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Emergency Medicine > Fracture Management > Flashcards

Fracture Management Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What are the 4 stages of fracture management?

A

4 R’s

  • Resuscitate
  • Reduce
  • Retain
  • Rehabilitate
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2
Q

What would you want to cover in a fracture assessment?

A
  • Who/What/When/where/why
  • Other injuries
  • Neurovascular status
  • Complications
  • Social and smoking history
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3
Q

What option are available to reduce a fracture?

A
  • Open reduction
  • Closed manipulation
  • Traction
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4
Q

What is involved in open reduction?

A

Surgical procedure where fracture is reduced

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5
Q

When is open reduction considered for a fracture?

A
  • When anatomical reduction is required
  • Associated neurovascular damage
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6
Q

What is involved in closed manipulation?

A

Manipulation of closed fracture in ED or under GA

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7
Q

When is closed manipulation considered for managing a fracture?

A

Extra-articular fractures where adequate and ecceptable reduction can be achieved

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8
Q

When is traction used to manage a fracture?

A

Aid reduction, analgesia and in patients who are unsuitable for anaesthesia

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9
Q

When is external fixation used to retain a fracture?

A
  • Contaminated open wounds
  • Severe open fractures
  • Severe associated soft tissue injury
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10
Q

When is internal fixation used to retain a fracture?

A
  • Comminuted or displaced fractures
  • Intra-articular fractures
  • Bones not able to be reduced by other methods
  • Associated with joint incongruity
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11
Q

What are intramedullary methods of internal fixation?

A
  • Intramedullary nail
  • K-wires
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12
Q

When would you consider using an intramedullary nail to retain a fracture?

A

Long bone fractures - femur/tibia/humerus

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13
Q

When are K-wires used for internal fixation?

A

Fracture fragments or for intramedullary fixation of small bones

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14
Q

What are different methods of extramedullary internal fixation methods?

A

Plates and screws

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15
Q

Why are plates and screws used for internal fixation?

A
  • Bridge comminuted fractures
  • Compress simple fractures around joints
  • Support areas of thin cortex
  • Secure tension side of fracture
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16
Q

What are different methods for retaining a fracture?

A
  • External fixations
  • Internal fixations
  • Conservative Immobilisation
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17
Q

What are examples of splint casts?

A
  • PLaster/fibre-glass backslab
  • Aluminium/wire/heat mouldable plastic splints
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18
Q

What is a splint?

A

Non-circumferential immobiliser

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19
Q

Why should you use a splint/backslab in an acute fracture?

A

Allow for swelling

20
Q

What are examples of sustained traction?

A
  • Collar and cuff arm sling
  • Skinng traction
  • Traction splint
  • Skeletal traction
21
Q

If you managed an acute fracture with a backslab/splint, what would you do in terms of follow up?

A

1 week post injury - full circumferential cast

22
Q

What are important aspects to consider for long-term management and rehabilitation?

A
  • Physio
  • Weight bearing status
  • Smoking status
  • Analgesia
  • Antibiotic prophylaxis
  • VTE prophylaxis
  • Cause of fracture
23
Q

What are immediate complications that can occur due to a fracture?

A
  • Haemorrhage
  • Arterial damage
  • Surrounding structure damage
  • Fat embolus
24
Q

What are early (within a few weeks) complications of a fracture?

A
  • Wound/prosthesis infection
  • Loss if position/fixation
  • VTE
  • Chest infection
  • Compartment syndrome
25
Q

What are late complications (months-years) of fracture?

A
  • Malunion
  • Non-union
  • Delayed union
  • Osteoarthritis
  • Avascular necrosis
26
Q

What are features of compartment syndrome?

A
  • Pain out of proportion with the injury
  • Exacerbated by passive stretching of the limb
  • Consider 6 P’s
27
Q

How long does it take for callus to form?

A

6 weeks - remove temporary fixations at this point

28
Q

How long does it take for full fracture healing?

A

12 weeks

29
Q

When are repeat X-ray performed?

A
  • Post op
  • After cast application
30
Q

What fractures are at risk of avascular necrosis?

A
  • Head of femur
  • Scaphoid waist
  • Neck of talus
31
Q

How would you manage a clavicular fracture?

A

Broad arm sling or polysling

32
Q

How would you manage a proximal humerus fracture?

A

Collar and cuff sling

33
Q

How would you manage a distal humerus fracture?

A

Above elbow backslab/cast

34
Q

How would you manage a mid-humerus fracture?

A

Collar and cuff sling and U-slab cast, or functional brace

35
Q

How would you manage a colles fracture?

A
  • Closed manipulation under haematoma block
  • Colles backslab/cast
36
Q

What is a colles backslab/cast?

A

Below elbow cast/backslab with wrist flexed and ulnar deviated

37
Q

How would you manage a scaphoid fracture?

A
  • Futuro splint +/- thumb extension
  • Thumb spica/splint if definitive
38
Q

How would you manage a displaced intracapsular NOF fracture in someone over the age of 60?

A

THR or hemiarthroplasty

39
Q

How would you manage a displaced/undisplaced intracapsular fracture in someone < 60?

A

Cannulated screws

40
Q

How would you manage an intertrachanteric extracapsular NOF fracture?

A

Dynamic hip screw/gamma nai

41
Q

How would you manage a subtrochanteric extracapsular NOF fracture?

A

Intramedullary nail

41
Q

How would you manage a femur/tibial fracture?

A

Intramedullary nail

42
Q

How would you manage a lateral malleolar fracture?

A

Below knee backslab/cast or aircast boot or stirrup brace

43
Q

How would you manage a bumalleolar/trimalleolar/lateral malleolar fracture which disrupts the syndesmosis?

A

Surgical fixation

44
Q

What analgesia whould you avoid in fracture management?

A

NSAIDs - interfere with bone healing

Emergency Medicine (32 decks)

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