Fractures and bone healing Flashcards
1
Q
What are the types of fracture?
A
.
Other terms:
- Angulation
- Impacted
2
Q
What is the physiology of bone healing?
A
Haematoma:
Soft callus:
Hard callus:
Bony regrowth:
3
Q
What are the principles of reduction?
A
Analgesia:
- To increase comfort and muscle relaxation
- Opiates - PO morphine
- Nerve blocks - intralesional lidocaine
- Entonox/Penthrox
- Propofol, ketamine, midazolam
Traction:
- To pull the bone away from each other - exaggerating the injury - and so then can align in right place - pull hard, with a friend
- Better done as close to time of injury as possible as bone will try and heal naturally in the mean time
- If not possible, will need to go to theatre for reduction
Maintain the reduction with immobilisation:
- Backslab = first layer of soft white bandage, then plaster of Paris over ONE side of fracture - as swelling occurs and we don’t want to cause discomfort or limb ischemia, so best for acute fractures; then layer of bandage to finish; then X-ray to check alignment before discharge
- (alternatively, or after backslab off after 1-2wks - casting = full circumference of limb = more restrictive)
- Neighbour strapping e.g. tape 2 fingers together
- Splints = thumb spica, wrist futura
- Polysling = clavicle fracture
- Collar and cuff = humeral fractures
- TLSO brace = T,L,S spinal fractures
- Aspen collar = c-spine fractures
4
Q
What follow up is needed after A+E in fractures?
A
?VTE prophylaxis e.g. aspirin, DOACs - if lower limb leading to immobilisation
Virtual fracture clinic
- Ortho reviews pre and post scans then calls patient to explain and organise follow up for cast off; or refer to ortho +/- admission if problematic
Trauma meeting:
- Morning discussion of previous days fractures to assess whether surgery needed
5
Q
What are is the time scale for operating in orthopaedics?
A
Operating on same day doesn’t happen often
- Want to see how things heal
- Want to let swelling progress normally
