Fractures Flashcards
What is an open fracture?
There is a direct communication between the external environment and the fracture, usually through a break in the skin
What are open fractures important?
High energy injury
Increased infection rate
Soft tissue complications
Long term morbidity
How is a type 1 open fracture classified?
Low energy
<1cm
Clean
Often bone piercing skin from inside
How is a type 2 open fracture classified?
Moderate soft tissue damage
Wound <10cm
No soft tissue flap or evulsion
How is a type 3 open fracture classified?
High energy
Extensive soft tissue damage
Severe fracture (compound, displacement)
Wound >10cm
Any gunshot, farm accident, segmental fracture, bone loss, severe crush injury or marine
What is a type 3A open fracture?
Soft tissue damage +++ but not grossly contaminated
What is a type 3B open fracture?
Periosteal stripping
Extensive muscle damage
Heavy contamination
What is a type 3C open fracture?
Associated neurovascular complication
What is the management procedure of an open fracture?
Full ATLS assessment and treatment
Tetanus and antibiotic prophylaxis
Cefuroxime / Augmentin / Clindamycin- Gent at time of fixation
Repeated examination n/v status
Wounds only handled to remove gross contamination, photograph, cover (saline swabs) and stabilise limb
No provisional irrigation / exploration
Radiographs- orthogonal views including joint above and below
What factors must be taken into account when deciding if amputation needs to occur?
Limb ischaemia
Age
Shock
Injury mechanism
What is dislocation?
Complete joint disruption
What is subluxation?
Partial dislocation, not fully out of joint
What is a fracture?
Break in the continuity of the bone, may be a crack, split, break, crumpling, buckle
Why do bones fail?
High energy transfer in normal bones
Repetitive stress in normal bones
Low energy transfer in abnormal bones
What does ATLS stand for?
Advanced trauma life support
What are the phases of bone healing?
Inflammatory
Reparative
Remodelling
How can fracture healing be measured?
Clinical examination
Radiology
Biomechanically (stiffness)
When is a fracture healed?
When patient can bear weight
X ray confirmation
What are some systemic problems that can arise due to fractures?
Hypovalaemia
Crush syndrome
Fat embolism and ARDS
Psychological and social aspects
What are some local problems that can arise due to fractures?
Neurovascualar damage Skin/wound problems Compartment syndrome Delayed union Nonunion Avascular necrosis
What is malunion?
Fracture has healed, but not in an anatomically correct position
What is delayed union?
Healing takes longer than average or that fracture in that individual
What is nonunion?
No further progress towards union
What are the problems associated with delayed or nonunion?
Inadequate immobilisation
Distraction of # by fixation device or traction
repeated manipulations
Periosteal stripping & soft tissue damage at operation
Anatomical vascular suspectibility, eg. femoral neck, scaphoid, talus, (distal tibia)
What are the different types of nonunion?
Atrophic
Hypertrophic
