Fractures Flashcards
When does a fracture require reduction
If slight displacement in functionally vital area (eg. articular surface)
If significantly displaced, angled or rotated
Which fractures do not require reduction
If undisplaced
If displacement likely to be corrected by remodelling
If risks of anaesthesia outweigh disadvantage of deformity
What are the different methods of reduction
Closed
Open reduction
Continuous traction (rarely used)
What are the indications for internal fixation
Fractures requiring open reduction
Unstable fractures
Intra-articular fractures
Multiply injured patients
What are the advantages of internal fixation
Anatomical reduction leading to absolute stability
Allows primary bone healing
Earlier mobilisation of joints
Earlier discharge from hospital
What are some complications of internal fixation
Infection
Anaesthetic risk
Failure of fixation
Malposition of metalwork
What are the advantages of external fixation
Rapid application
Useful for multiple injuries
Stabilises comminuted fractures that are unsuitable for internal fixation
Provides fixation outside zone of injury for open fractures and allows access to the wound
What are the disadvantages of external fixation
Cumbersome
Pin-track infection
May hold fracture in slight distraction resulting in non-union/delayed union
What are the early general complications of fractures
Hypovolaemic shock
Disseminated intravascular coagulation
Systemic inflammatory response syndrome (SIRS)
What are the early local complications of fractures
Arterial injury Nerve injury Compartment syndrome Infection Soft-tissue compromise
What are the late general complications of fractures
DVT PE UTI Respiratory tract infection Disuse atrophy
What are the late local complications of fractures
Delayed union/non-union/malunion Infection Joint stiffness Secondary osteoarthritis Avascular necrosis
What structures are at risk in a proximal humeral fracture/shoulder dislocation
Axillary nerve
What structures are at risk in a humeral shaft fracture
Radial nerve
What structures are at risk in a distal radial fracture
Median nerve (acute carpal tunnel syndrome)
