trauma: fractures Flashcards

1
Q

what factors contribute to the golden hour in early deaths

A

airways, head injury, fractures, blood loss

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2
Q

describe the advanced trauma life support (ATLS) guidelines initial and primary survery

A

primary: vital signs, ABCDE
secondary: head -> toe inspection, spine

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3
Q

when does primary bone healing occur, what happens and how do you manage it

A

mimimal fracture gap (<1mm) AKA hairline fractures, bone bridges gap from osteoblasts, fixed with screws and plates

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4
Q

what is secondary bone healing

A

gap in fracture site which needs to be filled and scaffold for new bone, inflam response and stem cells

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5
Q

describe the process of secondary bone healing (8)

A

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

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6
Q

how is soft callus produced and how long does it take to form

A

chondroblasts form cartilage - 2-3 weeks

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7
Q

how is hard callus produced

A

calcium mineralisation to hard callus - 6-12 weeks

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8
Q

why is excessive movement in fractures bad

A

can’t bridge gap

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9
Q

what types of fracture are there (5)

A

transverse, oblique, spiral, comminuted, segmental

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10
Q

describe a transverse fracture

A

bending force, flat fracture, one side fails on compression the other on bending

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11
Q

describe an oblique fracture

A

shearing force from fall/ deceleration, can shorten and angulate

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12
Q

describe a spiral fracture

A

torsional (rotational), can angulate

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13
Q

describe a comminuted fracture

A

3 or more fragments, high energy, very unstable, need surgery

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14
Q

describe a segmental fracture

A

2 separate fractures –> 3 pieces, very unstable

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15
Q

how is an oblique fracture managed

A

screws

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16
Q

how is a spiral fracture managed

A

interfragmentary screws

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17
Q

how is a segmental fracture managed

A

rods and plates

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18
Q

what is translation

A

movement of fragment anteriorly posteriorly medially or laterally

19
Q

how is translation measured

A

% out of place - 100% = off-ended

20
Q

what is angulation

A

distal fragment points inwards/ outwards ie varus and valgus

21
Q

what is rotation

A

malalignes and pivots around, unstable and poorly tolerated

22
Q

what are signs and symptoms of fractures

A

localised bony tenderness, swelling, deformity, crepitus, pain on movement

23
Q

what is usually first line in fracture assessment

24
Q

when would a tomogram be used

A

moving x-ray - usually mandibular fractures

25
when would a CT be used
complex bones eg vertebrae and pelvis - surgical planning
26
when would bone scans be used
stress fractures > (cant see stress fracture on X ray)
27
what is the initial management of long bone fractures
assessment, analgesia (IV morphine), splintage/ immobilisation, investigations (x ray etc)
28
what is the definitive management of long bone fractures
which bone, where, pattern, stability, neurovascular, soft tissue, age and morbidities
29
how would you treat undisplaced fractures (or minimally angulated/ displaced)
stable, splintage and rehab
30
how would you treat displaced or angulated fractures
reduction under anaesthetic, cast may be needed - unstable may need surgical stabilisation
31
how would you treat unstable extra-articular diaphysial fractures
ORIF (plates and screws)
32
how do you treat displaced intra-articular fractures
reduction and rigid ORIF (wires, screws and plates), may need joint replacement
33
what are open fractures and what do they increase risk of
spike from bone/ laceration of skin, need to prevent from infection
34
what is gustilo classification
higher energy = higher risk of contamination
35
what broad spectrum AB's would you use in open fractures
fluclox, gentimicin, metro
36
if skin is too contaminated after debridement of open fractures what is usually done
skin graft nd flap coverage
37
if skin is contaminate after open fracture how do you manage it
debride and leabe open 48 hours for infection to drain then close
38
how do you manage dislocations and instability
reduce ASAP, closed manipulation under sedation
39
who often presents with delayed presentation dislocations and how do you treat it
alcoholics, open manipulation
40
what associated injuries can be with dislocations
tendon tears, nerve injury, vascular injury, compartment syndrome, fractures
41
how are soft tissue (tendons/ ligament) injuries graded
grade 1 = sprain, grade 2 = partial tear, grade 3 = rupture
42
how do you treat soft tissue injuries
RICE (rest, ice, compression,elevation) movement after to prevent stiffness
43
which tendon tears need surgery
quadriceps and patellar tendon