Fractures and dislocations Flashcards
Polytrauma
severe injury to more than one body system
ATLS
- A
- B
- C
- D
- E
Advanced trauma life support
- airway + cervical spine control
- breathing and ventilation
- control of bleeding + replace lost blood
- disability brain protection
- exposure: remove clothes + inspect body for injury
SIRS
systemic inflammatory response syndrome
- response to noxious stressor (sepsis = SIRS in response to infection)
ARDS
acute respiratory distress syndrome
MODS
multiple organ dysfunction syndrome
Terrible triad
acidosis
coagulopathy
hypothermia
Damage control orthopaedics
control bleeding
soft tissue management (fasciotomy, decompress tension pneumothorax, arterial repair)
provisional fracture stability (external fixators)
Compartment syndrome
increased pressure in a closed space (compartment)
leads to ischaemia of components
urgent fasciotomy required
Fracture
no continuation between 2 parts of one bone
Twisting force causes a
spiral/oblique fracture
Bending force causes a
transverse fracture (and often a bending wedge)
High energy force causes a
comminuted fracture (+ lots of fragments)
Skin intact
closed fracture
Skin broken
open (compound) fracture
- increased risk of infection
Reading an x-ray (OSCE steps)
read name confirm name + DOB (with patient + wrist band) read hospital number check x-ray date note part of region (left/right) standing/weight-bearing?
Valgus
apex medial
Parallel
no angulation
Varus
apex lateral
Intertrochanteric femoral neck fracture
between lesser and greater trochanters
fix with dynamic hip screw
Sub-capital fracture
(neck of femur)
intracapsular femoral head fracture
Dislocation
no articulation between 2 bones when there usually is one
AMPLE
Allergies Medications Past medical history Last meal Events
Principles of fracture management
reduce
retain - maintain reduction until fracture heals
rehabilitate - restore to original status before injury
Dislocation initial management
analgesia
reduce dislocation
reassess neurovascular status before + after reduction
Principles of management of severely injured
save life
save limb
save joint
Areas you do not x-ray
ribs (x-ray doesn't change management) nasal bones (most of nose = cartilage) coccyx (only intervention = analgesia)
Radiographic fracture signs (bone)
lucent lines - darkenings on x-ray
sclerotic lines - whiter line on x-ray (due to increased density where ends of fracture overlap)
cortical breach - breach of outline of white bone
disruption of trabeculae - decreased space in joint
change in body contour
Radiographic fracture signs (complementary)
haemarthrosis (blood in joint) - may displace other structures (eg. elevated fat pad)
lipohaemarthrosis (fat and blood in joint)
soft tissue swelling - more grey than expected
Boney rings
rigid ring must break in at least 2 places
- pelvis
- obturator foramen x2
- paired longbones (forearm + leg)
- mandible
- zygomatic arch
- vertebra
Fracture description criteria
position (angulation, displacement, distraction, impaction, foreshortening) path of fracture line simple or comminuted joint involvement closed or open
Children fractures
plastic (bending) torus greenstick growth plate fractures non-accidental injury
Growth plate injury classification
SALTR
- Slipped
- Above
- Lower
- Through
- Ruined
Special fractures
- fatigue (stress) fractures
- insufficiency fractures
- pathological fractures
