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RB Y2 MSK Regional Trauma > Fractures > Flashcards

Fractures Flashcards

1
Q

polytrauma

A

more than one major long bone is injured/major fracture is associated with significant chest or abdominal trauma

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2
Q

what does polytrauma often cause

A

usually high energy fractures, with major blood loss (hypovolaemia)

pain, increased sympathetic response, fat embolism

ARDS, SIRS, MODS

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3
Q

SIRS

A

amplification of inflammatory cascades in response to trauma with pyrexia, tachycardia, tachypnoea and leukocytosis (high WCC)

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4
Q

ARDS

A

may occur due to hypoperfusion,SIRS, aspiration or fat embolism

inflammation of lung parenchyma leading to inflammatory exudates forming in alveoli and impairment of gas exchange

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5
Q

what is required in polytrauma

A

rapid skeletal stabilisation - limit biological trauma and blood loss and fat embolism

external fixators can be used because they can be rapidly applied with minimal blood loss

IM nails can also be applied - however risk of fat embolism

only unstable pelvic, femoral and tibial fractures treated, and injuries with vascular compromise, open fractures and (impending) compartment syndrome. minor fractures left till later

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6
Q

general fracture management

A
  • Resuscitation – ABCDE
  • Analgesia – IV morphine
  • Assessment
    • Open vs closed
    • Neurovascular status
      • Pulse
      • Capillary refill
      • Temperature
      • Colour
      • Sensation
      • Motor power
    • Soft tissue injury
    • Compartment syndrome
  • Splintage
  • Investigations
  • Reduction
  • Holding
    • Operative and non-operative
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7
Q

primary bone healing

A

minimal fracture gap (<1mm) and new bone is able to fill the gap from osteoblasts

eg in hairline fractures and when bones are fixed with compression screws and plates

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8
Q

secondary bone healing

A

gap at site of fracture that must be temporarily filled to act as a scaffold for new bone to be laid down (inflammatory response)

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9
Q

2y bone healing process

A
  • Fracture occurs
  • Haematoma occurs with inflammation from damaged tissues
  • Macrophages and osteoclasts remove debris and resorb the bone ends
  • Granulation tissue forms from fibroblasts and new blood vessels
  • Chondroblasts form cartilage (soft callus)
    • Osteoblasts lay down bone matrix (collagen type 1)– Enchondral ossification
  • Calcium mineralisation produces immature woven bone (hard callus)
  • Remodelling occurs with organization along lines of stress into lamellar bone
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10
Q
A
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11
Q

how do oblique fractures occur

A

sudden deceleration force

more likely to shorten

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12
Q

how do transverse fractures occur

A

bending of bone

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13
Q

how do spiral fractures occur

A

twisting

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14
Q

how do comminution fractures occur

A

high energy force/poor quality bone (osteoperosis in elderly)

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15
Q

how is location of a fracture in a long bone described

A

in thirds and type of bone involved (eg metaphyseal)

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16
Q

intra-articular and extra-articular

A

intra = extending into joint

17
Q

what greater risks do intra-articular fractures have

A

stiffness, pain, post-traumatic OA (especially if uneven surface)

18
Q

how is displacement described

A

direction of translation of distal fragment

volar (palmar) and dorsal in forearm. and radial and ulnar

19
Q

angulation of bone

A

describes the direction in which the distal fragment points towards and the degree of deformity

measured in degrees from longitudinal axis of diaphysis

20
Q

what is used to diagnose mandibular fractures

A

tomogram

21
Q

what is used to assess fracture of complex bones

A

CT

22
Q

what is used to detect stress fracture that may fail to show up on x ray (until hard callus appears)

A

technetium bone scan

23
Q

initial management of long bone fracture

A

Clinical assessment, analgesia, splintage/immobilisation and investigation (usually X rays)

splintage: temporary plaster slab, sling, orthosis, Thomas splint (femoral shaft in children)

if the fracture is grossly displaced or obviously dislocated, or risk of skin damage - reduction of fracture should be performed without waiting for X ray

24
Q

in general, how are undisplaced, minimally displaced and minimally angulated fractures which are considered to be stable treated

A

non-operatively

period of splintage/immobilisation then rehabilitation

25
Q

how are displaced/angulated fractures where the position is deemed unacceptable treated

A

reduction

cast application may be performed, serial x rays to ensure no loss of position

26
Q

how are unstable injuries treated

A

surgical stabilisation

(K wires, external fixation,IM nails, screws, plates etc)

27
Q

when is ORIF avoided

A

soft tissues too swollen

tenous blood supply to fracture

risk of extensive blood loss

28
Q

what is the aim of ORIF

A

anatomic reduction and rigid internal fixation leading to 1y bone healing

29
Q

management of open fractures

A

expediently to prevent infection which may result in non-union (atrophic or hypertrophic)

30
Q

Gustilo classification

A

used to describe the degree of contamination, size of wound, whether it will be able to be closed or require plastic surgery and the presence of an associated vascular injury (for open fractures)

31
Q

management of open fracture

A

initally:

  • IV broad spectrum antibiotics
  • sterile/antiseptic soaked dressing applied to wound to prevent further contamination before fracture is splinted
  • ensure tetanus immunisation
  • prompt surgery - debridement
32
Q

what does wound tension cause

A

skin necrosis and wound breakdown

If there is any doubt over the viability of soft tissues or if the wound is heavily contaminated, it is usually safer to leave the wound open and allow ongoing infection to drain out and return to theatre for debridement in 48 hours.

33
Q

what type of non union can infection cause

A

atrophic and hypertrophic

RB Y2 MSK Regional Trauma (7 decks)

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