and stabilise limb
How are open fractures managed?
Infection prophylaxis Excision and toilet Leave wound open Repeat wound review and toilet Cover bone and skin over 5-7 days Stabilise fracture
What are the first considerations for treating fractures?
Immobilisation
Pain relief
What are some conservative tactics for immobilisation?
Cast
Functional bracing
Traction
What are some operative tactics for immobilisation?
Pins
External fixators
Intramedullary rods
Screws and plates
What are some fracture managements which do not immobilise?
Strapping
Brace
What are some cast principles?
Three point loading
Hydraulics
Rotational control
What is three point loading?
Applying force in 3 places in order to correct alignment after a fracture
How is skin traction given?
Applied via adhesive or non-adhesive tape
What are some drawbacks of skin traction?
Blistering
Compartment syndrome
How is skeletal attraction applied?
Pin or wire in bone
Femur and tibia common sites for skeletal traction
What is a benefit of skeletal traction?
Allows greater force
What are external fixators?
Pins or wires through skin and bone
Fixed to an external frame
Why may external fixators be used?
Fracture with poor soft tissue conditions
Fragment reduction for distraction
Emergency pelvic stabilisation for haemorrhage control
Limb reconstruction
What are some possible complications in external fixation?
Neurovascular injury Pin tract infection Loss of fracture alignment (Joint contractures) (Tardy union)
When may intramedullary nailing be used?
Long bone diaphyseal fracture (tibia. femur, humerus, paeds)
What are some advantages to IM nailing?
Incisions remote from fractures
Minimal fracture exposure
Joints free to move
How do screws work?
Fix 2 pieces of bone together by compressing then fixing in position
How do plates work?
Fixed to outside of bone with screws
Plate and bone share load
What are some different kinds of plate treatment?
Compression - squeeze bone together
Neutralisation - Resist rotating forces
Buttress - stop collapse
Strut/bridging - No opening fracture
