Orthopaedic Trauma Flashcards
What are the 4 most common bones to fracture?
1) hip
2) vertebrae
3) radius
4) ankle
What are the 3 aims of fixing fractures?
Pain relief
Mobility
Nursing care
What is the general treatment for an intracapsular hip fracture?
Replace head of femur - hemiarthroplasty
What is the general treatment for extracapsular hip fractures?
Fixation
What the four options for fixation of hip fractures?
Dynamic hip screw
Intramedullary nail
Screws
Plates
When is a dynamic hip screw generally used to treat hip fractures?
Stable extracapsular fractures
DHS is a more forgiving implant and a lower risk surgery.
When is a intramedullary nail generally used to treat hip fractures?
For unstable extracapsular fractures
Or if loss of posterior medial buttres ?
As has greater mechanical properties due to shorter leaver arm
Why is an intramedullary nail a higher risk surgery than dynamic hip screw?
Longer surgery
Nail into medullary canal raises pressure - risk of fat embolism
What is commonly used to fix patella, olecramon and medial malleolus fractures?
Tension band wiring (TBW)
A 92 year old female fell backwards whilst making tea and sustained a intracapsular fracture of left head of femur. She has osteoarthritis, osteoporosis and crohns. She was previously unstable on her feet but mobilised independently using a walker.
What is the best treatment option?
Hemiarthroplasty
- no need for total
- hemi is a lower risk surgery and she doesn’t need total due to age etc
Don’t do fixation as is intracapsular fracture
What are the types of trauma?
Acute - resulting from a single incident
Chronic - repeated and prolonged such as domestic violence or abuse
Complex - exposure to varied and multiple traumatic events, often of an invasive nature
Polytrauma - multiple traumatic injuries in an individual resulting from a major catastrophic event
Blunt - e.g RTA, punch injury, fall from height
Penetrating e.g stabbing
What is the ATLS primary protocol of assessment?
A - airway
B - breathing
C - circulation - muscles survive 2hrs without blood, nerves 1hr
D - disability/ dysfunction of CNS
E - exposure (environment,events) or everything else
F - fingers and toes (extremities)
What is the ATLS secondary protocol of assessment?
S systemic assessment of the patient from head to toe, looking for occult injuries.
Usually done after first 24hrs, once pt is controlled.
How can airway control be achieved?
Guedel - tube sits along top of mouth, ends at tongue
Nasopharyngeal - thin, clear, flexible tube inserted into nostril. To bypass upper airway obstruction at level of nose, nasopharynx or base of tongue.
Cuffed ET tube - endotracheal tube. Low pressure to facilitate quick and easy incubation.
Tracheostomy - opening at front of neck so a tube can be inserted into trachea.
How do we manage circulation problems?
Give fluid on maintain circulatory volume:
- sodium chloride
- plasmalite
- sodium lactate
