Orthopaedics unit 5 Common fractures - deck 2 Flashcards
What must be done once a fracture has been diagnosed ?
A description of the fracture must be noted
Why is it important to describe the shape and degree of fragmentation of a fracture ?
Because these features indicate the amount of energy which has caused the injury, and so help us to understand it and how we may treat it.
What questions must be asked and answered in order to accurately describe a fracture ?
- Which bone is broken and on which side?
- Is the fracture open or closed?
- Where on the bone is it broken?
- What shape is the fracture ?
- How many fragments of bone?
- What is the position of the distal fragment ?
- Could it be a pathological fracture ?
8.
Define what is meant by both open and closed fractures
- Open fracture = a fracture in which the skin is broken
- Closed fracture = a fracture in which the skin is still intact
What are the 5 main locations in a bone that it can be broken?
- Intra-articular (in the joint)
- Mid-shaft
- Proximal third
- Middle third
- Lower third
What are the 3 main shapes a fracture could be described as?
- Spiral
- Oblique
- Transverse
How do spiral fractures occur ?
Through twisting forces, it is a common low energy mode of injury.
Describe the associated damage to the other structures (other than the bone) in a spiral fracture
They are usually associated with little soft tissue damage, so the blood supply to the bone is preserved and healing is unlikely to be a problem.
What type of injuries are oblique and transverse fractures caused by ?
They are caused by buckling or direct injury to the bone
Describe the associated damage to the other structures (other than the bone) in an oblique or transverse fracture
- These fractures involve a lot of energy, resulting in soft tissue stripping and damage to the blood supply.
- Such injuries will require a lot more consideration when the choice of treatment is being made and usually take longer to heal.
What are the 3 descriptions for how many fragments of bone are present in a fracture ?
- Simple
- Butterfly
- Comminuted
Describe what each of the following terms mean in terms of how many fragments of bone there is in the fracture:
- Simple
- Butterfly
- Comminuted
- Simple - there is a proximal and distal fragment
- Butterfly - The term is commonly used in orthopaedic surgery, and results from two oblique fracture lines meeting to create a large triangular or wedge-shaped fragment located between the proximal and distal fracturefragments, and resembles a butterfly.
- Comminuted - fractures with 3 or more fragments (think butterfly is technically a sub-type of comminuted)
How should fragments be described in relation to each other ?
The distal fragment should be described in relation to the proximal fragment
Why should the distal fragment of a fracture be described in relation to the proximal fragment ?
Because the proximal fragment takes up a position determined by the new muscle balance and so treatment must be aimed at repositioning the distal fragment.
What 3 things should the position of the distal fragment of a fracture be described by ?
- Displacement
- Angulation
- Rotation
Define what is meant by the displacement of the distal fragment of a fracture and list the different ways in which the fragment can be displaced
This describes the direction of translation of the distal fragment and is described using anatomic terms.
Fractures can be described as anteriorly or posteriorly displaced and medially or laterally displaced.
Define what is meant by the angulation of the distal fragment of a fracture and list the different ways in which the fragment can be displaced
This describes the direction in which the distal fragment points towards and the degree of this deformity
Angulation may be described as anterior, posterior, varus (medial) or valgus (lateral)
What are the 2 different ways in which the distal fragment of a fracture may be rotated ?
Internally or externally
Define what a pathological fracture is and what it suggests
- A pathological fracture is one in which the fracture seems out of proportion to the violence of the injury.
- This suggests that the bone is weak as a result of osteoporosis or other diseases such as cancer.
What are the 2 main ways in which pain relief from a fracture is achieved ?
- Use of pain-killing drugs
- Splintage
What type of pain killers of often necessary following a fracture ?
Strong pain-killing injections of morphine or pethidine are usually necessary.
Define what a splint is
A splint is a device which holds a fracture steady
What is the benefit of when a splint can often be applied in the treatment of a fracture ?
It can often be applied before arriving at hospital, which this alone can relieve pain
In general what should a splint immobilise/stabilise ?
The joint above and below the injury
Simple measures aiming at splinting an injury such as binding the arm to the chest, with or without a sling, or simply binding the legs together are often sufficient - T or F ?
True
The splint may need to be removed for definitive examination and radiographs - what should be avoided however ?
Repeated removal for innumerable doctors to examine the injured person
What is an alternative method to splintage and why is it sometimes used?
Traction
It may be used early in treatment to relieve muscle spasm, which is a major component of post-fracture pain.
Define what traction is
Traction refers to the practice of slowly and gently pulling on a fractured or dislocated body part. It’s often done using ropes, pulleys, and weights. The purpose of traction is to guide the body part back into place and hold it steady.
What specific fracture is traction particularly useful for and why?
Fractures of the femoral neck because splintage is almost impossible to apply.
For most upper limb and peripheral lower limb fractures, blood loss is in itself not too serious and is tolerated even by an elderly person. - T or F?
True
In what fractures should you be concerned about major blood loss becoming a problem?
In major long bone fractures, particularly of the femur and to a lesser extent the tibia, blood loss is significant
in general how much blood will a person with a femoral fracture lose?
Between 2-3 units of blood into the soft tissues
How many ml of blood is in one unit ?
450ml or one pint
How much blood may be lost in a tibial fracture ?
1 unit - which is in itself tolerable but when combined with other injuries may become significant
Along with long bone fractures what other area when fractured is associated with major blood loss?
Pelvic fractures, esp if unstable are associated with major bleeding
Where does the blood loss in a pelvic fracture come from ?
Major venous bleeding from the pelvic plexuses
How much blood loss can occur in a pelvic fracture ?
Up to 6 units or so
If pelvic fractures are combined with other skeletal injuries what could happen to the patient ?
They could die as the level of blood loss may be lethal, unless the fluid is replaced preferably with blood
In general what should be done for the management of all patients with major long bone fractures to combat the blood loss ?
- They should be cross-matched for blood
- A good-sized venous line for blood transfusion should be established
In general what should be done for the management of all patients with pelvic fractures to combat the blood loss ?
- Cross-matched for blood
- 2 good-sized venous lines may be needed and a central venous line should be established to ensure that transfusion is keeping up with loss.
What is another name for an open fracture ?
Compound fracture
What sort of injuries do open fractures tend to occur in ?
More violent injuries
What is the important thing to remember about all open fractures and how this then relates to its management
- In all open fractures the bone/wound is contaminated by bacteria from the environment
- The treatment strategy is to clean them out and remove all dead tissue as soon as possible, to prevent a contamination becoming an infection.
An open fracture is a surgical emergency, when should the patient be taken to the operating theatre?
ASAP provided that the patient’s general condition permits
When in surgery what is done to clean out the wound of an open fracture ?
The wound can be extended surgically and all debris and suspected dead tissue removed.
Why is it important to ensure These will only be discovered if a wide incision is made and exploration down to the bone is performed even in small open fracture wounds ?
Even in small wounds, bits of clothing which (inevitably have bacteria on them), dirt and fragments of wood or metal can be found.
When is it better to leave a wound open following debridment for an open fracture ?
If there is any doubt that closure can be achieved without any tension on the skin
The vast majority of wounds following debridment of an open fracture should be left open and closed either as a secondary procedure after a few days or left to heal spontaneously. - T or F?
True
For patients whos wound following debridment of an open fracture is left open, what additional treatment is needed to prevent infection still occurring ?
Broad spectrum antibiotics and some form of tetanus protection
