Frac Mx

Question 1

General frac cx

Which drug SLOWS frac healing?!

Answer 1

Shock
HEmorrhage 
RhABDO
Infection 
Fat embolus = fat globules ret hemorrhage - late present 

NSAIDS stop frac healing

Question 2

Rest bed frac cx

Answer 2

DVT/PE
Infection
Muscle waste
Pressure sore

Question 3

Anaesthetics frac cx

Answer 3

Anaphylaxis

Aspiration

Question 4

Plaster cast frac cx

Answer 4

Stiffness
Pressure
Allergy
Neuro vasc dx

Question 5

How to describe frac - iDOC

Answer 5

Intra/extra art
Displaced/Undisplaced
Open/closed
Complex/non-complex

Question 6

Describe complex fracs

Answer 6

Comminuted 3+ frac lines
Wedge butterfly
Segmental 2 frac lines

Question 7

Describe non-complex frac

Answer 7

Transverse
Oblique
Avulsion - tendon pull bit of bone off
Spiral

Question 8

Late frac cx

Answer 8

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

Question 9

Immediate frac cx

Answer 9

Nerve - pain/NV cx - fix with angio vasc repair

Artery and vein #hemorrhage

Question 10

Early frac cx

Answer 10

Infection

Compartment syndrome

Early

Question 11

Explain compartment syndrome

Answer 11

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

Question 12

How to treat open Frac

Answer 12

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

Question 13

NOF arteries?

TX??!

Answer 13

Med/lat femoral circumflex + ligamentum teres

Look at pic 16:55pm @ 8/11/18

Question 14

Tet and rabies vaccines

Answer 14

Tetanus:

Booster @ ?/not vacc
IgTet @ HRisk
No further action @ 5 full vaccines

Rabies:

Full vaccine
Ig Rab @ ?/not vacc

2+ vaccines @ immune

Question 15

Necrotising fasciitis presentation + treatment?

Types and association?

Answer 15

Necrotising fasciitis presentation + treatment?

Types and association?
________

Haemorrhagic bullae pain

Urgent debride meant

IV antibiotics

Type 1 = post surgery at diabetes

Type 2 - GAS

Question 16

Ulcer assoc with squamous cell cancer

@lower limb on chronic inflammation sites eg burns

Answer 16

Marjolins

Question 17

Ulcer on toes and heels

PAINful

Pulseless and cold

Poss gangrene

Low ABPI

Answer 17

Arterial ulcer

Question 18

Warm and pulses fine!!!

Sensory fucked

On plantar surface of

metatarsal head and hallux

Due to pressure

Cushioned shoes needed

Answer 18

Neuropathic ulcer

Question 19

Venous insufficiency -> Venous hypertension ->

Fibrin, WCC, RBC leak

Pigmentation lipodermatosclerosis eczema

Answer 19

Venous ulcer

4 layer compression bandage

Larvae/debridement

Graft skin

Question 20

What is phantom limb pain?

Answer 20

Hypersensitivity of divided nerves

Re-organisation of somatosensory cortex

+

proprioceptive memory –>

Other stimuli = pain

Question 21

Complication of amputation?

Answer 21

Wound infection

Stump ischaemia/non-heal

Precious sore

Immobility

Question 22

Wound healing stages

Bone healing stages

Primary and secondary intention healing

Answer 22

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