Dr Beaver's tute - how to reduce and splint a fracture and complications Flashcards
closed reduction
adequate anaesthesia - not just Panadol. need local, regional, or general anaesthetic.
how to nerve black the arm
nerve block the brachial plexus in the supraclavicular region to effect the ulnar, median and radial nerve and numb out the arm
bier’s block
method of using local anaesthetic to numb out the arm with a tournequet
if the tourniquet fails the patient goes into VF and dies
how to reduce a fracture of long bone
traction - pull outward
convex side - the periosteum is torn
concave side - the periosteum is intact
increase the deformity toward the concave side where the periosteum is intact
return to anatomical position
do not tear the intact periosteum as this will mean the surgeon will have to operate as the fracture will become unstable
what does a backslab do
applies three points of contact to support the fracture
general systemic complications of a fracture
blood loss
shock
fat embolism
ARDS
DIC
crush syndrome
urgent local complications of fracture
urgent (immediate treatment is needed):
injuries to nerves, vessels or soft organs, neurovascular compromise eg. spinal fracture damages spinal cord, pelvic fracture damages bladder
compartment syndrome
local bleeding
infection (if its an open fracture)
gas gangrene
what is gas gangrene
clostridium bacteria producing gas
gram positive spore forming bacteria that are obligate anaerobes (no oxygen). they produce gas as a byproduct.
can be lethal
indication of gas gangrene
subcutaneous emphysema
crackles when you push on the skin
if a wound is contaminated by soil, manure, clothing, older than 12 hours, is a battle wound (war, military), containing foreign material, or if you’re not sure what should you do
DO NOT CLOSE THE WOUND
risk trapping bacteria and causing gas gangrene.
reasons not to close a wound
if a wound is contaminated by soil, manure, clothing, older than 12 hours, is a battle wound (war, military), containing foreign material, or if you’re not sure
you will never kill anyone by not closing a wound
less urgent complications of fracture
skin problems eg. degloving wounds
pressure wound from bad casting technique
nerve entrapment
heterotypic ossification
ligament injury
stiffness
no complete plaster should ever be put on an
acute fracture
never ever or Dr beaver will kill you
only put a back slab (open on one side but has three points of contact)
heterotypic ossification
formation of bone in the soft tissues which may block a joint
stiffness
caused by spending a long time with the joint still while its healing
that’s why we internally fix fractures instead of causing them so people can go to the physiological and move their joints.
