Frac Mx Flashcards
General frac cx
Which drug SLOWS frac healing?!
Shock HEmorrhage RhABDO Infection Fat embolus = fat globules ret hemorrhage - late present
NSAIDS stop frac healing
Rest bed frac cx
DVT/PE
Infection
Muscle waste
Pressure sore
Anaesthetics frac cx
Anaphylaxis
Aspiration
Plaster cast frac cx
Stiffness
Pressure
Allergy
Neuro vasc dx
How to describe frac - iDOC
Intra/extra art
Displaced/Undisplaced
Open/closed
Complex/non-complex
Describe complex fracs
Comminuted 3+ frac lines
Wedge butterfly
Segmental 2 frac lines
Describe non-complex frac
Transverse
Oblique
Avulsion - tendon pull bit of bone off
Spiral
Late frac cx
Regional pain syndrome nerve dx assoc/not assoc
Ossificans myosotis - soft tissue calcification
AVN
Malunion - atrophic/hypertrophic -> pseudoarthroses
EMBOLUS FAT - ret hemorrhage, fat globules, petechaie
Immediate frac cx
Nerve - pain/NV cx - fix with angio vasc repair
Artery and vein #hemorrhage
Early frac cx
Infection
Compartment syndrome
Early
Explain compartment syndrome
Swell
Cap BF decrease
Compartment pressure > capillary bed pressure
Ischemia <6hrs
Pain 1/~ Sx / Parastheseia / Pulse still poss present - worse PASSIVE stretch
Fasciotomy
Analgesia
Limb level with body
Fluid @ myoglobinuria
How to treat open Frac
Aim=cover, splint/stablilise, Tet proph
Photo
ABCDE fluid/blood
VTE - LMWH/TES
Analgesia + AB’s
Reduce Hold Rehab
Reduce DISplaced/located ->
HOLD
non-op = splint/POP good 4 swell/fibreglass bad 4 swell: lighter but stronger
Op = k wire, IM nail, screw plate
->
Rehab=physio/OT
NOF arteries?
TX??!
Med/lat femoral circumflex + ligamentum teres
Look at pic 16:55pm @ 8/11/18
Tet and rabies vaccines
Tetanus:
Booster @ ?/not vacc
IgTet @ HRisk
No further action @ 5 full vaccines
Rabies:
Full vaccine
Ig Rab @ ?/not vacc
2+ vaccines @ immune
Necrotising fasciitis presentation + treatment?
Types and association?
Necrotising fasciitis presentation + treatment?
Types and association?
________
Haemorrhagic bullae pain
Urgent debride meant
IV antibiotics
Type 1 = post surgery at diabetes
Type 2 - GAS
Ulcer assoc with squamous cell cancer
@lower limb on chronic inflammation sites eg burns
Marjolins
Ulcer on toes and heels
PAINful
Pulseless and cold
Poss gangrene
Low ABPI
Arterial ulcer
Warm and pulses fine!!!
Sensory fucked
On plantar surface of
metatarsal head and hallux
Due to pressure
Cushioned shoes needed
Neuropathic ulcer
Venous insufficiency -> Venous hypertension ->
Fibrin, WCC, RBC leak
Pigmentation lipodermatosclerosis eczema
Venous ulcer
4 layer compression bandage
Larvae/debridement
Graft skin
What is phantom limb pain?
Hypersensitivity of divided nerves
Re-organisation of somatosensory cortex
+
proprioceptive memory –>
Other stimuli = pain
Complication of amputation?
Wound infection
Stump ischaemia/non-heal
Precious sore
Immobility
Wound healing stages
Bone healing stages
Primary and secondary intention healing
Hemostasis Inflammation Proliferation Remodelling
Haematoma
Inflammation
Callous (soft cart–> hard bone)
Granulation
Remodelling
Primary = wound edge approximated, epidermis dermis heal without penetration #SmallScars
Secondary = open wound – >granulate bottom two up #LargerScar
