Principles of Fracture Management Flashcards
Understand how fractures are managed in the orthopaedic setting, and how decisions are made
What is the important adage for fractures
Reduce, Hold, Rehabilitate
Define reduction (3)
1 restoration of anatomical alignment 2 of fracture or dislocation 3 of an affected limb
How reduction benefits fracture site (2)
1 tamponade of bleeding 2 reduced traction on soft tissues
Effects of swelling at wound site (2)
1 increased risk of complication 2 which can delay surgery
Advantage of reduction for nerves (2)
Reduced traction reduces: 1 risk of neuropraxia 2 risk of nerve damage
Advantage of reduction of vascular system (2)
1 reduced pressure in local blood vessels 2 which restores any affected blood supply
Main principle in reduction
Correct deforming forces that resulted in injury
Ways reduction may be performed (3)
1 closed 2 open 3 intra-operatively
Why reduction requires anaesthesia
Painful
Means of anaesthesia in reduction (2)
1 local/regional blockade 2 conscious sedation
Requirements for conscious sedation
1 anaesthetic agents 2 airway adjuncts 3 monitoring
Why reduction requires two people
1 one for reduction manoeuvre 2 another for counter traction
Define ‘hold’ of a fracture
Immobilising a fracture
When is traction required
Pull of soft tissues makes fracture unstable
Examples of fractures which require traction in hold (3)
1 Subtrochanteric 2 femoral shaft 3 displaced acetabular fractures
Methods of holding fractures (4)
1 casting 2 internal fixation 3 external fixation 4 locking plates
Why back slabs used in initial holding (2)
1 Allow fracture to swell 2 without causing compartment syndrome
Advantages of casting (4)
1 simplest and 2 cheapest method 3 quick pain relief 4 lowest infection risk
Complications with casting (3)
1 pressure sores 2 loosening/breakdown 3 thromboembolism
Indications for internal fixation (7)
1 unstable fractures 2 intra-articular fractures 3 neurovascular damage 4 polytrauma 5 elderly patients (lower limb) 6 long bone fractures 7 failure of conservative management
Why internally fixate an intra-articular fracture
Decrease risk of OA (NoF)
Need for internal fixation in fractures with neurovascular damage
Stability prevents repaired structures being damaged by fragments
Advantage of internal fixation in polytrauma (2)
1 Allows early mobilisation and 2 facilitates nursing care
Advantage of internal fixation in lower limb fractures of elderly patients
Long periods of immobilisation poorly tolerated
