Fractures: General Management Flashcards
Causes of fractures?
Trauma (excessive force to bone)
Stress (repetitive low-velocity injury)
Path (abnormal bone which fractures after minimal trauma)
What does fracture diagnosis involve?
Evaluate fracture (site, injury type), associated injuries, distal NV deficits
So clinical examination + radiographs of prox. and distal joints
How should fracture x-rays be assessed?
Bone length changes
Angulation of distal bone
Rotational effects
Presence of materials like glass
What are the five types of fracture?
COSTS
Comminuted
Oblique
Segmental
Transverse
Spiral
What is a comminuted fracture?
> 2 fragments
What is an oblique fracture?
Oblique to the long axis of the bone
What is a segmental fracture?
More than one fracture along the bone
What is a transverse fracture?
Perpendicular to the long axis of the bone
What is a spiral fracture?
Severe oblique fracture + rotation along long axis of the bone
What is the difference between an open vs. closed injury?
Open: exposed tissue/organs.
Closed: no exposure to underlying tissue/organs.
What is the Gustilo-Anderson classification system used for?
Classification system for open fractures.
Describe the Gustilo-Anderson classification system?
1 - low energy wound <1cm
2 - >1cm wound + mod soft tissue damage
3 - high energy wound >1cm + ext soft tissue damage
What are the subgroups of grade 3 of the Gustilo-Anderson classification system?
3A - adequate soft tissue coverage
3B - inadequate soft tissue coverage
3C - a/w arterial injury
General points in fracture Mx?
Reduce
Immobilise - incl. prox and distal joints
Rehabilitate
(+ Monitor NV status - esp. after reduction + immobilisation)
Mx for open fracture wounds?
EMERGENCY
INITIAL:
ABCDE + C-spine
Haemorrhage control (direct pressure)
Analgesia
Assess: NV status, soft tissues, photography
Antisepsis: wound swab, irrigation, betadine/saline-soaked impermeable dressing
Immobilisation: align # + splint
Abx: fluclox IV/IM + benpen IV/IM OR augmentin + tetanus prophylaxis
THEATRE (<6h of injury):
Debridement and lavage
External fixation (<72h)
What should be avoided in open fracture wound Mx?
Internal fixation devices (or use with extreme caution)
All farm wound injuries are automatically classed as what G-A grade?
At least grade 3A
When should open contaminated wounds be debrided?
<12h for high energy injuries
<24h for all other injuries
What is the definitive management of open fractures?
Wound debridement/excision (<24h) on routine emergency trauma operating lists
External fixation device at time of primary debridement
Definitive soft tissue construction within 1wk
When may one go straight to surgical fixation in open fracture Mx?
Only done initially if it can be followed by definitive soft tissue coverage
External fixation device is generally first used in interim until soft tissue coverage is achieved
What is the most important sign which would indicate an urgent need for surgery in a distal humeral fracture?
Distal neurovascular deficit
Fractures here = risky to brachial artery. Fractured end of distal humerus could shear it -> distal NV loss. NEEDS IMMEDIATE EXPLORATION.
