fracture management/ complications

Question 1

what is the classification for open fractures?

Answer 1

• Gustillo and Andersen:
• Grade 1: low energy wound <1cm
• Grade 2: >1cm wound with moderate tissue damage
• Grade 3: high energy wound, extensive soft tissue damage
• 3a: adequate soft tissue coverage
• 3b: inadequate soft tissue coverage
• 3c: associated arterial damage

Question 2

name some general principals of fracture management?

Answer 2

• immobilise the fracture including proximal and distal joints
• monitor and document neurovascular status (particularly following reduction and immobilisation)
• manage infection including tetanus prophylaxis
• IV broad spectrum abx

Question 3

what should happen to open fractures within 6 hours?

Answer 3

• debridement and lavage

Question 4

what early complications may you get due to a fracture?

Answer 4

• vascular injury
• nerve injury
• compartment syndrome
• infection

Question 5

what late complications do you get in fracture?

Answer 5

• non-union (fracture doesn’t heal)
• mal-union
• AVN
• post-traumatic osteoarthritis
• complex pain syndrome
• fat embolism
• DVT/PE

Question 6

what fractures are most likely to cause avascular necrosis?

Answer 6

• displaced NOF
• scaphoid
• talus

Question 7

what are the risk factors for non-union?

Answer 7

• high energy fractures
• open fractures
• infection
• bone loss

Question 8

what are the symptoms of fat embolism?

risk factors for FES?

Answer 8

• respiratory dysfunction
• tachypnoea, confusion/ agitation
• ARDS with bilateral diffuse infiltrates
• large diaphyseal fractures (femur)
• multiple fractures
• closed fractures

Question 9

how do you confirm osteomyelitis?

what conditions predispose osteomyelitis?

how should it. be managed?

Answer 9

• MRI, very sensitive
• DM
• sickle cell anaemia
• IVDU
• immunosuppression
• alcohol xs
• flucloxacillin 6 weeks (clindamycin if penicillin allergic)