Fracture management Flashcards
What does fracture treatment depend on? (3)
Stability of the fracture
Patient factors (fitness, other injuries etc)
Closed vs open
Which type of fracture is completely stable?
Transverse fracture
How would you define an open fracture?
A fracture is said to be ‘open’ if there is a direct communication between the external environment and the fracture.
This is usually through a break in the skin, but not always! i.e a fractured pelvis can penetrate through the rectum
In which 2 main ways do open fractures differ from closed fractures?
Higher risk of infection
Higher energy of injury
What is the Gustilo grading system?
A grading tool used to guide management of compound fractures, with higher grade injuries associated with higher risk of complications.
Describe the Gustilo grading of open fractures
Type 1 - low energy, smaller wound (<1cm)
Type 2 - moderate soft tissue damage, wound 1-10cm
Type 3 - high energy, wound >10cm; any gunshot, farm accident. Type 3 is split into 3a, 3b and 3c (more severe injury)
How are open fractures managed initially?
Give the patient tetanus (if not covered) and antibiotic prophylaxis - to prevent/slow down bacterial growth + pain relief
Photograph the wound so that it can be sent to surgeons/plastic surgeons so that they can start to plan treatment.
Cover the wound and stabilise the limb (prevent bone movement and further soft tissue damage or pain)
Open fractures are regarded as a surgical emergency - all operations within 24hrs but some in 6hrs if they are highly contaminated etc
Management of fractures during/after surgery
Early and thorough wound excision and toilet by senior experienced surgeons (flush/wash out the wound)
Wound is left open and this allows for a wound review - check if there is any more dead material and if so it is washed out again
Early definitive skin cover (5-7 days)
Stabilise the fracture
What is involved in the clinical assessment of a patient with a fracture?
Examine the fracture
Circulation
Neurological assessment
Open vs closed
Once a fracture is back in its required position (i.e reduced back to normal anatomical alignment) this position needs to be maintained.
How can this be maintained?
Conservative treatment
Operative treatment
Give examples of conservative fracture treatment
If no initial immobilisation or reduction required they may need no support at all or they may require support i.e Strapping or a Brace
If initial immobilisation is required then:-
Cast
Functional bracing
Traction
Give examples of operative fracture treatment
Pins
External fixators
Internal fixation:- Intra-medullary rods, screws and plates
What 3 principles of casts maintain the alignment of bone?
Three point loading
Hydraulics by using functional bracing
Rotational control
- By including joint above and below
Describe three point loading
A fracture can be reduced back by applying force at either end of the bone – the bone bends back into position
Above the fracture there will always be a bit of intact soft tissue (the soft tissue hinge) which acts like a spring and helps maintain the alignment of the bone.
Functional bracing
Used mainly for long bones i.e femur, tibia + humerus
The joint is left free to mobilise (prevents stiffness)
This is what caitlin’s mum had after her cast
