pathological fracture Flashcards
main thing to be aware of
history of malignancy
patients with ‘well controlled’ cancer
what is pathological fracture
fracture in an abnormally weakened bone
fracture from low energy injury
when to suspect pathological fracture
low trauma
pain before trauma
history of cancer
sunburst matrix
codmans triangle
osteosarcoma
score for fracture risk in metastatic bone disease
mirels score
>9 operate
what is plasmacytoma
solitary myeloma
management of plasmacytoma
WLE and reconstruction
early complications of fracture
bleeding infection shock compartment syndrome fat embolism neurovascular damage
late complications fracture
DVT or PE chest infection non / mal union pressure sore AVN stiffness
treatment of shock
IV fluids
blood transfusion
coagulation
surgery
risk factors DVT
prolonged immobility pelvis limb fracture venous stasis hyper coagulable state smoking dehydration previous DVT
diagnosis of DVT
Doppler US veins
PE = VTPA
DVT symptoms
red swollen calf
prevention of DVT
TED stockings
LMWH eg enoxaparin
treatment DVT
LMWH at therapeutic dose
long term warfarin
symptoms fat embolism
hypoxia tachycardia tachypnoea pyrexia dyspnoea petechial rash (late)
prevention of fat embolus
long bones eg femur high flow oxygen rapid splint age maintain fluids urgent stabilisation of fracture
treatment fat embolism
supportive respiratory support early ICU high flow oxygen resuscitation with fluids corticosteroids
what is compartment syndrome
haematoma and oedema from fracture raises pressure within osteofascial compartment resulting in decreased perfusion of tissues and muscle ischaemia
symptoms compartment syndrome
PAIN!!!!!!!!!!!!!! UNCONTROLLABLE PAIN!!!!!!!!!!!!!
not 5ps
treatment compartment syndrmoe
urgent fasciotomy
analgesia
high flow oxygen
contact senior
factors affecting fracture healing
smoking NSAIDs diabetes steroids poor nutrition
