Treatment Flashcards
What surgery can be done to fix fractures?
Open Reduction Internal Fixation (ORIF): plate and screws
Closed Reduction Internal Fixation (CRIF): k-wires percutaneously and intermedullary fixation of long bones with wires or nails (IM nail)
When is compression used as a treatment?
In simple fractures. It allows primary bone healing without callus formation.
What is arthroplasty?
When the bone is not salvageable, it can be replaced. It can be total (both parts of the joint) or partial (one component of the joint). Knee and hip are the most common due to trauma and osteoarthritis.
How can an extra-capsular hip fracture be fixed?
DHS or IM nail
How can an intra-capsular hip fracture be fixed?
Minimally displaced ones can be salvaged because the blood supply won’t be damaged but displaced intracapsular fractures will require arthroplasty.
The treatment depends on the severity of the fracture according to the Garden classification (1-4) - 1,2 give it a screw, 3,4 Austin-Moore
Describe the benefits and cons of joint replacement
- Finite lifespan - exhaust other medical options first
- Need good baseline mobility
- Need to be medically fit for surgery
How do you treat potential septic arthritis?
Empirical antibiotics are essential until cultures are back and often will be IV for several weeks.
What are the empirical antibiotics?
Flucloxacillin for 4-6 weeks IV. If MRSA is suspected, use vancomycin instead, if penicillin allergy use clindamycin.
What is the treatment for osteomyelitis?
Empirical antibiotics - flucloxacillin +/- rifampicin for the first 2 weeks (if penicillin allergic, clindamyciin +/- rifampicin)
What should be given to a patient if the diagnosis is pointing more at inflammation than infection?
Intra-articular steroids for symptomatic relief
What are the treatments for inflammation?
- Analgesia
- Anti-inflammatories
- Immunosuppression (DMARDs) - steroids, steroid-sparing agents e.g. azathioprine, methotrexate, biologic therapy
Describe steroid use
Wide range of immunosuppressive action and are often used in conjunction with other DMARDs. They have a wide range of side effects and can cause adrenal suppression, making it necessary to wean down doses carefully.
What therapies are used in conjunction with steroids?
Bone protection e.g. vit D, calcium and bisphosphonates, if the patient is to be on a long reducing course of steroids.
What tests do patients have to undergo before biologic therapy?
- Standard blood tests ruling out current infection
- Screen for latent TB (as it can reactive long term TB suppression)
What is the action of biologic therapy?
They aim to reduce the effect of tumour necrosis factor (TNF) which is a widespread immune mediator.
