Fractures And Dislocation Flashcards
What features should you look for on general approach when suspecting a fracture
Deformity
Wounds
Skin tenting
What should be assessed when feeling a suspected fracture
Apex of deformity
Bone continuity
Discolouration of foot/hand
Distal sensation
Distal movement
How should a suspected fracture be movement
Analgesia/sedation -> small test movement -> realign to anatomical position
What should you do if there is crepitus or the fracture ‘gets stuck’ while realigning
Crepitus - continue realigning as tolerated
Stuck - stop and stabilise in that position / return to position of maximum comfort
Anatomical position for realigning upper and lower limb
Upper - elbow at 90, arm across body, sling
Lower - knee flexed to 15-30
PH management of acromioclavicular dislocation
No specific interventions needed
Watch for skin tenting
Which injury is suggested by a ‘squared off shoulder’
Shoulder dislocation
Which nerve is commonly injured in a shoulder dislocation
Axillary
Shoulder dislocation PH management
Analgesia
Broad arm sling
? Relocation
Luxatio erecta
Inferior shoulder dislocation
Rare Shoulder dislocation usually caused by hyper abduction injury to the arm
Proximal humerus fracture management
Analgesia
Collar and cuff sling
Surgery not usually needed
Which nerve is most at risk in a mid shaft Humeral fracture
Radial
Midshaft humerus fracture management
Bene cast in anatomical position
Surgery if v unstable
Sternoclavicular dislocation PH management
No specific intervention
Clavicular fracture PH management
No specific ph intervention
Watch for skin tenting
Are distal humerus fractures more likely to cause NV injuries in kids or adults
Kids
Which Humeral fracture should NOT be manipulated
Distal humerus
Which humeral fractures have differing management depending on NV exam
Midshaft
Distal
Distal Humeral fracture PHM management
Immobilise in current position
DO NOT manipulate (esp in kids)
Usually needs surgery
Elbow dislocation and articular injury PH management
Analgesia
benecast in current position
Do not manipulate
?surgery
Forearm fracture PH management
Immobilise w benecast in Current position
DO NOT manipulate
Usually need surgery
Where should a pelvic binder be centred
Greater trochanter
Types of hip fracture
Intra capsular
- femoral head
- femoral neck
Extracapsular
- intertrochanteric
- subtrochanteric
Method of splinting/reducing proximal, middle, and distal femur fracture
Proximal - realign
Middle - KTD
distal - benecast or realign
Tearing of which structure allows the patella to be displaced completely out of the femoral trochlea
Medial retinaculum
Steps for assessing any fracture or dislocation
Look
Feel
Move
Neuro and vascular assessment
Analgesia
Reduce and stabilise
Which fractures should not be manipulated/reduced
Distal humerus fracture
Elbow dislocation
Articular injuries
Forearm fractures
How to dress open fracture
Take photo before dressing
Remove macroscopic debris
Don’t wash out - delays tx
Saline soaked gauze + occlusive dressing + crepe dressing + splint
What should be done before dressing an open fracture
Take photo
What should be done before and after manipulating a fracture
NV exam
Document and handover findings
What should be done before and after manipulating a fracture
NV exam
Document and handover findings
Surgical fracture management
Wash out
Debride
External fixation
Convert to definitive surgical fixation within 3 days
Which fracture can impact breathing
Sternoclavicukar
What can cause recurrent dislocations
Ehlos Danlos
CT disorders
What lower limb position suggests hip fracture/dislocation
Internal rotated
Abducted
PH NOF fracture management
Little OH intervention
?Strap leg to uninjured leg
Surgery
Tibiofemoral dislocation sign
Significant bruising at back of knee
Tibiofemoral dislocation ph management
Realign
Benecast in anatomical safe position
What position should the knee be in when realigning a patellar dislocation
Knee hyperextended
Ankle fracture PH management
Realign
