fracture healing and management

Question 1

5 R’s

Answer 1

Resuscitate ABC - ANALGESIA

Reduce THE FRACTURE

Retain the reduction

Reduce complications snd Respect the Soft tissues

Rehab

Question 2

fracture reduction

Answer 2

• pilcher manoeuvre
• open/closed
  direct/indirect

Question 3

retain the reduction

Answer 3

• operative or conservative (non-operative example, cast)

Question 4

reduce complications and respect the soft tissue

Answer 4

blood vessels damage
nerve damage
deep venous thrombosis and pulmonary embolism
fat embolism
compartment syndrome
infection
2ndry arthirits
leg length discrepancy

Question 5

post- fracture

Answer 5

rehab, physio
early weight-bearing and mobilisation

Question 6

fracture healing

Answer 6

Primary fracture healing (direct) no callous cutting cores

Secondary fracture healing (indirect) four stages
Haematoma
Soft callous,
Hard Callous
Remodelling

Question 7

secondary fracture- steps

Answer 7

haematoma - blood clot
- macrophages and monocytes present
soft callus- chondrocytes, osteobalsts and osteoclasts. laying down collagenous
hard woven callus- myelopoietic cells, osteocytes, collagen type 2 into type 1, no organisation, strong, haematopic
remodelling- slow process, organise woeven bone into bone (differenet process in children)

Question 8

strain across different stages of healing

Answer 8

0%- no callus induction
>10%- tolerated by cartilage
2-10%- tolerated by woven bone
<2%- tolerated by lamellar bone

Question 9

types of fractures

Answer 9

• open/closed
  -simple/complex
  -low/high energy
  -intra/extra articular