trauma: fractures Flashcards
what factors contribute to the golden hour in early deaths
airways, head injury, fractures, blood loss
describe the advanced trauma life support (ATLS) guidelines initial and primary survery
primary: vital signs, ABCDE
secondary: head -> toe inspection, spine
when does primary bone healing occur, what happens and how do you manage it
mimimal fracture gap (<1mm) AKA hairline fractures, bone bridges gap from osteoblasts, fixed with screws and plates
what is secondary bone healing
gap in fracture site which needs to be filled and scaffold for new bone, inflam response and stem cells
describe the process of secondary bone healing (8)
1) fracture 2) haematoma and inflam 3) macrophages/ osteoclasts remove debris and damaged bone 4) granulation tissue and new blood vessels (fibroblasts) 5) chondroblasts form soft callus 6) osteoblasts lay bone matrix (enchondral ossification) 7) calcium mineralisation makes hard callus 8) remodelling
how is soft callus produced and how long does it take to form
chondroblasts form cartilage - 2-3 weeks
how is hard callus produced
calcium mineralisation to hard callus - 6-12 weeks
why is excessive movement in fractures bad
can’t bridge gap
what types of fracture are there (5)
transverse, oblique, spiral, comminuted, segmental
describe a transverse fracture
bending force, flat fracture, one side fails on compression the other on bending
describe an oblique fracture
shearing force from fall/ deceleration, can shorten and angulate
describe a spiral fracture
torsional (rotational), can angulate
describe a comminuted fracture
3 or more fragments, high energy, very unstable, need surgery
describe a segmental fracture
2 separate fractures –> 3 pieces, very unstable
how is an oblique fracture managed
screws
how is a spiral fracture managed
interfragmentary screws
how is a segmental fracture managed
rods and plates
what is translation
movement of fragment anteriorly posteriorly medially or laterally
how is translation measured
% out of place - 100% = off-ended
what is angulation
distal fragment points inwards/ outwards ie varus and valgus
what is rotation
malalignes and pivots around, unstable and poorly tolerated
what are signs and symptoms of fractures
localised bony tenderness, swelling, deformity, crepitus, pain on movement
what is usually first line in fracture assessment
x rays
when would a tomogram be used
moving x-ray - usually mandibular fractures
when would a CT be used
complex bones eg vertebrae and pelvis - surgical planning
when would bone scans be used
stress fractures > (cant see stress fracture on X ray)
what is the initial management of long bone fractures
assessment, analgesia (IV morphine), splintage/ immobilisation, investigations (x ray etc)
what is the definitive management of long bone fractures
which bone, where, pattern, stability, neurovascular, soft tissue, age and morbidities
how would you treat undisplaced fractures (or minimally angulated/ displaced)
stable, splintage and rehab
how would you treat displaced or angulated fractures
reduction under anaesthetic, cast may be needed - unstable may need surgical stabilisation
how would you treat unstable extra-articular diaphysial fractures
ORIF (plates and screws)
how do you treat displaced intra-articular fractures
reduction and rigid ORIF (wires, screws and plates), may need joint replacement
what are open fractures and what do they increase risk of
spike from bone/ laceration of skin, need to prevent from infection
what is gustilo classification
higher energy = higher risk of contamination
what broad spectrum AB’s would you use in open fractures
fluclox, gentimicin, metro
if skin is too contaminated after debridement of open fractures what is usually done
skin graft nd flap coverage
if skin is contaminate after open fracture how do you manage it
debride and leabe open 48 hours for infection to drain then close
how do you manage dislocations and instability
reduce ASAP, closed manipulation under sedation
who often presents with delayed presentation dislocations and how do you treat it
alcoholics, open manipulation
what associated injuries can be with dislocations
tendon tears, nerve injury, vascular injury, compartment syndrome, fractures
how are soft tissue (tendons/ ligament) injuries graded
grade 1 = sprain, grade 2 = partial tear, grade 3 = rupture
how do you treat soft tissue injuries
RICE (rest, ice, compression,elevation) movement after to prevent stiffness
which tendon tears need surgery
quadriceps and patellar tendon
