SA Fracture 3 Flashcards
List and briefly describe the 4 A’s of fracture healing
Alignment - leg straight
Apposition - fracture surfaces apposed
Apparatus - implant position, loosening, breakage
Activity - callus, fracture healing
Decribe the three types of open fractures.
Grade 1 - small puncture wound caused by bone puncturing skin
Grade 2 - Wound (>1cm) larger skin wound caused by external trauma
Grade 3 - Extensive loss of skin and bone, often severe fractures
Describe in detail how you manage open fractures
Institute haemostasis
Cover wound with sterile dressing
Wear sterile apparel
Applie water soluble gell to wound
Clip hair
Flush wound
Saline (water)
Large volume
Take bacterial swab
Apply sterile dressing & bandage/splint
Debridment
When is the ‘golden period’ for correction of open fractures?
Within 6-8 hours
List two stabilisation methods of open fractures
ESF - open grade 2 and 3
Simple grade 1 - internal fixation methods
What is oesteomyelitis?
Any inflammatory conditions of the bone/marrow/periosteum
What is a sequestrum and how does it appear radiographically?
A necrotic bone fragment
Radiographically appears as a dense area of bone with sharp, well defined edges.
What is an involucrum?
The body attempts to wall off the sequestrum by an avascular wall of fibrous tissue and sclertoic bone - the involucrum.
List radiographic changes you may see with osteomyelitis
Soft tissue swelling
Periosteal new bone
Lucencies
Disuse osteopenia
Sequestra and involucrum
Loose implants
How long should antibiotics be given for when a patient has osteomyelitis?
6 weeks
What is a glycocalyx?
Implants may be covered by a gelatinous mucinous carbohydrate layer where bacteria can lie dormant and protected from antibiotics
All implants may need removal for the infection to resolve
Define delayed union in relation to fracture healing
A fracture that has not healed in the time normally expected for that type of fracture to heal
Define non-union
Fracture healing has stopped and union will not cocur without surgical intervention
What is the acronym for causes of a delayed/non-union in fracture healing and what does it stand for?
BIG RIB
Loss of blood supply
Inadequate immobilisation
General factors
Inadequate reduction
Infection
Loss of bone
How would a delayed union/non-union fracture appear on a radiograph?
Radiolucent gap
Feathery appearance and moderate/no callus
Sealed medullary canal
Rounded fracture ends
