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Year 2 Medicine > Principles of Fracture Management > Flashcards

Principles of Fracture Management Flashcards

1
Q

Trauma and Fractures

Can be minor or severe

A
  • Can be minor or severe
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2
Q

Trauma and Fractures

  • Motorcycle accident
    • Open book … fracture
    • Significant proximal … fracture
    • … of left hip
A
  • Motorcycle accident
    • Open book pelvic fracture
    • Significant proximal femoral fracture
    • Dislocation of left hip
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3
Q

Complications of Surgery

  • Loss of …
  • Loss of …
  • Loss of …
A
  • Loss of Life
  • Loss of Limb
  • Loss of function
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4
Q

Complications of Surgery

  • General/Systemic
    • CVS,RS,GIT,GUS,NS
  • Specific/Local
    • I…
    • D…
    • N… damage
    • F…
    • Metalwork failure
    • Operation specific
A
  • General/Systemic
    • CVS,RS,GIT,GUS,NS
  • Specific/Local
    • Infection
    • Dislocation
    • Neurovascular damage
    • Fracture
    • Metalwork failure
    • Operation specific
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5
Q

Complications of Surgery

  • General/Systemic
    • CVS,RS,GIT,GUS,NS
  • Specific/Local
    • Infection
    • Dislocation
    • Neurovascular damage
    • Fracture
    • M… failure
    • O… specific
A
  • General/Systemic
    • CVS,RS,GIT,GUS,NS
  • Specific/Local
    • Infection
    • Dislocation
    • Neurovascular damage
    • Fracture
    • Metalwork failure
    • Operation specific
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6
Q

Trauma
Acute Management - Acute handover

  • ATMIST
    • A..
    • T..
    • M..
    • I… (top to toe)
    • S..
    • T…
A
  • ATMIST
    • Age
    • Time
    • Mechanism
    • Injuries (top to toe)
    • Signs
    • Treatment
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7
Q

ATLS

  • Revolutionised the treatment of … patients in 1980s
  • Plane crash in Nebraska in 1976
  • Now international system taught in 47 countries
A
  • Revolutionised the treatment of trauma patients in 1980s
  • Plane crash in Nebraska in 1976
  • Now international system taught in 47 countries
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8
Q

What is the ATLS approach??

A
  • 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
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9
Q

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

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

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10
Q

Save Life

  • … care vital
    • Anaesthetists, Orthopaedics, General Surgery, Cardiothoracic Surgery, Neurosurgery etc etc
  • … essential
  • All singing from same hymn sheet
A
  • Multidisciplinary care vital
  • Anaesthetists, Orthopaedics, General Surgery, Cardiothoracic Surgery, Neurosurgery etc etc
  • Communication essential
  • All singing from same hymn sheet
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11
Q

Save Limb

  • Only once … … and patient …
  • What contributes to loss of limb?
A
  • Only once life saved and patient stabilised…
  • What contributes to loss of limb (Vessels, Nerves, Bones, Soft tissues/muscles)
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12
Q

Vascular problems

  • Direct … injury
    • What to do?
  • … of venous outflow
    • How might this occur in a trauma patient?
A
  • Direct arterial injury
    • What to do?
  • Occlusion of venous outflow
    • How might this occur in a trauma patient?
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13
Q

Compartment syndrome

  • What is the treatment?
A
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14
Q

Compartment syndrome

  • What happens if you miss this diagnosis??
A
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15
Q

Bony injuries

  • Can these lead to loss of a limb?
    • Directly? - open lower leg tibial fracture
    • Indirectly? - soft tissue wound can risk ..
A
  • Can these lead to loss of a limb?
    • Directly? - open lower leg tibial fracture
    • Indirectly? - soft tissue wound can risk infection
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16
Q

Physiology of Shock (5)

A
  • Tachycardia
  • Decreased pulse pressure
  • Altered conscious level
  • Decreased urine output
  • Reduced BP (late)
17
Q

Physiology of Shock

  • T…
  • Decreased pulse …
  • Altered … level
  • … urine output
  • … BP (late)
A
  • Tachycardia
  • Decreased pulse pressure
  • Altered conscious level
  • Decreased urine output
  • Reduced BP (late)
18
Q

Fracture Management - History

  • AMPLE
    • A…
    • M..
    • … … Hx
    • Last …
    • E…/E..
      • (incl T…)
A
  • AMPLE
    • Allergies
    • Medications
    • Past Medical Hx
    • Last meal
    • Environment/Event
      • (incl Temp)
19
Q

Specific Fracture History

  • Red Flags
    • V..
    • N…
    • Soft tissues
      • V..
      • C..
    • Ch…
A
  • Red Flags
    • Vessels
    • Nerves
    • Soft tissues
      • Viability
      • Compartment
    • Children
20
Q

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)
A
  • Start at the top, remember ATLS
  • Listen to the patient
  • Remember your anatomy
    • LOOK
    • FEEL (carefully)
    • MOVE (carefully)
    • SPECIAL TESTS (nerves and vessels)
21
Q

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……..?
A
  • 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……?
22
Q

Fracture Management - Investigations

  • Xrays
    • … views
    • … joints
    • ?… times
A
  • Xrays
  • Two views
  • Two joints
  • ?Two times
23
Q

Xray Description

  • Which bone
  • Where in the bone
    • Intra-…
    • Ep…
    • p..
    • M…
    • D…
  • What sort of bone
    • Normal, P..
A
  • Which bone
  • Where in the bone
    • Intra-articular
    • Epiphysis
    • Physis
    • Metaphysis
    • Diaphysis
  • What sort of bone
    • Normal, Pathological
24
Q

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…
A
  • “This is a ….”
  • 1.Displaced
  • 2.Intra-articular
  • 3.Fracture
  • 4.Of the distal
  • 5.Tibia
26
Q

Fracture Pattern Description

  • Simple
    • Transverse, oblique, spiral
  • C…
    • How many parts?
  • D…
    • Angulated, translated, burst
  • Special Types
    • G…, avulsions
A
  • Simple
    • Transverse, oblique, spiral
  • Comminuted
    • How many parts?
  • Displaced
    • Angulated, translated, burst
  • Special Types
    • Greenstick, avulsions
27
Q

Fracture Management….the basics (3)

A
  • Reduce
  • Stabilise
  • Rehabilitate
28
Q

Fracture Management….the basics - Reduce (1)

  • reduce - c… vs …
  • Correct
    • L..
    • A..
    • R..
A
  • reduce - closed vs open
  • Correct
    • Length
    • Alignment
    • Rotation
29
Q

Fracture Management….the basics - Stabilise (2)

  • … – sling, POP, external fixator
  • Internal – w…
    • intramedullary (n…)
    • extramedullary (p..)
A
  • External – sling, POP, external fixator
  • Internal – wires
  • intramedullary (nail)
  • extramedullary (plates)
30
Q

Fracture Management - further options

  • Nothing – ie n…
  • R..
A
  • Nothing – ie mobilise
  • Replacement
31
Q

Polytrauma

  • Damage Control Vs Early Total Care
  • Physiological parameters
    • A… (Lactate<2)
    • H…
    • C…
  • = terrible triad of trauma
A
  • Damage Control Vs Early Total Care
  • Physiological parameters
    • Acidosis (Lactate<2)
    • Hypothermia
    • Coagulopathy
  • = terrible triad of trauma
32
Q

Non-union - Causes

  • Biological
    • Hypo…
  • Mechanical
    • Poor frx …
A
  • Biological
    • hypovascular
  • Mechanical
    • poor frx stability
33
Q

Fracture Management

  • R…
    • Essential
  • … of surgery
    • Yes there are
    • KISS
    • again ‘Primum non nocere’ (first, do no harm)
A
  • Rehabilitation
    • Essential
  • Complications of surgery
    • Yes there are
    • KISS
    • again ‘Primum non nocere’ (first, do no harm)

Year 2 Medicine (162 decks)

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