Orthopaedic Trauma Flashcards
Fractures:
Disruptions in the continuity of bone
Open fractures require (2):
- Urgent tetanus and antibiotics
- Semi-urgent surgical debridement
Beset test to order for fx:
X-ray
Most sensitive test for fx:
MRI
Fx treatment (4):
- Recognition
- Reduce
- Retain
- Rehab
Nonunion (2):
- Bone does not heal
- Lack of radiographic evidence of progression of callus formation of a 3-5 month period
Malunion:
Bone heals in unacceptable alignment
Primary fx healing (2):
- Direct healing with no callous
- Rigid fixation from plates
Secondary fx healing (2):
- Indirect formation of bone from uncommitted mesenchymal cells
- Controlled motion (rods, casts)
Three stages of secondary fx healing:
- Inflammatory for 48 hours
- Reparative for 8 weeks
- Remodeling for 1 year
Osteogenic bone healing (2):
- Bone forming
- Only autologous bone graft
Osteoinductive (3):
- Bone stimulation
- Encourages differentiation of mesenchymal cells in to osteoblasts
- BMP-2 and BMP-7
Osteoconductive (2):
- Bone scaffold
- Cancellous allograft
Casting pro’s (3):
- Undisturbed fracture milleu
- No incisions
- Heals by endochondral ossification
Casting con’s (2):
- No anatomic reduction
- Stiffness
Traction pro’s (2):
- Undisturbed fracture milleu
- No risk of surgery
Traction con’s (3):
- Poor reduction
- Pin site problems
- Fracture disease
External fixation pro’s (4):
- Load bearing
- Small incisions
- Fracture milleu ok
- Early motion
External fixation con’s (2):
- Pin sites
- Pain in the ass
IM nail pro’s (4):
- Load bearing
- Small incisions
- Periosteal blood supply ok
- Stimulates endosteal blood suppy
IM nail con’s (3):
- Non anatomic
- Callus formation
- Too much movement?
ORIF pro’s (4):
- Anatomic reduction
- Load sharing
- Early motion
- Heals with intramembranous ossification
ORIF con’s (2):
- Stripping of periosteum increases nonunion
- Bigger wounds
ORIF locked pro’s (5):
- Load bearing
- Early motion
- Less stripping
- Smaller wounds
- Good for poor bone quality
ORIF locked con’s (3):
- Decreased healing due to lack of micromotion
- Cost
- Not anatomic reduction
