Surgical Replacement and Repair (Week 4--Schwartz) Flashcards
History to get
Mechanism of injury
Area of pain
Numbness
Past history of similar injury or anything that would compromise healing (diabetes)
Physical exam
Document circulation and neurologic (sensory and motor) status
Note deformity at area of injury and open wounds
Radiology
Multiple views and might need CT
For pediatrics need bilateral to compare physes
Special considerations
Osteoporosis
Pathological fracture
From physical abuse (elder, spousal or child abuse)
Compound fractures (bone meets world)
Open (compound) fracture
“Bone meets world”
Emergent
Usually requiring immediate surgery
Open fractures require debridement and irrigation
Types of fixation (support)
Shoes or boots
Braces (removable, non-removable, hinged)
Splints (removable or non-removable)
Casts (immobilize above and below fracture)
External fixation
Percutaneous pinning
ORIF (open reduction internal fixation)
Primary joint replacement
Type of surgery for displaced fractures
Closed reduction and immobilization
Closed reduction and pinning
Open reduction and internal fixation (one pin or screw, plate + screws, rod + screws, combination, replacement)
ORIF (open reduction internal fixation)
One pin or screw
Intra-articular fracture: usually smooth pin fixation
Plate + screws
Long bone fracture: plates and screws or intramedullary rod
Combined fractures: combination of plates, screws, wires
Total joint replacements
Hip, knee, shoulder
Post-operative complications
Venous blood clotting (thrombosis), can be asymptomatic or produce local phlebitis; some clots travel to lung (pulmonary embolism)
Fat embolism develops as fatty marrow (exposed at fracture site) and can be carried to lungs (usually happens in long bones); signs include respiratory compromise, change in mental status, petechial rash
Edema
Compartment syndrome
Neurovascular compromise
Chronic post-operative complications
Osteomyelitis
Delayed union
Nonunion
Pseudoarthrosis
Hardware failure
How to numb area for closed reduction
Some sort of nerve block
Median, ulnar, radial nerve, etc
