Management of specific fractures Flashcards
what are the general principles for treating trauma to bone
advanced trauma life support
reduce fracture
hold fracture
rehabilitate once fracture has healed
what are the general principles for orthopaedics
history
examination
look>feel>move
investigations
what are the clinical signs of a fracture
pain swelling crepitus deformity adjacent structural injury - nerves,vessels,ligaments,tendons
what are the investigations for fractures
radiographs
bone scan
xray
ct
how do you describe a fracture radiograph
location - which bone and which part pieces - simple, multifragmentary pattern - transverse/oblique/spiral? displaced/undisplaced? translated/angulated? xyz plane
how do fractures heal
bleeding->inflammation->new tissue formation->remodelling
blood->neutrophils,macrophages -> fibro/chndro/osteoblasts->collagen->macrophages,osteoclasts/blasts
what happens in the inflammation stage of fracture healing
haematoma formation
release of cytokines
granulation tissue and blood vessel formation
what happens in the repair stage in the fracture healing
soft callus formation
(type 2collagen to cartilage)
converted to hard callus
type 1 collagen to bone)
what happens in remodelling stage in fracture healing
callus responds to activity, external forces, functional demands and growth
excess bone is removed
what is primary bone healing
- intramembranous healing
- absolute stability
- direct to woven bone
what is secondary bone healing
- endochondral healing
- involves responses in periosteum and external soft tissues
- relative stability
- endochondral ossification - more callus
what are the closed methods for reduction
manipulation
traction - pulling skin or sticking pins in bones (skeletal)
what are the open methods for reduction
mini incision
or full exposure
what are some general fracture complications
fat embolus
dvt
infection
prolonged immobility - uti, chest infections, sores
what are some specific fracture complications
neurovascular injury muscle/tendon injury non union/mal union local infection degenerative change - intraarticular reflex sympathetic dystrophy
factors affecting tissue healing
mechanical environment - movement and forces
biological environment - blood supply, immune function, infection and nutrition
what are some causes of fractured neck of femur
osteoporosis - older
trauma - younger
combination
when would you expect to see fractured neck of femur
age
cormorbidity - respiratory/cardiovascular/diabetes/cancer
preinjury mobility/shopping/walking/sports
social hx
how to fix/replace extracapsular fractures
will be minimal risk to blood supply and avascular necrosis - fix with plate and screws
how to fix/replace intracapsular fractures
if undisplaced and less risk to blood supply - fix with screws
if displaced and 25-30% risk avn - replace in older patients and fix in younger patients
how does a shoulder dislocation present
variable hx but usually direct trauma
pain
restricted movement
loss of normal shoulder contour
how would you carry out a clinical examination for shoulder dislocation
assess neurovascular status- axillary nerve
xray prior to any manipulation - identify fracture e.g humeral neck/glenoid
scapular
what is management techniques for shoulder dislocation
numerous techniques - to reduce dislocated shoulder
vigorous manipulation/twisting manipulation should be avoided to avoid fractures
patient relaxation - entonox, benzodiazepines
stimson method if alone
how to manage distal radius fracture
cast and splint - temporary treatment, reduction of fracture
mua and k wire - for extra articular fractures (pin into wrist)
orif - any displaced, unstable fractures not suitable for k wires or with intra articular involvement
non operative management for tibial plateau fracture
only truly undisplaced fractures with good joint line congruency assessed on ct/high fidelity imaging
operative management for tibial plateau fracture
restoration of articular surface using combination of plate and screws
bone graft/cement may be necessary to prevent further depression after fixation
non operative management for ankle fracture
non weightbearing below knee cast for 6-8wks - can transfer into walking boot then physiotherapy to improve range of motion/stiffness from joint isolation
weber a - below syndesmosis and therefore thought to be stable
weber b - if no evidence of instability
operative management for ankle fracture
soft tissue dependent - patients need strict elevation as injuries often swell considerably
open reduction internal fixation +- syndesmosis repair
syndesmosis screws can be left in situ but may break after sometime
weber b - unstable fractures
weber c - fibular fracture above level of syndesmosis therefore unstable
