BOAST Key points

Question 1

What key things should be done in ED for an open fracture?

Answer 1

Arterial vs PNI?
Abx within 1 hour
Tetanus up to date
Gross contamination removed
Photos
Saline soaked swab + Occlusive dressing
Plastics

Question 2

Which open fractures should go immediately to theatre?

Answer 2

Contaminated- agricultural, sewage, aquatic
Ischaemia

12 hours for high energy
24 hours for low energy

Question 3

When should definitive soft tissue coverage and stabilisation occur?

Answer 3

Within 72 hours

Question 4

How should you manage arterial injuries associated with fractures in ED?

Answer 4

Control major haemorrhage- direct pressure/tourniquet

Reduce/realign
Assess
If CT scan should have CTA without repositioning

Involve vascular/plastics

Question 5

How quickly should revascularisation occur in an arterial injury and how?

Answer 5

Within 4 hours

DIrect closure attempted first

If fails for shunting and skeletal stabilisation.

Then for interposition grafting rather than bypass grafting

Question 6

What else should you consent for with arterial injury in a fracture?

Answer 6

Fasciotomies and amputation

Question 7

What simple things can you do to improve nerve symptoms post op?

Answer 7

Loosen bandages, split plaster, reposition limb (relax nerve)

Question 8

How do you control the bleeding in pelvic trauma?

Answer 8

Pelvic binder
TXA
Major haemorrhage protocol
Packing if venous
Embolisation if Arterial

Question 9

How to reduce a pelvic fracture?

Answer 9

Pelvic binder
Traction for vertical sheer fractures

Question 10

If pelvic binder goes on what must you get?

Answer 10

Binder off xray!!!

Question 11

When should you take pelvic binder off?

Answer 11

Within 24 hours- under monitoring of haemodynamic stability

ASper local protocols
Post binder xrays!!!

Question 12

Important examination points for all pelvic trauma?

Answer 12

Open fracture finding
External genitalia, PV/PR, Blood at meatus- catheterise if scrotal swelling

Question 13

Talk through the urological injury algorithm for pelvic fractures

Answer 13

Single attempt at catheterisation allowed- 16ch
Look for blood at external meatus

If blood stained urine for retrograde cystogram

If frank blood/cannot be passed for retrograde urethrogram

Involve urology

Suprapubic catheter for urethral injury

Question 14

If there is a bladder/urethral injurywhich medication needs to be started?

Answer 14

As an open fracture- with antiobiotics

Question 15

If stable distal radius fracture what management should they have?

Answer 15

Consider for early mobilisation and a removable support

Question 16

What radiological parameters should be assessed in distal radius fractures?

Answer 16

Intra-articular step, dorsal angulation, ulnar variance/radial shortening

+ reflect on patient needs

Question 17

What to do if for surgical management and distal radius fracture can be reduced closed?

Answer 17

Consider K-wire fixation

Question 18

Timeperiod to fix intra and extra-articular distal radius fractures?

Answer 18

72 hours for intra

1 week for extra

Question 19

What other assessments should you consider for a patient with a distal radius fracture?

Answer 19

Bone health
Falls assessment

Question 20

What points in a history of an ankle fracture should you consider?

Answer 20

Peripheral neuropathy
Diabetes
Mobility impairement
PVD
Osteoporosis
Renal disease
Smoking
Alcohol excess`

Question 21

What to do with stabl ankle fractures and ones with uncertain stability?

Answer 21

Stable- let weight bear in a cast
?weight bearing xrays at one week in fracture clinic

Question 22

What ankle fractures are unstable?

Answer 22

Bimalleolar fractures
Trimal
Posterior mal >25%
Pilon
Medial malleolus fracture + talar shift
Weber B/C + talar shift

Question 23

What to consider with a patient with a suspected SCI?

Answer 23

Full in line spinal immobilisation
Blocks + collar
4 person log rolling
Nurse flat
I+V if resp failure
Cardiovascular support if Neurogenic shock
Catheterise +NGT

MRI post CT scan

Question 24

For a metastatic bone tumour when to do a sarcoma referral?
CT TAP?

Answer 24

Within 72 hours
Within 24 hous

Question 25

Where should bone biopsies occur for a sarcoma?

Answer 25

At the sarcoma centre

Question 26

What should happen prior to prophylactic fixation of MBD?

Answer 26

MDT decision about neoadjuvant treatment

Question 27

How to tell if tumour is more likely to be a primary bone tumour?

Answer 27

Bony destruction/formation, periosteal involvement, soft tissue swelling

Question 28

Important investigations in children with acute MSK infections?

Answer 28

Obs- septic?
Bloods- WCC, CRP, ESR, Blood cultures
Imaging- xrays
MRI (within 48 hours) + USS (concurrently)

Question 29

What is the first line management of Septic A?

Osteomyelitis, pyomyositis, or discitis?

Osteomyleitis with abscess formation?

Answer 29

Surgical Drainage

ABx

Surgical drainage

Question 30

What else should be examined in a child with suspected MSK infection?

Answer 30

Spine, all other systems, extremities

Question 31

How long should MSK infections in children be followed up for?

Answer 31

Minimum 12 months

Question 32

When is a DAIR indicated?

Answer 32

Acute PJI in a well fixed and functioning implant

Question 33

When should 1/2 stage revision be considered?

Answer 33

MDT decision- If sinus, loose implant, weird infections, immunocompromised patients, chronic infection, when pre op bacteria/sensitivities obtained, failed single stage

Question 34

What to do re sampling in a DAIR?

Answer 34

5 samples for MCS
2 for histo if uncertain re diagnosis/chronic infections

No abx until sampling

Question 35

Spiel for assessment of MSK infections in Kids?

Answer 35

Joint care
Full exam including spine
Exclude other sources
Blood cultures
Xrays
MRI +/- USS

Question 36

Spiel for management of MSK INfections in Kids?

Answer 36

If septic then BCs then IV Abx
If stable delay Abx till deep tissue samples (5 MCS, 2 Histo)

Surgery if abscess/septic A
Involve Micro
Consider PICC
F/U for 12 months minimum