fractures: general management Flashcards
how long does it take for soft callus to form after a break
2-3 weeks
how long does it take for hard callus to form after a break
6-12
how do transverse fractures usually occur + what are they
bending force (can angulate) // perpendicular - 1 break
how do oblique fractures usually occur + what are they
shearing force with fall or deceleration // diagonal along long axis of bone
how are oblique fractures usually managed
screw
how to spiral fractures usually occur + what are they
rotational force // severe form of oblique fracture
how are spiral fractures managed
screws
how are segmental fractures managed + what are they
long rods and plates // more than 1 fracture in a bone
what classification is used for open fractures
Gustila and anderson: 1 = <1cm wound // 2 = >1cm wound + some soft tissue damage // 3 = >1cm wound + significant soft damage // a = enough coverage // b = not enough coverage // c = vascular injury
mx open fractures
immobilise, IV abx, debride, external fixation
how are undisplaced fractures usually managed
splint, immobilise, rehab
how are angulated/ displaced fractures usually managed
reduction under anaesthesia + cast // X ray for progress
how are unstable extra-articular fractures usually managed
ORIF (plates and screws)
how are displaced intra-articular fractures usually managed
ORIF (wires, screws, plates) - poor outcomes
what early local complications of fractures can occur
compartment, neurovascular injury, ischaemia
what systemic complications of fractures can occur
hypovolaemia, ARDS, renal failure, SIRS, PE, fat embolism
which fractures usually cause compartment syndrome
supracondylar (humerus at elbow) or tibial shaft
symtpoms compartment syndrome
pain+++, loss of function, swollen, pallor, extensive analgesia (pulse may still be present)
invx compartment syndrome
pressure >40 mmHg // Xrays will not show anything
mx compartment syndrome
remove tight clothing // fasciotomy // IV fluids
SE fasciotomy
myoglobulinuria
what neurovascular component is commonly damaged in knee dislocation
popliteal artery
what neurovascular component is commonly damaged in paediatric supracondylar fracture at elbow
brachial artery
what neurovascular component is commonly damaged in shoudler dislocation
axillary
RF fat embolism
long bone fracture
symptoms fat embolism
tachypnoea, dyspnoea within 72 hours injury, hypoxia, brown peticheal rash, oral or eye haemorrhage, confusion + agitation
invx fat embolism
CTPA - ground glass appearance
mx fat embolism
DVT prophylaxis and supportive care
symptoms of a non-union fracture
pain, oedema, movement, xray: bridging callus
which fractures have poor blood supply
scaphoid, distal clavicle, femur
what fractures may cause DVT
pelvic or lower limb
which fractures may cause AVN
femoral neck, scaphoid, tallus
which fractures may cause OA
intra-articular
