Fracture management in Sport Flashcards
Risks in sport
- head and neck injuries (concussion, SDH, hyperextension, direct trauma eg scrum)
- organ injuries (blunt trauma, pneumothorax)
- joint dislocations (shoulder, knee)
- Neurovascular damage
- Fractures
- Soft tissue injury (burns, haematoma, tears, tendon)
ATS- what presentations would lead to transport to a trauma center i.e. identify the most serious injuries in trauma?
- all penetrating injuries to head, neck, torso and extremities proximal to elbow and knee
- Chest wall instability or deformity e.g. flail chest
- 2+ proximal long bone fractures
- crushed, degloved, mangled extremity
- Amputation proximal to ankle/wrist
- Pelvic fractures
- paralysis
A-E principles of ATLS
A- airway or C spine B- breathing C- circulation D- disability E- exposure
what is the A principle of A-E in ATLS?
- look for any suggestion of head/neck injury
- patent airway- no obstruction of tongue
- Gum shield? broken teeth?
- 3-POINT IMMOBILISATION OF C-SPINE- collar, blocks and tape
What is the B principle of ATLS?
- RR
- symmetrical expansion
- SaO2
- vitals
Difference between ATLS and PHTLS
ATLS:
Systematic approach to identify and manage life threatening injuries in resus- with all equipment available
PHTLS:
don’t have all resus equipment at disposal
What is the C principle of ATLS?
- Signs of shock
- BP/HR
- obvious haemorrhage
What is the D principle of ATLS?
- GCS
- pupils- reflex and symmetry
- glucose
What are the 3 main benefits of immobilisation?
- Allow healing
- Manage pain
- Avoid further neurovascular damage
What is the primary risk of joint immobilisation?
Joint stiffness
- this is why you have POSI- position of safe immobilisation
First step in fracture management
ANALGESIA
- Attempt to reduce if displaced
- early immobilisation by temporary splinting
- pain relief with paracetamol or diclofenac
Summarise Mx steps for pitchside fracture
- A-E
- Attempt to reduce
- Immobilise with box splint
- Stretcher
- Assess need for major trauma centre (PTLS)
- X-ray and reduction if not already achieved
- Back slab while deciding on surgical or non-operative management
When would a simple splint be indicated?
When a fracture is undisplaced or minimally displaced- no reduction needed
When would a broad arm sling be indicated?
Shoulder is kept adducted and internally rotated and weight taken off arm :
- forearm fractures
- cast support
- clavicle fractures
- AC ligament tears
- elbow injuries
Indications for a collar and cuff sling
Head of/proximal humerus fractures
- allows gravity from the weight of the arm to disimpact the fracture- traction holds in right position
Indications for back slab
Initial fracture management in first week to allow for swelling to subside before full cast
- ankle, forearm, knee
- elbow fractures
- crush injuries, open fractures
- can’t do proximal joints as there is too much movement
What are splints used for?
Temporarily immobilise a limb for pain and spasm, to decrease swelling, and to minimise further potential soft-tissue or neurovascular injuries
Mallet splint indication
Finger tendon injuries- keeps finger straight till tendon heals
Which splint is used pitchside?
Box splint
leg is strapped in to prevent rotation
Which splint is indicated for knee dislocations?
Cricket bat splint
Keeps leg in extension
Important to align bones to decrease risk of bleeding
Knee dislocations most commonly occur in which direction?
Laterally
due to muscle + ligature of knee
what is traction and why is it necessary in long bones?
- pulling on limb to re-align
- muscles pull on bones so when they break can mal-align
- this can lead to bleeding esp in long bones
What splint is indicated for a femoral shaft fracture?
Traction splint- provides temporary pain relief (prior to operative fixation) and reduces risk of bleeding
traction ensures bones remain aligned
What splint is used for metatarsal fractures?
extended sole boot
takes weight off of toes when walking
