Classification Systems and Processes Flashcards
Outline the process of fracture healing? 1st stage
Formation of haematoma at fracture site
Angiogenesis of microvessels
Formation of granulation tissue
Deposition of mineral salts
Outline the process of fracture healing? 2nd stage
New woven bone formed from periosteum to form collar of subperiosteal bone around end of each bony fragment
Bridging callus formation in medullary cavity and progressive stabilisation of fracture site
Outline the process of fracture healing? 3rd stage
Cortical bone unites with endosteal bone formation
Ingrowth of fracture callus from medullary cavity into fibrous tissue at fracture site
Inflexible fracture site
Outline process of fracture healing? 4th stage
Occurs following union of cortical bone
Fracture site remodels along sites of stress and Haversian systems laid down along these
Remodelling - osteoclasts remove bridging callus
10 factors determining rate of fracture union?
Site of fracture
Degree of displacement
Degree of comminution
Poor immobilisation
Contamination
Blood supply
Soft tissue loss or destruction
Loss of periosteum
Comorbidities
Age
Complications of fracture healing by stage?
1 - poor blood supply or excessive mobility - cartilage formation instead of callus
2 - displacement inhibits bridging callus formation
3 - internal fixation can reduce likelihood of bridging callus formation and delay onset of mechanical stability
4 - rotational deformity can be harder to remodel
Process of staging pancreatic cancer?
Stepwise until uncurable/non-resectable disease demonstrated
CTCAP - if no mets or invasion of SMA/SMV then do
PET CT - for distal mets missed by CT.
If then negative to diagnostic lap to look for peritoneal disease.
Also E/MRCP for bile duct assessment
Classification system for open fractures? Outline grades
Gustilo and Anderson System depending on size of wound, degree of contamination and bony disruption
Grade 1 = low energy less than 1cm
Grade 2 = over 1cm with moderate soft tissue damage
Grade 3 = split into a, b, c depending on contamination and vascular injury where 3c is worst and has separate scoring system
What are grade 3 Gustilo Anderson open fractures? Separate scoring system for worst kind?
High energy injuries or wound over 10cm
a = no soft tissue defect good coverage
b = inadequate soft tissue coverage but no vascular injury
c = vascular injury
MESS mangled extremity scoring system predicts need for primary amputation
4 classification systems for hip fractures? Which is most commonly used? Outline?
Elderly intracapsular = Garden 1 - 4
Young intracapsular = Pauvel’s
Intertrochanteric = Evans
Subtrochanteric = Russell Taylor
What alternatives are there to red cell transfusion e.g. for Jehovah’s?
Iron transfusion
Autulogous methdos e.g. cell saver, wound drains post op
Haemodialysis, acute normovolaemic haemodilution
Cell free blood products
PCC, albumin, recombinant clotting factors etc
