Principles of fracture management Flashcards
Complications of surgery
Loss of life
Loss of limb
Loss of function
General/ systemic complications of surgery
CVS
RS
GIT
GUS
NS
Specific/ local complications of surgery
Infection
Dislocation
Neurovascular damage
Fracture
Metalwork failure
Operation specific
Acute handover ATMIST
Age
Time
Mechanism
Injuries
Signs
Treatment
Airway
With cervical spine control
Give oxygen
Talking
How might an airway be compromised?
Drugs/ alcohol
Vomit
Immediate life threatening A and B problems
ATOM FC
Air obstruction
Tension pneumothorax
Open pneumothorax
Massive haemothorax
Flail chest
Cardiac tamponade
Physiology of shock
Tachycardia
Decreased pulse pressure
Altered conscious level
Decreased urine output
Reduced BP
Save limb
Vessels
Nerves
Bones
Soft tissues/ muscles
Vascular problems
Direct arterial injury
Occlusion of venous outflow
Compartment syndrome
Pressure in enclosed space is increasing
Venules damaged
Pressure builds up
Diagnosis- pain out of proportion to what you’d expect
Treatment for compartment syndrome
Fasciotomy
Where can you bleed from enough to die quickly?
Pelvis- normally venous
Abdomen
Neck
Chest
Long bones
What to do with an arterial bleed?
Compress
Operating theatre
Occlusion of venous outflow
Compartment syndrome
What happens if you miss compartment syndrome?
Muscle dies
Permanent contraction
Volkman’s ischamic contracture
Specific fracture history- red flags
Vessels
Nerves
Soft tissues
- viability
- compartment
Children
Fracture examination
Start at the top, ATLS
Listen to the patient
Look
Feel
Move
Special tests
Fracture management
Relieve pain
- analgesia
- splint the bone
Avoid further damage
- reduce dislocations
- straighten bent limbs
- re-establish circulation
- relieve pressure on nerves close by
Fracture management: investigations
X rays
- two views
- two joints
Two times?
X ray description
Which bone
Where in the bone
- intra-articular
- epiphysis
- physis
- metaphysis
- diaphysis
What sort of bone
- normal
- pathological
Fracture pattern description
Simple
- transverse, oblique, spiral
Comminuted
- how many parts
Displaced
- angulated, translated, burst
Special types
- greenstick, avulsions
Fracture management: the basics
Reduce
Stabilise
Rehabilitate
Reduce
Closed vs open
Length
Alignment
Rotation
Stabilise
External- sling, POP, external fixator
Internal- wires, intramedullary nail, extramedullary plates
Terrible triad of trauma
Acidosis
Hypothermia
Coagulopathy
