Principles of Fracture Management Flashcards
Trauma and Fractures
Can be minor or severe
- Can be minor or severe
Trauma and Fractures
- Motorcycle accident
- Open book … fracture
- Significant proximal … fracture
- … of left hip
- Motorcycle accident
- Open book pelvic fracture
- Significant proximal femoral fracture
- Dislocation of left hip
Complications of Surgery
- Loss of …
- Loss of …
- Loss of …
- Loss of Life
- Loss of Limb
- Loss of function
Complications of Surgery
- General/Systemic
- CVS,RS,GIT,GUS,NS
- Specific/Local
- I…
- D…
- N… damage
- F…
- Metalwork failure
- Operation specific
- General/Systemic
- CVS,RS,GIT,GUS,NS
- Specific/Local
- Infection
- Dislocation
- Neurovascular damage
- Fracture
- Metalwork failure
- Operation specific
Complications of Surgery
- General/Systemic
- CVS,RS,GIT,GUS,NS
- Specific/Local
- Infection
- Dislocation
- Neurovascular damage
- Fracture
- M… failure
- O… specific
- General/Systemic
- CVS,RS,GIT,GUS,NS
- Specific/Local
- Infection
- Dislocation
- Neurovascular damage
- Fracture
- Metalwork failure
- Operation specific
Trauma
Acute Management - Acute handover
- ATMIST
- A..
- T..
- M..
- I… (top to toe)
- S..
- T…
- ATMIST
- Age
- Time
- Mechanism
- Injuries (top to toe)
- Signs
- Treatment
ATLS
- Revolutionised the treatment of … patients in 1980s
- Plane crash in Nebraska in 1976
- Now international system taught in 47 countries
- Revolutionised the treatment of trauma patients in 1980s
- Plane crash in Nebraska in 1976
- Now international system taught in 47 countries
What is the ATLS approach??
- A - Airway - With cervical spine control - Give oxygen - How do you control the cervical spine? (Manually - tape, hold with 2 hands/ foam blocks) -How do you assess the patency of an airway? - ask where they are, see if they answer - When might the airway be compromised? blood, vomit, swelling, tongue - What might you need to do? surgical airway potentially or formal tracheostomy
- B - Breathing And ventilation - What is the difference? Breathing = mechanical process, negative pressure is created within thoracic cavity and expand lung and draw air, ventilation - gaseous exchange at membrane level - How do you assess this? - assess What might interfere with breathing?- What might you need to do?
- C - Circulation - With haemorrhage control - How do you assess this? - Classes of shock? - Where can you bleed from enough to die quickly?
- D - Disability -
- E - Exposure
A - Airway - With cervical spine control - Give oxygen - How do you control the cervical spine? (Manually - tape, hold with 2 hands/ foam blocks) -How do you assess the patency of an airway? - ask where they are, see if they answer - When might the airway be compromised? blood, vomit, swelling, tongue - What might you need to do? surgical airway potentially or formal tracheostomy
B - Breathing And ventilation - What is the difference? Breathing = mechanical process, negative pressure is created within thoracic cavity and expand lung and draw air, ventilation - gaseous exchange at membrane level - How do you assess this? - assess What might interfere with breathing?- What might you need to do?
C - Circulation - With haemorrhage control - How do you assess this? - Classes of shock? - Where can you bleed from enough to die quickly?
D - Disability -
E - Exposure
A - Airway - With cervical spine control - Give oxygen - How do you control the cervical spine? (Manually - tape, hold with 2 hands/ foam blocks) -How do you assess the patency of an airway? - ask where they are, see if they answer - When might the airway be compromised? blood, vomit, swelling, tongue - What might you need to do? surgical airway potentially or formal tracheostomy
B - Breathing And ventilation - What is the difference? Breathing = mechanical process, negative pressure is created within thoracic cavity and expand lung and draw air, ventilation - gaseous exchange at membrane level - How do you assess this? - assess What might interfere with breathing?- What might you need to do?
C - Circulation - With haemorrhage control - How do you assess this? - Classes of shock? - Where can you bleed from enough to die quickly?
D - Disability -
E - Exposure
Save Life
- … care vital
- Anaesthetists, Orthopaedics, General Surgery, Cardiothoracic Surgery, Neurosurgery etc etc
- … essential
- All singing from same hymn sheet
- Multidisciplinary care vital
- Anaesthetists, Orthopaedics, General Surgery, Cardiothoracic Surgery, Neurosurgery etc etc
- Communication essential
- All singing from same hymn sheet
Save Limb
- Only once … … and patient …
- What contributes to loss of limb?
- Only once life saved and patient stabilised…
- What contributes to loss of limb (Vessels, Nerves, Bones, Soft tissues/muscles)
Vascular problems
- Direct … injury
- What to do?
- … of venous outflow
- How might this occur in a trauma patient?
- Direct arterial injury
- What to do?
-
Occlusion of venous outflow
- How might this occur in a trauma patient?
Compartment syndrome
- What is the treatment?
Compartment syndrome
- What happens if you miss this diagnosis??
Bony injuries
- Can these lead to loss of a limb?
- Directly? - open lower leg tibial fracture
- Indirectly? - soft tissue wound can risk ..
- Can these lead to loss of a limb?
- Directly? - open lower leg tibial fracture
- Indirectly? - soft tissue wound can risk infection
Physiology of Shock (5)
- Tachycardia
- Decreased pulse pressure
- Altered conscious level
- Decreased urine output
- Reduced BP (late)
Physiology of Shock
- T…
- Decreased pulse …
- Altered … level
- … urine output
- … BP (late)
- Tachycardia
- Decreased pulse pressure
- Altered conscious level
- Decreased urine output
- Reduced BP (late)
Fracture Management - History
- AMPLE
- A…
- M..
- … … Hx
- Last …
- E…/E..
- (incl T…)
- AMPLE
- Allergies
- Medications
- Past Medical Hx
- Last meal
-
Environment/Event
- (incl Temp)
Specific Fracture History
- Red Flags
- V..
- N…
- Soft tissues
- V..
- C..
- Ch…
- Red Flags
- Vessels
- Nerves
-
Soft tissues
- Viability
- Compartment
- Children
Fracture Examination
- Start at the top, remember ATLS
- Listen to the patient
- Remember your anatomy
- L..
- F.. (carefully)
- M… (carefully)
- S.. T.. (nerves and vessels)
- Start at the top, remember ATLS
- Listen to the patient
- Remember your anatomy
- LOOK
- FEEL (carefully)
- MOVE (carefully)
- SPECIAL TESTS (nerves and vessels)
Fracture Management
- Relieve pain
- A…
- S… the bone
- Avoid further damage
- Reduce D..
- S.. B… limbs
- Re-establish C…
- Relieve P… on nerves close by
- Open F……..?
- Relieve pain
- Analgesia
- Splint the bone
-
Avoid further damage
- Reduce dislocations
- Straighten bent limbs
- Re-establish circulation
- Relieve pressure on nerves close by
- Open Fractures……?
Fracture Management - Investigations
- Xrays
- … views
- … joints
- ?… times
- Xrays
- Two views
- Two joints
- ?Two times
Xray Description
- Which bone
- Where in the bone
- Intra-…
- Ep…
- p..
- M…
- D…
- What sort of bone
- Normal, P..
- Which bone
-
Where in the bone
- Intra-articular
- Epiphysis
- Physis
- Metaphysis
- Diaphysis
-
What sort of bone
- Normal, Pathological
How to talk the talk - X-ray fracture management
- How you ‘think’
- 1.It’s a tibia
- 2.It the far end of it
- 3.Its broken
- 4.It goes into the joint
- 5.The bits have moved!
- change order…
- “This is a ….”
- 1.Displaced
- 2.Intra-articular
- 3.Fracture
- 4.Of the distal
- 5.Tibia
