day 3 - Principles of Fracture Management

Question 1

Bone healing process

Answer 1

Haematoma / cell injury releases gf / cytokines→inflammation
Mesenchymal precursors differentiate to osteoblasts
Lay down osteoid - primitive bone tissue (soft callus) which ossifies (hard callus)
Callus = mass of new bone at fracture site
6-12/52 ossification with mechanical strength
Remodelling months to years

Question 2

Perkins’ rule of thumb for union of bones during healing

Answer 2

Child upper limb ~ 3/52

Double for the lower limb ~ 6/52

Double for adult
Upper limb adult ~ 6/52
Lower limb adult - double the time ~ 12/52

Double time for high energy / open fracture
Assess union clinically & radiographically

Question 3

what is a compound fracture

Answer 3

A wound communicating with a fracture

Question 4

Principles of treatment of fractures

Answer 4

Reduce the fracture
 - Traction (ligamentotaxis)
 - +/-Increase deformity to engage fragments
Hold Immobilised until unites
 - Stability determines method
Rehabilitate
 - Stiff joints
 - Wasted muscle

Question 5

Methods to treat fractures

Answer 5

Non-operative = conservative
Sling / ‘Collar & cuff’
Plaster cast
Traction

Operative: 
Internal fixation (Open Reduction Internal Fixation)
 - Intra-medullary (nail)
 - (Cortical) Plate / screws / wiring
Replacement (involving a joint)
External fixation
Mono-axial / hybrid / circular

Question 6

Compartment syndrome

Answer 6

Extreme swelling in a confined fascial space
Disproportionate pain
Increasing analgesia requirements
Pain on passive movement of muscles / tendons of the compartment
New / progressive neurological symptoms
Pulses usually present
Can measure pressure (normal ~ 5mmHg)
∆p (diastolic – compartment pressure) < 30mmHg means tissue perfusion critical
Treatment = fasciotomy