Fractures Flashcards
How are fractures described?
- Integrity of skin/tissue (closed/open)
- Location (epiphyseal/ metaphyseal/ diaphyseal/physis)
- Orientation/fracture pattern
- Displacement
What is an open v closed fracture?
Closed: skin overlying intact
Open: skin overlying lacerated, fracture exposed to external environment
Characteristics of a transverse fracture?
Fracture line perpendicular to long axis of bone, direct force, high energy.
Characteristics of an oblique fracture?
Angular fracture line, angular or rotational force.
What is a spiral fracture?
Complex multi-planar fracture line. Rotational force with high energy.
What is a comminuted fracture?
More than 2 fracture segments.
What are the indications for open reduction of a fracture?
NO CAST: N: Non-union O: Open fracture C: neurovascular Compromise A: intra-Articular fracture S: Salter-Harris 3/4/5 T: polyTrauma
How should fractures be managed?
- ABC, 1” and 2” survey
- AMPLE Hx
- Analgesia
- Imaging
- Splint
- Reduction and maintenance
- Rehabilitation
What is an AMPLE Hx?
- Allergies
- Medications
- PMHx
- Last meal
- Events surrounding injury.
How is a closed reduction conducted?
- Apply traction in long axis of the limb
- Reverse mechanism that produced trauma
- Reduce with IV sedation and muscle relaxation
What are the potential complications of open fracture reduction?
- Infection
- Mal-union
- Non-union
- Implant failure
- New fracture
Describe normal fracture healing.
W 0-3: Haematoma, M0 surround fracture
W 3-6: osteoclasts remodel sharp edges, callus forms within haematoma
W 6-12: bone forms within callus, bridges fragments
M 6-12: Cortical gap bridged by bone
Y1-2: normal architecture through remodelling
What are the early local complications of fracture?
- Compartment syndrome
- Neurovascular injury
- Infection
- Implant failure
- Fracture blisters
What are the systemic complications of fracture?
- Sepsis
- DVT/PE
- ARDS (2” to fat embolism)
- Haemorrhagic shock
What are the late local complications of fracture?
- Mal/non-union;
- AVN,
- osteomyelitis,
- Heterotopic ossification
- OA, stiffness.
What is the emergency management of open fractures?
- Remove obvious foreign material
- Irrigate with normal saline if contaminated
- Cover with sterile dressing
- IV ABx
- Tetanus toxoid/Ig
- Reduce and splint
- NPO and OR prep
What are the Xray rules in fracture investigation?
Xray Rule of 2s:
- 2 sides = bilateral
- 2 views = AP + lateral
- 2 joints = above and below
- 2 times = before and after reduction
What does displacement refer to?
Distal fragment relative to the proximal fragment
What is heterotopic ossification?
Formation of bone in abnormal locations (e.g. in muscle), secondary to pathology.
What are the orthopaedic emergencies?
VON CHOP: V- Vascular compromise O - Open fracture N - Neurological compromise C - Compartment Syndrome H - Hip Dislocation O - Osteomyelitis / septic arthritis P - unstable Pelvic Fracture
What is an open fracture?
Fractured bone in communication with the external environment. Increased risk of osteomyelitis.
Emergency management of open fracture?
STAND (splint, tetanus prophylaxis, ABx, Neurovascular status, dressings to cover).
- Clean/irrigate/cover
- Immediate IV ABx
- Consider tetanus toxoid / Ig
- Reduce and splint fracture
- NPO and OT prep
How are open fractures classified?
Gustilo Classification (I-III) based on length of open wound (10cm).
Prophylactic ABx in open fractures?
GUSTILO I: Cefazolin for 3d
GUSTILO II: Cefazolin 3/7 + gentamicin (G-ve cover) 3/7
