General Management of Fractures Lecture Powerpoint

Question 1

What questions to ask in general management of fractures?

Answer 1

-How did injury occur - what was the mechanism and was it high or low energy?

Question 2

Fractures at different levels usually indicate ___ energy mechanism, whereas fractures at the same indicate ___ energy mechanism

Answer 2

lower, higher

Question 3

3 peak times of death after trauma

Answer 3

• 50% die within first few mins of sustaining injury due to massive blood loss or neurologic
• 30% die within first few days after injury most commonly from neurologic injury
• 20% within days to weeks following injury due to multi system organ failure

Question 4

Indicators of adequate resuscitation*** (3)

Answer 4

• serum lactate levels normal <2.5mmol/L*** (sees if some circulatory beds remain inadequately perfused)
• MAP >60
• HR <100

Question 5

Class III or higher hemorrhagic shock requires not only fluid resuscitation but also….

Answer 5

….blood as well

Question 6

Pain control/procedural sedation in orthopedic patients (5)

Answer 6

• narcotics morphine or dilaudid IV OR
• norco or percoset PO/
• zofran and or benadryl simultaneously
• valium for muscle relaxant
• propofol (IV) or ketamine (IV)

Question 7

Rule for local anethetic without epi

Answer 7

No fingers, toes, nose, or hose (penis)

Question 8

Types of immobilization (4)

Answer 8

• Splint - generally applied acutely after fracture or injury, do not want to apply a cast to acute fracture in adult because of risk for swelling and compartment syndrome so use a splint
• plaster or fiberglass molds to splint reduction better
• casting
• traction device

Question 9

Most important early management tool in open fractures

Answer 9

Early IV antibiotics 2gm of ancef (pending allergy) and add PCN if dirt exposure, vanco if allergic, update tetanus if not up to date

Question 10

Washing out of open fractures

Answer 10

Remove gross debris and use low pressure lavage of sterile saline alone

Question 11

Patient specific factors in bone healing (4)

Answer 11

• diet (nutritional deficiencies)
• diabetes (take longer to heal)
• nicotine use (decreases rate of fracture healing and decreases strength of fracture callus, can take up to 70% longer)
• NSAIDS slow rate

Question 12

A complication in children wearing casts can be if they…

Answer 12

….put things down their cast (introduce bacteria to warm dark moist environment to thrive)

Question 13

High energy mechanisms of injury (4)

Answer 13

• GSW
• MVA
• fall from significant height
• crush

Question 14

Low energy mechanisms of injury (3)

Answer 14

• twisting
• fall from standing height
• insufficiency fractures