Trauma & orthopaedics Flashcards
Where can a catastrophic haemorrhage be?
floor, chest, abdomen, pelvis, long bones
5 ways to stop bleeding
Tourniquet Lift it up Pelvic binding Interventional radiology (intravascular coagulation) Packing
What is cerebral perfusion pressure?
MAP - intracranial pressure
Most important blood test in trauma?
Group and save!
Which fractures need fixation?
Open
Neurovascular damage
Displaced (loss of function, arthritis)
Unstable (non union, DVT/PE)
3 classifications of fracture and subcategories
Traumatic #
• Direct: e.g. assault, metal bar
• Indirect: e.g. fall on an outstretched hand → clavicle #
• Avulsion
Stress #
• Bone fatigue due to repetitive strain e.g. foot #s in marathon runners
Pathological #
• Normal forces but diseased bone
• Local: tumours
• General: osteoporosis, Cushing’s, Paget’s
6 parts of describing a fracture
1. Demographics • Pt. details • Date radiograph taken • Orientation and content of image 2. Pattern • Transverse • Oblique • Spiral • Multifragmentary 3. Anatomical Location 4. Intra- / extra-articular • Crush • Greenstick • Avulsion • Dislocation or subluxation 5. Deformity (distal relative to proximal) • Translation • Angulation or tilt • Rotation • Impaction (→shortening) 6. Soft Tissues • Open or closed • Neurovascular status • Compartment syndrome
What do you need before describing a fracture?
Pt details
Radiographs at right angles
At least 2 views
Need images of join above and below #
What are the 4 R’s of fracture management?
Resuscitation
Reduction
Restriction
Rehabilitation
What is involved in resuscitation (1st R of fracture management)
- Trauma care (ABCDE, 1º survey, C-spine)
- Neurovascular status and dislocations
- Consider reduction and splinting before imaging (reduce bleeding, pain and risk of neurovascular injury)
- X-ray once stable
- Open fractures need: analgesia, wound swab, irrigation, dressing, alignment, anti-tetanus and antibiotics
- Gas gangrene is most dangerous complication of open fracture: debridement and clindamycin + benpen
What is involved in reduction (2nd R of fracture management)
- All displaced fractures should be reduced, alignment is more important than opposition
- Manipulation/closed reduction (under local/regional/general anaesthetic, traction to disimpact, manipulation to align)
- Traction (not usually used)
- Open reduction and internal fixation (accurate but risks of surgery, used in open and intra-articular #s or if conservative management fails)
What is involved in restriction (3rd R of fracture management)
- Fixation to decreases strain and lead to bone formation
- Slings, elastic supports
- Plaster of paris (full cast only after 48hrs due to risk of compartment syndrome)
- Functional bracing (only bone shaft supported, free to move joints)
- Continuous traction
- External fixation (pins & wires connected to external frame, allows wound access and decreases infection risk)
- Internal fixation (pins, plates, screws, IM nails, perfects anatomical alignment, increases stability and aids early mobilisation)
What is involved in rehabilitation (4th R of fracture management)
- Mobilisation to keep muscle and bone mass up, decreases joint stiffness
- Maximise mobility of uninjured limbs
- Quick return to function, less chronic morbidity
- Physiotherapy
- OT (splints, mobility aids, home modification)
- Social services (meals on wheels, home help)
What are the types of complication you would list for fractures?
General
Specific
Early
Late
Give 5 general complications of fractures
- Haemorrhage
- Pain
- Muscle damage (rhabdomyolysis)
- Anaesthesia (teeth damage, aspiration, anaphylaxis)
- Prolonged bed rest (UTI, pneumonia, pressure sores, DVT, PE, reduced bone mineral density
Give 2 specific complications after fractures
Neurovascular damage
Visceral damage
Give 3 early complications after a fracture
- Compartment syndrome
- Infection
- Fat embolism
Describe pathophysiology of compartment syndrome
Oedema after # Pressure can’t be released due to fascia Decreases venous drainage If compartment pressure>capillary pressure= ischaemia Pain on passive muscle stretching Warm erythema Weak/absent peripheral pulses
Name 6 late complications after a fracture
- Problems with union of bone (ischaemia, infection, interposition of tissue between fragments, malignancy, malnutrition)
- Avascular necrosis (eg femoral head, scaphoid. Soft and deformed bone)
- Growth disturbance (crush injury may injure physis and lead to growth arrest)
- Post traumatic osteoarthritis
- Pain (complex regional pain syndrome affecting neighbouring area, sensory and abnormal blood flow)
- Myositis ossificans (bone tissue formed within muscle after trauma, restricted painful movement, can be excised)
Define a burn
An injury to the body tissues as a result of extremes of energy
What are the 6 functions of skin
1) Sensory Organ
2) Endocrine
3) Thermoregulatory
4) Immune Response
5) Barrier to fluid loss
6) Social
Name 6 types of burn
- Heat (dry flame, sunstroke, wet scalds)
- Electrical
- Chemical
- Radiation
- Mechanical (friction)
- Cold
What are burns associated with?
(Mad Bad Glad Sad) • Carelessness • Accidents • Epilepsy/stroke/psychiatric problems • Alcohol/substance misuse • Extremes of age
Pathophysiology of burns
- Hypovolaemic shock (tissue damage-> inflammatory mediators-> leaking vessels-> vascular resistance
- Capillary leakage mediators (histamine, prostaglandins, oxygen free radicals)
- Vasoconstriction and burn extensions (thromboxane, catecholamines)
- Multisystem shock and reduced cardiac output
- Blood cells lost in urine
