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
How much blood is in the body, how much can you loose without negative effects?
5 litres in body
Can loose 500ml without negative effects
What can cause dysfunction of CNS?
Inter-cranial bleeds
Spinal injury
What to check for in exposure?
Look at whole body
Including abdominal, pelvic and long bone injuries.
Whole body CT
What are some physiological effects of trauma?
Endocrine, metabolic, immunological changes.
Early/Ebb phase - 24-48hrs, hemodynamic disturbances (decrease in blood volume), increased catecholamines (adrenaline).
Catabolic (flow phase) - lasts 24hrs-week, increased metabolic rate, O2 and protein utilisation, fat breakdown, relative insulin resistance, catecholamine and corticosteroid mediated.
Anabolic phase - 5-8 days to weeks - positive N2 balance and protein synthesis.
