Fractures - Principles of Management

Question 1

What are the 3 main aims of managing a fracture

Answer 1

Reduce
maintain reduction
rehabilitate

Question 2

What is meant by debridement

Answer 2

Cleaning and removing devitalised tissue

Question 3

Bone cannot be covered directly by split-skin grafting. What is needed to cover bone

Answer 3

soft-tissue flap

Question 4

What are the 5 areas of consideration for a reduction

Answer 4

Function 
Mobility 
Union
Neurovascular compromise 
Cosmesis

Question 5

What are the 4 main techniques of fracture reduction

Answer 5

Manipulation under anaesthesia
Traction
Open reduction
Closed reduction and fixation

Question 6

What is the advantage of using open reduction

Answer 6

It has the advantage of allowing very accurate reduction

Question 7

What does open reduction usually involve

Answer 7

Internal fixation

Question 8

How can we achieve stability in a fracture reduction

Answer 8

intrinsic stability
external splint age
internal fixation

Question 9

What are the advantages of the newer form of moulded splints

Answer 9

Lighter in weight
very strong
Waterproof

Question 10

What are the advantages of a Plaster of Paris

Answer 10

Cheap and easily available 
Versatile and readily applied and fashioned 
Reasonably comfortable 
Absorbs secretions to some extent 
Fairly strong 
Radio-translucent

Question 11

What are some disadvantages of a Plaster of Paris

Answer 11

Heavy and warm
Unyielding , so may cause pressure problems or uncertain immobilisation
difficult to inspect the limb so it may conceal trouble
Not waterproof

Question 12

What is a cast brace

Answer 12

A hinged or jointed cast

Question 13

What fractures are cast braces often used for

Answer 13

Femur and tibia

Question 14

What are the advantages of a cast brace

Answer 14

They allow the patient to be mobilised and exercised whilst avoiding the risks of internal fixation

Question 15

What is traction

Answer 15

pulling bones directly or indirectly in order to reduce and hold fractures

Question 16

What are the 2 main ways of applying traction

Answer 16

skin traction

skeletal traction

Question 17

How does skin traction work

Answer 17

Force is exerted tangentially along the skin using adhesive strapping to attach the cord and weight

Question 18

What are the problems with skin traction

Answer 18

a limited force can be applied as the skin can become damaged
people become sensitive to the adhesive

Question 19

How does skeletal traction work

Answer 19

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

Question 20

How does fixed traction work

Answer 20

Traction is applied against a counter force applied to the patient’s body

Question 21

Give an example of a fixed traction device and where is the counter force applied

Answer 21

Thomas’ splint

To the ischial tuberosity

Question 22

In what joint condition is simple sliding traction used

Answer 22

The hip

Question 23

What is Hamilton-Russel Traction

Answer 23

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

Question 24

Give some examples of internal fixation

Answer 24

screws
plates
compression plates
intramedullary nails

Question 25

What are some advantages of internal fixation

Answer 25

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

Question 26

What are some disadvantages of internal fixation

Answer 26

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

Question 27

When is screw fixation used

Answer 27

to attach small bony fragments e.g. malleoli

Question 28

What is involved with an intramedullary nail

Answer 28

Passage of a rod into the medullary canal of a long bone and across the fracture site, thus stabilising it in bending

Question 29

How can we treat infection that has occurred following intramedullary nail

Answer 29

Remove the nail
medullary canal is the reamed to debride the infection
bone retailed

Question 30

In what cases is intramedullary nailing most commonly used

Answer 30

Femur and tibia

Question 31

When are wires used to hold bone fragments in position

Answer 31

Colles Fracture: stiff Kirschner wires

Patella fractures

Question 32

What is the main advantage of a frame fixation

Answer 32

They allow good fixation whilst allowing access to the fracture site

Question 33

What type of fixtures have large screws into eh bone which have a bar on one side of the bone

Answer 33

monolateral fixator

Question 34

What type of fixtures have multiple fine wires through the bone which are then joint to form rings around the bone

Answer 34

circular frames

Question 35

When should fracture fixation be used

Answer 35

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

Question 36

When does rehabilitation begin

Answer 36

immediately after the primary treatment