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Sports and Exercise Medicine iBSc > Fracture Management > Flashcards

Fracture Management Flashcards

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1
Q

What fractures common in contact sports

A

Head and neck injuries

Fractures in C spine- can have bleed in brain

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2
Q

Vital signs and levels of consciousness for ATLS Prehospital assessment- Step 1

A

Glasgow Coma Scale score <13 (or equal)
Systolic BP <90mmHg
Resp Rate <10 or 29 breaths/min (<20 in infants <1 year)

any of these yes –> trauma centre

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3
Q

ATLS Prehosp assessment Step 2 if vitals okay

A

If any of these yes, take to trauma centre:

  • penetrating injuries to head, neck, torso and extremities proximal to elbow + knee
  • Chest wall instability or deformity e.g. flail chest
  • Two or more proximal long bone fractures
  • Crushed, degloved, mangled, or pulseless extremity
  • Amputation proximal to wrist or ankle
  • Pelvic fractures
  • Open or depressed skull fracture
  • Paralysis
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4
Q

Flail chest

A

Multiple ribs broken together and they can move independently of rest of torso- don’t ventilate effectively

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5
Q

ATLS Prehosp assessment if Step 2 okay

A

If any of these, trauma centre:

  • Falls- adults >20 feet/6m, children >10 feet/3m
  • High risk motor vehicle crash
  • Auto vs pedestrian/bicyclist thrown, run over, or with significant impact
  • motorcycle crash
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6
Q

ATLS Prehosp assessment special patient considerations

A

If any below, trauma centre:

  • Older adults- risk injury/death increases after 55
  • Children
  • Anticoagulant use and bleeding disorders
  • Burns
  • Pregnancy >20 weeks
  • EMS provider judgement
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7
Q

20% of patients that have calcaneal fracture have an associated…

A

Fracture in spine

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8
Q

Fall over 6 metres

A

Take to trauma centre regardless of anything

Likely to be damage you can’t see

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9
Q

ATLS Principles- Airway and C spine

A

Make sure C spine isn’t broken- if it is and you move can cause transection of spinal cord
–> immobilise C spine first
Is patient maintaining own airway?
Gumshield? Broken teeth?

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10
Q

ATLS- Breathing

A

Respiratory rate

Equal chest expansion

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11
Q

ATLS- Circulation

A

Signs for shock
Pulse
BP

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12
Q

ATLS- Disability

A

GCS

Pupils

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13
Q

ATLS- Exposure

A

Look for long bone deformity

Any obvious bleeding

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14
Q

Immobilisation of Upper limb

A 
Broad arm Sling
Collar and cuff
Humeral brace
Back slab
Splints
Vertura Splint
Mallett Splint
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15
Q

Broad arm sling UL

A

offloads all upper limb so arm doesn’t pull down- good for any collar bone or AC joint injuries, or forearm if heavy if its in a cast

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16
Q

Collar and cuff UL

A

sling wrapped around neck and wrist- weight of arm pulls down and pulls fractures of humerus down and outs into place

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17
Q

Humeral brace UL

A

humeral shaft fractures- keeps everything lined up

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18
Q

Back slab UL

A

half of a plaster – supports joint- not full plaster as allows for inflammation and growth of injury so as to not cut off blood supply

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19
Q

Zimmer splint UL

A 
Keeps finger in safe position
o	Posi (position of safe immobilisation) or Edinburgh position= wrist extended to 45 degrees, carpa-metacarpal joints at 90 degrees, interphalangeal joint neutral (0 degrees)- at this position collateral ligaments are under maximum tension, are taught- important as means doesn’t go stiff
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20
Q

Stiffness

A

One of most difficult things to treat
Apart from hand, elbow joint one of most notorious for getting stiff
Don’t want to keep someone with elbow at 90 degrees for more than you have to as otherwise will never straighten arm again

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21
Q

Vertura splint UL

A

Wrist comfy

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22
Q

Mallett splint UL

A

mallett injury is where FDP tendon can take small tuft of bone with it- so this keeps it back up in right position

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23
Q

Immobilisation Lower limb

A 
Box splint
Cricket pad splint
Kendrick splint
Backslab
Boots/shoe
Heal bearing shoe
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24
Q

Box splint LL

A

Stable lower limb splint

Keeps everything together in right position

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25
Q

Cricket pad splint LL

A

Keep knee in extension

Good for patella

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26
Q

Kendrick splint LL

A

Traction splint
Important if have fracture of long bones in leg and want to keep them under tense and traction
Helps stop bleeding
Can lose 4L of blood in femur

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27
Q

Greater trochanter

A

Insertion for gluteus medius

28
Q

Weber A ankle injury

A

Fibular fracture below level of syndosmosis

Combination of ligaments and intra-osseus membrane that keeps tibia and fibula together

29
Q

Heal bearing shoe

A

Keeps foot flat throughout gait cycle

During toe off foot will extend in the middle and puts pressure on metatarsals –> this will stop this from happening

30
Q

Bone Healing pathways

A

Primary and Secondary pathways

Which pathway used depends on stability of fracture site and location

31
Q

Strain

A

The percentage of change in length of the material in relation to original length
Change in length/original length

32
Q

Stress

A

Force per unit area

33
Q

Sheer stress

A

On joint surfaces, opposing directions to each other

34
Q

Tensile stress

A

Pull stuff away

35
Q

Compressive stress

A

Push

36
Q

Yield strength

A

The lowest stress that produces a permanent deformation in a material

37
Q

Stability

A

Ability to maintain its original configuration

38
Q

Bone Healing strain

A

<2% change in bone length= Primary
2-10%= Secondary
>10%= Won’t heal

39
Q

Osteoclasts

A

Bone cells that break down bone tissue

40
Q

Osteoblasts

A

Bone cells that create new bone tissue

41
Q

Cutting cone

A

Bone remodelling unit
At the front is osteoclasts, behind it is osteoblasts laying down layers of bone
In middle, Haversian canal

42
Q

Cortical bone

A

On outside
Thick and compact
Up and down stress

43
Q

Travecular bone

A

Centre

Withstands stress in different irections

44
Q

Osteonal Remodelling

A

Primary bone healing
Gap at fracture site must be less than 1mm
Process of fully formed osteons bridging a fracture gap may take months
<2% strain- has to be absolutely stable with almost no movement at fracture site

45
Q

Secondary bone healing

A
  1. Haematoma formation
  2. Fibrocartilaginous callus formation
  3. Bony callus formation
  4. Bone remodelling
46
Q

2dary bone healing- Step 1

A

Fracture leads to haematoma formation at fracture site

Up to 1 week from injury

47
Q

2dary bone healing- Step 2

A

1 week to 1 month after injury
Strain/movement at the fracture site stimulates multipotent cells in the periosteum to differentiate into osteoprogenitor cells which produce bone without first forming cartilage (external callus)
Bridging callus forms fibrocartilage which become calcified and is then replaced by bone

48
Q

2dary bone healing- Step 3

A

1-4 months
Soft calcified chondral callus becomes hard mineralized osteoid callus
At this point, fracture is united, solid and pain free

49
Q

Primary bone healing overall

A 
No callus
Absolute stability
No movement
Biological process- osteoid cutting cone/haversion
Gap <1mm
Strain <2%
50
Q

Secondary bone healing overall

A 
Inflammation phase --> soft callus --> hard callus --> bone remodelling
Biological process- callus formation
Gap >1mm
Strain 2-10%
Relative stability required
51
Q

Fracture fixation Aim

A

Restoring function
Normal function- normal ROM, pain free, stable
Restoring anatomy
Reduction (length, rotation, angulation)

52
Q

What happens if don’t fix fracture

A

Malunion/deformity

Post traumatic arthritis

53
Q

Intra-articular fractures

A

Requires absolute stability
Aim is to restore joint anatomy to restore function
Do not want callus formation/post traumatic arthritis (pain free)
Usually fixed with plates and screws

54
Q

Extra-articular fractures

A

Requires relative stability
Callus formation will not affect functional outcome
Any modality that will maintain reduction

55
Q

Plate fixation

A

Can use plate to bridge fracture, to stop rotation

56
Q

Intramedullary nailing

A

Don’t need to open all up- just top

Important to respect soft tissue envelope- e.g. don’t disrupt blood supply

57
Q

Screw fixation

A

Use screw to get absolute stability as can compress fracture

Screw converts rotation force into longitudinal force

58
Q

External fixator

A

When soft tissue too inflamed to operate yet

59
Q

K wire fixation

A

Wire stays until bone heals

60
Q

Absolute stability methods

A

Aim- primary bone healing
Plate and screw fixation
Screw fixation alone

61
Q

Relative stability methods

A 
Aim- secondary bone healing
Intramedullary nail
K wire fixation
Plaster
Sling
External fixator
Plate fixation
62
Q

Risk of treating a fracture

A 
Pain
Infection
Bleeding
Damage to nerves, tendons, blood vessels, fracture of bones
Non-union
Mal union
Failure of metalwork
Stiffness
63
Q

Non-union

A

An arrest in the fracture repair process

64
Q

Non-union types

A

 Septic (secondary to infection)
 Hypertrophic (callus but not bridging)
 Pseudoarthritis (new joint)
 Atrophic (disruption to blood supply)

65
Q

Collar bones and non-union

A

o 15% of collar bone fractions go into non-union if conservative treatment done, if do surgery only 5% go into no-union

66
Q

Failure of metalwork

A

Whole point is to hope biological process finishes and is done before the metalwork fails
If non-union, metal ends up taking all of force and eventually fails

Sports and Exercise Medicine iBSc (13 decks)

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