Principles of fracture management

Question 1

List some complications of surgery

Answer 1

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

Question 2

Which mnemonic is used for an acute surgical handover?

Answer 2

Age
Time
Mechanism
Injuries (top to toe)
Signs
Treatment

Question 3

What is the ATLS approach?

Answer 3

ABCDE

Question 4

Describe the management of airway

Answer 4

With cervical spine control - brace, hands

Give oxygen

Question 5

Describe the management of breathing

Answer 5

Breathing and ventilation
Oxygen stats
Respiratory rate
Vomit, drugs and alcohol may interfere with breathing

Question 6

What is ATOM FC

Answer 6

Airway obstruction
Tension
Open pneumothorax
Massive pneumothorax 
Flail chest 
Cardiac taponarde

Question 7

Describe the management of circulation

Answer 7

With hemorrhage control

Question 8

Give the physiology of shock

Answer 8

Tachycardia
Decreased pulse pressure
Altered conscious level
Decreased urine output
Reduced BP (late)

Question 9

Where can you bleed from and die quickly?

Answer 9

Limbs
Abdomen
Chest

Question 10

Describe the multidisciplinary approach to surgery

Answer 10

Multidisciplinary care vital
Anaesthetists, Orthopaedics, General Surgery, Cardiothoracic Surgery, Neurosurgery etc etc
Communication essential

Question 11

What contributes to loss of limb

Answer 11

Vessels
Nerves
Bones
Soft tissues/muscles

Question 12

Describe some vascular problems

Answer 12

Direct arterial injury

Occlusion of venous outflow

Question 13

How do you treat compartment syndrome?

Answer 13

Fasciotomy

Question 14

How can bony injuries cause limb loss?

Answer 14

Direct or indirect

Question 15

Describe AMPLE

Answer 15

Allergies
Medications
Past Medical Hx
Last meal 
Environment/Event (incl Temp)

Question 16

Give the red flags of fracture history

Answer 16

Red Flags
Vessels
Nerves
Soft tissues
Viability
Compartment
Children

Question 17

Describe fracture examination

Answer 17

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

Question 18

Describe the management of fracture

Answer 18

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

Question 19

How do you describe xrays

Answer 19

Which bone
Where in the bone
Intra-articular
Epiphysis
Physis
Metaphysis
Diaphysis
What sort of bone
Normal, Pathological

Question 20

Describe fractures

Answer 20

Simple
Transverse, oblique, spiral
Comminuted
How many parts?
Displaced
Angulated, translated, burst
Special Types
Greenstick, avulsions

Question 21

List the basic steps to fracture management

Answer 21

Reduce

Stabilise

Rehabilitate

Question 22

How do you reduce the fracture

Answer 22

closed vs open
Correct 
Length
Alignment
Rotation

Question 23

How do you stabilize the fracture?

Answer 23

External – 	sling, POP, external fixator
Internal – 	wires
			intramedullary (nail)
			extramedullary (plates)
Further Options
Nothing – ie mobilise
Replacement

Question 24

Describe polytrauma care

Answer 24

Damage Control
Vs
Early Total Care

Physiological parameters
Acidosis (Lactate<2)
Hypothermia
Coagulopathy
= terrible triad of trauma

Question 25

List non union causes

Answer 25

Non-union - Causes

Biological
hypovascular

Mechanical
poor frx stability