Ortho Med Unit 5 Flashcards
What questions should be be asked when taking a trauma history?
- What happened?
- (different amount of energy between low impact fracture from a slip, or a RTA - radiograph may look the same)
- Determines the likelihood of injury to soft tissues and blood supply disruption - How did it happen? (look for injury pattern)
- Where and when? (how long since injury)
- What were they like before it happened? (PMH)
- Who is the person (social history)
Why is it important to keep detailed notes as soon as possible after managing an incident?
May be important relating to insurance or litigation
May not be months of years until asked to give an account of the incident
What are the 6 signs of a fracture?
Deformity Tenderness Swelling Discolouration/bruising Loss of function Crepitus
What other tissues may be damaged in an injury causing fracture?
Skin Fat Muscle Blood vessels Nerves
How can bruising be used to age an injury?
Dark at first; loss of deoxygenated blood into soft tissues
Green-yellow; haemoglobin in the RBCs broken down + carried to liver (by scavenger cells)
What information may be given but he deformed appearance of a fracture?
The direction of injury
How are fractures investigated?
X-ray; coronal + sagittal plane
CT scan; if hidden by shadows on X-ray
USS; show resulting blood accumulation
Radioisotope scanning; for a suspected fracture that is a couple of weeks old and can’t be seen on X-ray
How does radioisotope scanning work?
Inject a small amount of radioactive substance into the blood stream, binds to phosphorus which is uptaken by bones - the more uptaken, the more metabolically active
Will identify a site of unusual metabolic activity (ie fracture)
Especially useful for scaphoid fractures
How should a fracture be described?
Bone
Side
Open/closed
Where on bone (prox/dist/mid-shaft/intra-articular)
Shape (spiral, oblique, transverse)
How many fragments (simple, butterfly, comminuted)
Position of distal fragment
- displacement (ant/post/med/lat)
- angulation (ant/post/varus/valgus)
- rotation (internal/external)
Could it be pathological (if seems out of proportion to the violence of the injury)
What type of injury causes a spiral vs oblique/transverse fracture?
Spiral: through twisting (low energy mode of injury)
- assoc with little soft tissue damage
- blood supply is preserved and healing unlikely to be a problem
Oblique/transverse: buckling or direct injury (high energy mode of injury)
- results in soft tissue stripping + damage to blood supply
- usually takes longer to heal
What is the difference between a simple, butterfly and comminuted fracture?
Simple: 2 fragments
Butterfly: 3 fragments
Comminuted: multiple fragments (shattered)
What is the immediate management of a fracture?
Pain relief - analgesia/splintage
Control of blood loss (may need to replace blood)
If open = immediate surgery (surgical emergency)
How does splintage/traction help in the immediate management of pain from a fracture?
Helps to relieve muscle spasm, a major component of post fracture pain
(should include the joint above/below a fracture)
Arm to chest, bind legs together
How much blood is lost in different fractures?
Upper limb + peripheral lower limb; very minimal (even tolerated by the elderly)
Femur; 2-3pints
Tibia; 1unit (only serious if combined with other injuries)
Pelvic; 6units (due to venous plexus disruption - very serious)
What should be done for an open fracture?
Surgery
- extend the fracture and remove all debris (otherwise will miss contaminants - bits of clothing)
- clean wound + remove all dead tissue
- broad spec Abx + tetanus protection
What is the definitive management of a fracture?
Reduction + holding
What are the aims of reduction? How is reduction of a fracture done?
Aim to restore as close to a normal position as possible (joint should be very accurate whereas mid shaft is more margin for error)
Closed reduction; traction + manipulation (general or regional anaesthetic required)
Open reduction; surgically open + relocated under vision