principles of fractures Flashcards
what is a fracture ?
break in the structural continuity of bone
what are the causes of fractures ?
injury
repetitive stress
pathological fracture
what type of fracture does twisting cause ?
spiral fracture
what type of fracture does compression cause ?
oblique fracture
what type of fracture does bending cause ?
triangular butterfly fragment
what type of fracture does tension cause ?
transverse bone fracture
when does a stress fracture happen ?
1- occur in normal bone which is subjected to repeated heavy loading
2- can happen on steroid therapy
what are the causes of pathological fractures?
osteoporosis
osteogenesis imperfecta
what is the difference in healing time between a transverse and spiral fracture ?
transverse - slow to join because the area of contact is small - stable under compression
spiral - joins more rapidly - not stable under compression
what are the main principles of fracture management ?
resuscitation
reduction
immobilization
rehabilitation
how should history be taken in emergency situations ?
AMPLE
Allergies
Medications
Past Medical History
Last Meal
Events surrounding injury
what are the different outcomes in initial reduction ?
successful reduction + stable= conservative
successful reduction + unstable = surgical
unsuccessful reduction = surgical
what are the two methods of definitive reduction ?
closed
open
what are the indications for open reduction ?
closed reduction fails
or if there is a large articular fragment that needs accurate positioning
what are the methods of immobilization ?
traction ( skin and skeletal )
cast splintage ( backslab and complete cast )
bracing ( static brace and dynamic brace )
percutaneous fixation
internal fixation
external fixation
how is percutaneous fixation achieved ?
fracture reduced by manipulation first
then stabilized by k wires
when do we perform temporary external fixation ?
1- fractures associated with nerve or vessel damage
2- severe tissue damage
3- fractures of the pelvis
4- infected fractures
5- severe multiple injuries
how is rehabitilatioin achieved ?
physiotherapy
occupational therapy
what are open fractures ?
also called compound fractures , with direct communication to the external environment
what is the initial management of open fractures ?
wound irrigation
gross contamination removed
take a photo
saline soaked dressing
backslab
broad spectrum ab
tetanus prophylaxis
what is the gustilo classification ?
Type 1 - wound less than 1 cm
Type 2 - wound 1-10 cm, moderate soft tissue injury
Type 3A - more than 10 cms , high energy, extensive soft tissue damage
Type 3B - wound requires soft tissue coverage
Type 3C - vascular injury requiring vascular repair
farm injuries are automatically considered what type of gustilo ?
at least 3A
what is the definitive management for open fractures ?
must assume that they are contaminated
1- antibiotic prophylaxis
2- urgent wound debridement
3- temporary stabilization
4- definitive fixation and wound cover
what are the principles of management of intra-articular fractures ?
anatomical reduction
rigid fixation
early mobilization
what are the common complications of intra-articular fractures ?
secondary osteoarthritis
stiffness of the affected joint
what are the skin complications associated with fractures ?
fracture blisters
cannot perform open fixation until blisters heal
which nerve is affected in shoulder dislocation or proximal humerus affection ?
axillary nerve
which nerve is affeected in humeral shaft damage ?
radial nerve
what is a holstein lewis fracture ?
spiral fracture off the distal humerus
which nerve is affected in fractures of the distal radius ?
median nerve
what nerves are affected in knee dislocation ?
all peripheral nerves
which nerve is affected in fractures of the higher end of the fibula ?
common peroneal nerve
what is the most sensitive finding associated with compartment syndrome ?
pain with passive motion
if there is no pulse found in association with compartment syndrome what is the most likely management ?
amputation is usually required
how is the diagnosis of compartment syndrome made ?
mainly a clinical diagnosis
compartment pressure more than 40 mmhg
treatment for compartment syndrome ?
fasciotomy
