Fractures - Principles of Management Flashcards
What are the 3 main aims of managing a fracture
Reduce
maintain reduction
rehabilitate
What is meant by debridement
Cleaning and removing devitalised tissue
Bone cannot be covered directly by split-skin grafting. What is needed to cover bone
soft-tissue flap
What are the 5 areas of consideration for a reduction
Function Mobility Union Neurovascular compromise Cosmesis
What are the 4 main techniques of fracture reduction
Manipulation under anaesthesia
Traction
Open reduction
Closed reduction and fixation
What is the advantage of using open reduction
It has the advantage of allowing very accurate reduction
What does open reduction usually involve
Internal fixation
How can we achieve stability in a fracture reduction
intrinsic stability
external splint age
internal fixation
What are the advantages of the newer form of moulded splints
Lighter in weight
very strong
Waterproof
What are the advantages of a Plaster of Paris
Cheap and easily available Versatile and readily applied and fashioned Reasonably comfortable Absorbs secretions to some extent Fairly strong Radio-translucent
What are some disadvantages of a Plaster of Paris
Heavy and warm
Unyielding , so may cause pressure problems or uncertain immobilisation
difficult to inspect the limb so it may conceal trouble
Not waterproof
What is a cast brace
A hinged or jointed cast
What fractures are cast braces often used for
Femur and tibia
What are the advantages of a cast brace
They allow the patient to be mobilised and exercised whilst avoiding the risks of internal fixation
What is traction
pulling bones directly or indirectly in order to reduce and hold fractures
What are the 2 main ways of applying traction
skin traction
skeletal traction
How does skin traction work
Force is exerted tangentially along the skin using adhesive strapping to attach the cord and weight
What are the problems with skin traction
a limited force can be applied as the skin can become damaged
people become sensitive to the adhesive
How does skeletal traction work
A pin or similar device is applied directly through the bone which enables a greater force than skin traction to be used but can cause infection
How does fixed traction work
Traction is applied against a counter force applied to the patient’s body
Give an example of a fixed traction device and where is the counter force applied
Thomas’ splint
To the ischial tuberosity
In what joint condition is simple sliding traction used
The hip
What is Hamilton-Russel Traction
A traction force in line with the shaft of the femur is applied whilst allowing movement of the hip and knee
A force is pulled in 2 directions giving a resultant force in the disorder line in all positions of the limb
Give some examples of internal fixation
screws
plates
compression plates
intramedullary nails
What are some advantages of internal fixation
accurate reduction and maintenance of position
Allows the patient and his/ her joints more mobility thus encouraging rehabilitation and avoiding joint stiffness
May encourage union, but only if sufficiently strong
Diminishes time spent in hospital
What are some disadvantages of internal fixation
may introduce infection
technically exacting and operative complications may occur
union may not occur if infection raises
further surgery may be required to remove the device
When is screw fixation used
to attach small bony fragments e.g. malleoli
What is involved with an intramedullary nail
Passage of a rod into the medullary canal of a long bone and across the fracture site, thus stabilising it in bending
How can we treat infection that has occurred following intramedullary nail
Remove the nail
medullary canal is the reamed to debride the infection
bone retailed
In what cases is intramedullary nailing most commonly used
Femur and tibia
When are wires used to hold bone fragments in position
Colles Fracture: stiff Kirschner wires
Patella fractures
What is the main advantage of a frame fixation
They allow good fixation whilst allowing access to the fracture site
What type of fixtures have large screws into eh bone which have a bar on one side of the bone
monolateral fixator
What type of fixtures have multiple fine wires through the bone which are then joint to form rings around the bone
circular frames
When should fracture fixation be used
When adequate reduction cannot be maintained by external splint age
When it is important to allow early movement of a limb or a joint
When it is important to avoid a long period of bed rest (e.g. femoral neck fracture in elderly)
Multiple trauma where internal or external fixation of one or more fractures may simplify treatment of other injuries and has been shown to reduce mortality
Certain pathological fractures e.g. those resulting from malignancy
When does rehabilitation begin
immediately after the primary treatment
