L8 - Principles of fracture management Flashcards
COMPLICATIONS OF SURGERY
i) what three things can be lost
ii) name three general complications
iii) name four specific complications
i) loss of limb, function, life
ii) general > CV, RS, NS
iii) specific > infection, dislocation, neurovasc damage, fracture
ACUTE MANAGEMENT
i) what does ATMIST stand for?
ii) what is ATLS?
i) Age of pt
Time of accident
Mechanism of accident
Injuries top to tie
Signs (vital)
Treatment to that point
ii) ATLS is standardised care of trauma patients - A to E
AIRWAY MANAGEMENT
i) name two ways to control the cervical spine in possible injury
ii) what can you give to the patient?
iii) how do you assess airway patency?
iv) name one thing that can allow assesment of airway patency, breathing and circulation?
v) name three things that can occulde an airway
i) manually with two hands or with collar/foam blocks
ii) give oxygen
iii) ask questions and see if they respond
iv) asking questions assess airway and breathing and if answered correct then circulation to brain etc is ok
v) foreign object, tongue, sick, inflamm, epiglottitis
BREATHING MANAGEMENT
i) what is breathing? what is ventillation?
ii) what does ATOMFC stand for? what does it mean?
iii) what may have happened if the trachea is deviated?
iv) what does flail chest represent?
v) what non pathological reason may there be ground glass opacity on CXR?
i) breathing is a mechanical process that generates negative pressure in the thoracic cavity which allows lung expansion
- ventilation is gas exchange at a membrane level
ii) Air obstruction
Tension pneumothorax
Open pneumothorax
Massive haemothorax
Flail chest
Cardiac tamponade
- all these things can kill the patient
iii) deviated trachea > tension pneumothorax
iv) flail chest represents 2+ ribs broken
v) patient laying supine during Xray
CIRCULATION MANAGEMENT
i) what are the five causes of bleeding/shock?
ii) how is heart rate affected in shock? what is this due to?
iii) how is pulse pressure affected? what is this due to?
iv) how are concious level and urine output affected?
v) what is a late sign?
vi) how many classes of haemmorhagic shock are there?
i) one floor and four more
- external bleeding
- occult - pelvic, long bone fracture, abdominal, chest
ii) tachycardia due to increased sympathetic drive
iii) decreased pulse pressure due to initial increase in diastolic pressure
iv) altered conciousness and decreased urine output
v) reduced BP is a late sign
vi) four classes
SAVING LIMBS
i) what must be done first?
ii) name four things that need to be preserved for a functional limb
i) save life
ii) preserve vessels, nerves, bone and soft tissue/muscles
VASCULAR PROBLEMS
i) what would you do in a direct arterial injury?
ii) why may occulsion of venous outflow occur?
iii) what can swelling lead to?
i) repair a direct arterial injury
ii) occlusion of venous outflow can occur due to swelling compressing pre venous venules which occludes them which increases pressure in muscle compartments
iii) can lead to compartment syndrome
COMPARTMENT SYNDROME
i) what causes it?
ii) what does it cause?
iii) what is the main symptom?
iv) how is it treated?
v) what happens if its not treated?
i) caused by swelling which increases pressure in muscle compartments
ii) causes tissue necrosis
iii) main symptom is pain that is disproportionate to expected
iv) treat by releasing pressure which a fasciotomy
v) if not treated you get a fixed contracture = Volkmans ischaemic contracture
FRACTURE MANAGEMENT - HISTORY
i) what does AMPLE stand for?
ii) name two red flag injuries
iii) what two things must be assessed in the soft tissue?
iv) what must be flagged in children?
i) Allergy
Medications
Past medical hx
Last meal
Environment/event
ii) nerve and vessel damage
iii) viability and compartment syndrome
iv) non accidental injuries > safeguarding
FRACTURE EXAMINATION/MANAGEMENT
i) what format is used to examine?
ii) what do you do first? name two ways to do this
iii) name three ways you can avoid further damage
iv) which imaging technique would you use? how many views and how many joints?
i) ATLS
ii) first relieve pain > analgesia and splinting the bone
iii) reduce dislocation Asap, straighten bent limbs to reduce tension on BVs, re estab circulation, relieve pressure on nerves
iv) XRAY - two views over two joints
XRAY DESCRIPTION
i) what are the two keys facts that should be said first?
ii) which part is last?
iii) what is a simple fracture?
iv) what is a comminuted fracture?
v) which three things are affected if the bone is displaced?
vi) what type of fractures are common seen in children? what is an avulsion?
i) if it is displaced and if it goes into the joint (intra articular)
ii) which bone it is
iii) simple fracture > broken into two pieces and not pierced the skin
iv) comminuted fracture - broken to several parts
v) length, alignments and rotation are affected if bone is displaced
vi) greenstick fractures are commonly seen in children
- avulsion - involves ligament
CAUSES OF FRACTURES
i) what is an unusual cause of fracture?
ii) what type of action causes an oblique fracture?
iii) what type of action causes a butterfly fracture?
iv) what type of action causes a spiral fracture
i) tension
ii) compression causes oblique fracture
iii) bending causes a butterfly fracture
iv) torsion causes a spiral fracture
BASICS OF FRACTURE MANAGEMENT
i) what needs to be looked at to reduce the fracture? which three things need to be correct?
ii) name two external and two internal ways to stabilise a fracture
iii) name two other things that can be done
iv) would a joint replacement be done for an intra or extracapsular fracture of the hip?
i) is it closed or ipen
- need correct length, alignment and rotation
ii) external > sling, plaster cast
internal > wires, nails (intramedullary), plates (extramedullary)
iii) can do nothing eg mobilise or can replace joint
iv) joint replace for an intracapsular fracture
POLYTRAUMA
i) which two things need to be balance
ii) name three parameters that need to be normalised to manage the patient
iii) give a biological and mechanical reason why fractures may not heal
iv) which disease can cause a fracture to not heal and causes bone thickening and deformity
i) damage control (stabilise pt) vs early total care (treat fracture)
ii) acidosis (lactate <2), hypothermia and coagulopathy
iii) biol - hypovascular (due to infection or soft tiss deficiency)
mech - insufficient stability at the fracture site
iv) pagets disease
