Principles of Fracture Management / repair Flashcards
What should the first assessment be?
Airway patency +/- oxygen
Breathing - chest trauma, airway trauma - thoracocentesis
Circulatory - iv cath & fluids
Disabilities - ortho/neuro exam, analysis, imaging
What is your minium database?
- PCV
- TS
- BG
- BUN
- USG
What other analysis might we want to do ?
- haem
- biochem
- urinalysis
- POCUS
- Radiography
First line management for fracture?
- Oxygen
- Fluid therapy
- Analgesia -> opioids, NSAIds, LA, others
- ABs
What to assess about our fracture?
- Bruising
- Swelling
- Open wounds -> extent of trauma, debris, neuro vasc damage
Management of soft tissue injuries in fract?
OPEN WOUNDS
- Sterile cover
-Wide clipping
- Remove debris
- Lavage
- Debride
CLOSED -> splint lower limbs
How should we plan to Xray fract?
- 2 orthogonal views
- Whole bone (inc joint above and below )
- Contralat bone
-> Magnification & lateralisation marker
Fracture classification?
- Location (bone & part of it)
- type/shape/N° lines
- Reducibility
- Open/closed
- stability after anatomic reconstruction
Classification of open fracts?
Classification of Physeal fractures?
What is involved in planning & decision making
- Biological factors
- Mechanical factors
- Client / patient factors
Biological factors?
- Age
- Weight
- Concurrent injuries
- Overall health
- Fracture location
- Soft tissue injuries
- Soft tissue coverage
Mechanical factors?
- Fracture configuration
- Reconstruction possible?
- Other MSK injuries or abnormalities?
Client/ patient factors?
- Patient’s activity level
- Work?
- Ability of postoperative care
- Client compliance
What factors affect return to full function?
- Prolonged surgery time
- Soft tissue trauma
- Technical errors
- High complication rate
Patient prep for fracture repair?
Fasting prior to anaesthesia
Clip hair & vacuum
Foot covered sterily & hunged
Cleansing – antiseptic
Patient positioning
Appropriate attire
What different implants might we use ?
Screws & plates
External fixators
Pins & Kirschner wires
External fixators
Interlocking nails
Cerclage wire
Detail use of screws?
<40% diameter
Self tapping vs non self-tapping
Cortical vs cancellous vs shaft
Locking vs non-locking
What different screws can we use?
- Lag screw
- Positional screw
- Plate screw
What are some different plates ?
- Dynamic compression plate (DCP)
- Limited contact dynamic compression plate
- Veterinary cuttable plates
- Reconstruction plates
- Locking plates
What different plate application modes?
- Compression
- Neutralisation
- Buttress
- Bridging (Plate Rod)
How do interlocking nails work/when to use ?
- Medullary cavity + locking bolts
- High resistance bending stresses
+ axial & rotational forces - Bones -> humerus, femur, tibia
- Bridging mode
Describe steinmann pins?
- Intramedullary cavity – 2.0-5.0mm
- Resist bending forces
- Do not resist: compression or rotation
- Adjuct implant – not alone
Describe Kirschner wires?
- Pins 0.8-2.0mm
- Maintain position
- Physeal – growing patients
What can be sued in external skeletal fixators?
-> Pins -> smooth vs traded ; positive vs negative threads ; end-threaded or centrally threaded
-> Clamps
->Conecting bars
Describe HOW we use External skeletal fixators
Below elbow/ stifle
Closed application
Use of soft tissue corridors
≥ 2 pins/fragment
Pin ≤ % bone diameter
Threaded > smooth
Detail use fo orthopaedic wire?
Malleable 316L Stainless steel
Close contact to bone
Temporary or supplementary
What applications for orthopaedic wire?
Cerclage wire
Hemicerclage or interfragmentary
Tension band wire
What to look for in postop appraisal ?
ALIGNEMENT
APPOSITION
APPARATUS
ACTIVITY
Post op care?
Elizabethan collar – protect surgical site
Rest at home – small room or crate
Avoid: jumping/running/stairs
Modified exercise: 5-10min on-lead walks
Complications?
Delayed unions
Nonunion
Malunion
Osteomyelitis & surgical site infection
Implant failure
