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MBBS 3: Surgery > Principles of Fracture Management > Flashcards

Principles of Fracture Management Flashcards

1
Q

Goals of fracture management?

A
  1. Achieve bony union in a satisfactory position
  2. Facilitate the restoration of function
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2
Q

The 4R’s of fracture management?

A
  1. RECOGNISE
  2. REDUCE
  3. RETAIN
  4. REHABILITATE
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3
Q

What is to recognise?

A

rescucitation - ABCDE

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4
Q

What is to reduce?

A

is a surgical procedure to repair a fracture or dislocation to the correct alignment
- for closed and open fractures

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5
Q

What is to retain?

A
  1. non surgical
    - POP
    - traction
  2. Surgical
    - Internal fixation
    - External fixation
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6
Q

What is rehabilitation?

A

physiotherapy

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7
Q

Choice of fracture management depends on?

A
  1. Available skills
  2. Available resources
  3. Patient factors
  4. Fracture factors
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8
Q

Conservative treatment vs available treatment?

A
  1. Conservative treatment usually requires less skill to perform than surgical treatment
    - However, it usually necessitates closer and more frequent monitoring
  2. Conservative treatment is much less expensive and requires less theatre time
  3. Surgical treatment requires more theatre time and the equipment is specialised and expensive
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9
Q

What patient patient factors contribute to choice of method in fracture management?

A
  1. General
    - Age
    - Co morbidity
    - Ability to pay!
  2. Specific
    - Polytrauma/multiple fractures
    - Stability of patient condition
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10
Q

Fracture factors that contribute to choice of treatment method?

A
  1. Open or closed fracture
  2. Simple or comminuted
  3. Intra articular fractures
  4. Special cases eg neck of femur, talus
  5. Multiple fractures, particularly in one limb
  6. Neurovascular injury
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11
Q

What is POP treatment?

A

plaster of paris
- quick setting gypsum plaster consisting of a fine white powder (calcium sulfate hemihydrate) which hardens when moistened and allowed to dry

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12
Q

What is POP treatment for?

A

closed reduction

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13
Q

Application of POP?

A
  1. Joint above and below fracture
  2. Whilst still wet the POP is moulded to press and hold the fracture in a reduced position
  3. As the swelling decreases the POP may become loose and need to be changed
  4. Removal of POP once fracture is well consolidated and start exercises to restore function
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14
Q

Steps in POP application?

A
  1. examine the limb
  2. position the limb in the correct position for splinting
  3. use stockinette to cover the skin of the affected limb
  4. wrap cotton wool padding starting distally going proximally and overlapeach layer by 50%
  5. soak plaster in water until bubbles cease to rise remove from the water and gently swueeze the excess water
  6. overlap each layer by 50% and smooth the p[laster with your palm
  7. ensure joint immobilization
  8. repeat examination
  9. radiography
  10. patient education
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15
Q

Pros of POP?

A
  1. Cheap and simple
  2. Successful in many fractures
  3. Avoids the risks of surgery
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16
Q

Cons of POP?

A
  1. Joint immobilisation causing stiffness and muscle wasting
  2. Doesn’t always result in adequate reduction
  3. Requires close monitoring, fracture can re-displace
17
Q

What is traction?

A
  • Applying weights to the limb distal to the level of the fracture to reduce and then immobilise the fracture
  • Can be skin traction or skeletal traction
  • Counter traction is provided by the weight of the patient
18
Q

What is skin traction?

A

applied by strapping the patients affected lower limb and attaching weights

19
Q

Describe skin traction?

A
  1. Children, to avoid risk of pin and growth plates
  2. Used for initial splintage
  3. Can tolerate less weight
20
Q

What is skeletal traction?

A

a pin is placed inside your bone

21
Q

Describe skeletal traction?

A
  1. Adults
  2. More weight
  3. Can stay for longer
22
Q

When do we use traction?

A
  1. Femur fractures
  2. Distal humerus fractures
  3. Occasionally in tibial fractures
23
Q

What is internal fixation?

A

the surgical implementation of implants for the purpose of repairing a bone - physically reconnects bone

24
Q

Pros of internal fixation?

A
  1. Can achieve more accurate reduction
  2. Can achieve better control of reduction
  3. Allows earlier return to function
  4. Decreases joint stiffness and muscle weakness
25
Q

Cons of internal fixation?

A
  1. Risks of surgery / infection
  2. Cost/resources
26
Q

What is ORIF?

A

open reduction internal fixation
open reduction = a surgeon makes an incision to re-align bone
internal fixation = bones are held together with hardware
Note: used in serious fractures that cant be treated with cast or splint

27
Q

Indications for ORIF?

A
  1. Comminuted fractures
  2. Multiple fractures / multiple limbs
  3. Polytrauma
  4. Articular fractures
  5. Special fractures
  6. Vascular injuries
  7. Malunion / nonunion (failed conservative treatment)
28
Q

What is external fixation?

A
  • Insertion of percutaneous pins or wires into bone
  • Attachment of external frame to pins
29
Q

Types of external fixators?

A
  1. Hoffman 1
  2. Hoffman 2
  3. Orthofix
  4. Lizarov
30
Q

Indications for external fixation?

A
  1. Severe open fractures
  2. Polytrauma / rapid stabilisation
  3. Reconstruction
    - Bone transport
    - Leg lengthening
    - Deformity correction
  4. broken bone accompanied by significant swelling, bone loss or soft tissue loss
31
Q

Pros of external fixation?

A
  1. Usually easier and quicker to apply
  2. Pins away from wound / fracture
  3. Can do secondary reduction
  4. Still allows joint movement / weight bearing
  5. Good access to wounds
32
Q

Cons of external fixation?

A
  1. External, bulky
  2. Pin sites
  3. Tethering of muscles
  4. Higher non union rate
32
Q

Complications of POP?

A
  1. Tightness / compartment syndrome
  2. Pressure sores
  3. Loss of reduction
  4. Joint stiffness / muscle wasting
33
Q

Complications of traction?

A
  1. Pin site infection
  2. Malunion
  3. Joint stiffness / muscle wasting
34
Q

Complications of internal fixation?

A
  1. Infection
  2. Implant failure
35
Q

Complications of external fixation?

A
  1. Neurovascular injury on insertion
  2. Pin site infection
  3. Non / mal union
  4. Joint stiffness

MBBS 3: Surgery (42 decks)

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