Principles of fracture management Flashcards
List some complications of surgery
Loss of Life Loss of Limb Loss of function General/Systemic - CVS,RS,GIT,GUS,NS Specific/Local - Infection, Dislocation, Neurovascular damage, Fracture, Metalwork failure, Operation specific
Which mnemonic is used for an acute surgical handover?
Age Time Mechanism Injuries (top to toe) Signs Treatment
What is the ATLS approach?
ABCDE
Describe the management of airway
With cervical spine control - brace, hands
Give oxygen
Describe the management of breathing
Breathing and ventilation
Oxygen stats
Respiratory rate
Vomit, drugs and alcohol may interfere with breathing
What is ATOM FC
Airway obstruction Tension Open pneumothorax Massive pneumothorax Flail chest Cardiac taponarde
Describe the management of circulation
With hemorrhage control
Give the physiology of shock
Tachycardia Decreased pulse pressure Altered conscious level Decreased urine output Reduced BP (late)
Where can you bleed from and die quickly?
Limbs
Abdomen
Chest
Describe the multidisciplinary approach to surgery
Multidisciplinary care vital
Anaesthetists, Orthopaedics, General Surgery, Cardiothoracic Surgery, Neurosurgery etc etc
Communication essential
What contributes to loss of limb
Vessels
Nerves
Bones
Soft tissues/muscles
Describe some vascular problems
Direct arterial injury
Occlusion of venous outflow
How do you treat compartment syndrome?
Fasciotomy
How can bony injuries cause limb loss?
Direct or indirect
Describe AMPLE
Allergies Medications Past Medical Hx Last meal Environment/Event (incl Temp)
Give the red flags of fracture history
Red Flags Vessels Nerves Soft tissues Viability Compartment Children
Describe fracture examination
Start at the top, remember ATLS Listen to the patient Remember your anatomy LOOK FEEL (carefully) MOVE (carefully) SPECIAL TESTS (nerves and vessels)
Describe the management of fracture
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
How do you describe xrays
Which bone Where in the bone Intra-articular Epiphysis Physis Metaphysis Diaphysis What sort of bone Normal, Pathological
Describe fractures
Simple Transverse, oblique, spiral Comminuted How many parts? Displaced Angulated, translated, burst Special Types Greenstick, avulsions
List the basic steps to fracture management
Reduce
Stabilise
Rehabilitate
How do you reduce the fracture
closed vs open Correct Length Alignment Rotation
How do you stabilize the fracture?
External – sling, POP, external fixator Internal – wires intramedullary (nail) extramedullary (plates) Further Options Nothing – ie mobilise Replacement
Describe polytrauma care
Damage Control
Vs
Early Total Care
Physiological parameters Acidosis (Lactate<2) Hypothermia Coagulopathy = terrible triad of trauma
List non union causes
Non-union - Causes
Biological
hypovascular
Mechanical
poor frx stability
