Introduction to Trauma Flashcards
Fracture patterns:
Complete vs Incomplete
- Complete: fracture all the way through the bone
- Incomplete: whole cortex not broken
Types of complete fracture
Primary Healing
Direct healing without a fracture callus
Requires edges to be in contact perfectly with zero movement
Done with surgery only
Secondary healing
The standard way bone heals
- Heamatoma develops filled with osteoblasts
- < 2weeks You get a callous that forms consisting of soft cartilage
- Soft cartilage is replaced by woven bone, this is quick to form but not stress oriented
- Remodelling occurs over years, this is where woven bone becomes lamella bone and it does according to wolff’s law e.g. according to stress
Definition: Fracture
A disruption in bone continuity
Definition: Dislocation
Complete loss of continuity of two bones forming a joint
What do you call the partial loss of continuity of two bones forming a joint?
Subluxation
What do you call a fracture consiting of multiple fragments
Comminution
What do you call a fracture extending to a joint
Intra-articular
Definition: Open Fracture
A fracture in direct communication with the open environment
Congenital risk of fracture?
Osteogenesis imperfecta
Aquired metabolic risk of fracture?
Rickets
Osteomalacia
Aquired degenerative risk of fracture?
Osteoporosis
Cancer related fracture risk?
A tumor in the bone can weaken the bone and increase risk of fracture
Risk factors that increase risk of injury (not risk of fracture after injury)
- Visual impairment
- Drug/alcohol use
- Neuropathy
- Balance disorder
- Epilepsy
Sex patterns with fracture numbers
When young more males tend to get fractures and they tend to be high energy
When old more females tend to get fractures and they tend to be low energy
Wolff’s law
Woven bone orients into lamella bone based on the stress it experiences
What is a non-union?
This is where there has been too much movement during the callus staging of bone healing. The movement means that osteogens become chondroblasts and never become osteoblasts. If this happens then woven bone never forms and you get a non-union
6 extremely important life-threatening things to look out for during trauma
ATOM-FC
- Airway Obstruction
- Tension Pneumothorax
- Open Pneumothorax
- Massive Haemothorax
- Flail Chest
- Cardiac Tamponade
Do you know what each of these mean?
Emergency department management of an open fracture
- IV antibiotics
- Anti tetanus
- Splint or cast
- Sterile dressing
Surgical management of an open fracture
Primary
- Wound debridement (removal of all contaminants and dead tissue including bone)
- Skeletal stabilisation
Secondary
- Tissue inspection and further debridement
- Wound closure
Compartment syndrome signs
- Pain abnormal to inury
- Muscles feel tight
Compartment syndrome treatment
Required a fasciotomy
Compartment syndrome red herring
Can still have a distal pulse, the pressure doesn’t necessarily cut off arterial flow. The localised hypoxia instead comes from decreased O2 perfusion due to a decreased perfusion pressure because of such high muscle pressure.
