Fractures Flashcards
Basic approach:
The 4 Rs are used. What are they?
Resus
Reduction
Restriction
Rehabilitation
Basic approach:
Resuscitation:
- What should be assessed? - 2
- What would open fractures need? - 3
- What is tetanus?
- Why is a tetanus booster needed for open fractures, if they have not had one in the last 10 yrs?
Neurovascular status
Analgesia
Antibiotics
Cleaning
Possible debridement
Tetanus is a serious disease caused by a bacterial toxin that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles. Tetanus can interfere with your ability to breathe and can threaten your life. Tetanus is commonly known as “lockjaw.”
A person usually becomes infected with tetanus when dirt enters a wound or cut, but other instances can also allow the bacteria to enter the body (e.g.puncture wounds)
If the wound is clean and you have not had a tetanus booster in the last 10 years, it is recommended that you receive one. If the wound is dirty or tetanus-prone, then your doctor would likely recommend a tetanus booster if you have not had a tetanus booster shot within the last five years.
Basic approach:
Reduction - when does this need to be done?
Restriction - how long is this done for?
Rehabilitation - why is this important?
If a fracture is displaced
Until the fracture heals
Promotes fracture healing and encourages early movement - physio!
Reduction:
What is closed (over the skin) reduction called?
What is traction? When is this needed?
When is open reduction (surgery) needed?
Manipulation - can be done under GA if very painful
Traction is a technique for realigning a broken bone or dislocated part of the body using weights, pulleys, and ropes to gently apply pressure and pull the bone or injured body part back into position.
When large muscles are maintaining the displacement
Intra-articular fractures
Restriction:
What are fractures that can easily displace after reduction called?
What are the first 2 options used?
Casting:
- How long are they worn for upper limb or ankle malleolus fractures?
- How long are they worn for lower limb fractures?
- What must patients avoid while wearing this to prevent it from falling apart?
Functional bracing (cast bracing): - Just look up!
Unstable fractures
Splinting or sling
6 wks
12 wks
Avoid getting it wet - keep it dry - FREDDY FROM ICARLY
Restriction:
Internal fixation:
- What is used to fix fractures?
External fixation:
- What is this?
- Why are they used for open fractures?
Pins
Plate
Screws sit under the skin
Pins in bone with an external frame to join them
Because of the risk of infection from internal fixation
Complications:
Immediate risk - what are they?
What vascular pathology could fracture of long bones cause?
Nerve injury types:
- Neuropraxia - what is this?
- Axonotmesis - what is this?
- Neurotmesis - what is this?
Fat embolism - a triad of SOB, CNS sym, and petechial rash
Bleeding
Neurovascular injury
Muscle damage
Temporary injury from stretching
Axonal damage but with surrounding connective tissue preserved
Nerve cut, with recovery unlikely
Early Complications:
What can happen initially due to inflammation?
What may happen especially in open fractures?
What are some complications of bed rest?
Compartment syndrome
Infection
DVT
Bed rest increases the risk of pneumonia and atelectasis (collapse of lung tissue). Fluid tends to build up in the lungs because the muscles aren’t working to remove excess fluid from the body.
UTI
Pressure sores
Late complications:
What is it called when the fracture simply doesn’t heal or doesn’t heal well?
What can happen if there is a lack of blood supply to the fracture (happens in femoral head fractures)?
Think of some other longterm complications?
Complex regional pain syndrome (CRPS) - what is it?
Non-union/malunion
Avascular necrosis
Reduced joint use
Growth impairment
A sympathetic-mediated injury that presents wks post-injury with tender, pink, warm skin
