Treatment of Fxs Flashcards
What part of the bone is the key to fx healing?
- periosteum: provides the vascular supply
Biology of fx healing - diff phases?
- reactive phase: fx and inflammatory phase (vessels contract, hematoma), granulation tissue formation (fibroblasts take over)
- reparative phase: cartilage callus formation (periosteal cells - turn to chondroblasts), lamellar bone deposition (form fx callus)
- remodeling phase: remodeling to original contour, trabecular bone is replaced w/ compact bone
Healing rates depend on what?
- vary w/ age, comorbidities, nutritional status
- effected by thyroid and GH levels, calcitonin
- common conditions that impair healing:
diabetes, arteriovascular disease, anemia, vitamin deficiencies (A and C), tobacco use, chronic alcohol use, meds: NSAIDs, glucocorticoids, cipro
Eval of fx pt?
- vital signs and mental status
- MOI: beware of high energy injuries
- neurovascular status of extremity (elbow and knees): record it for posterity
- where is deformity? beware of knee and elbow injuries
- open or closed?
- check jts above and below fx
- min of 2 xray views of injured pt
Common injury patterns of FOOSH?
- scaphoid radial head, wrist, proximal humerus
Common injury patterns - falling off roof?
- os calcis, tibial plateau, TL compression fx
How do you describe fx?
- name of injured bone
- location (dorsal, volar: epiphysis, metaphysis, diaphysis - proximal, middle, distal third)
- orientation of fx: transverse, oblique, spiral, angulated, comminuted, segmental, intra-articular, displaced, compression and impaction
- condition of overlying tissues (open or closed): 1 puncture, 2 laceration w/ mod ST injury, 3 grossly contaminated
What factors effect tx?
- open or closed injury
- nature and severity of fx:
energy involved: stable or unstable
is position acceptable, is jt involved? - possible neuro-vascular injuries/complications: N/V issues and compartment syndromes
- age, health, demands of pt
Complications of fxs?
- pelvic and femoral fxs can have significant blood loss
- injuries to other structures: nerves/vessels, esp at knee and elbow
- acute compartment syndromes
- increased risk of venous thrombosis w/ major trauma
- Fat emboism syndrome: femur fx
- complex regional pain syndromes (sympathetic dystrophy)
- late: osteomyelitis, non/mal-union, post-traumatic arthritis
Principles of tx?
acute stabilization:
- eval the pt
- immobilize fx: usually splinting
- provide analgesia: ice, elevation, immobilization, pain meds
- decide on definitive tx
- create conditions where the body will heal the fx while pt is as fxnl as possible:
allow for jt motion when possible, pts need est of when they can return to work/sports
Tx options for fxs?
- reassurance or min. tx: rib fxs, torus fxs, metacarpal fxs, toe fxs
- immobilization w/ cast, splint or brace: works well for stable, well aligned fx, down side: prolonged immobilization, loss of reduction, fxnl limits
- traction: better options than this now
- fx reduction closed or open: maintain w/ cast, hardware or both
- surgical fixation:
displaced, unstable fx, early mobilization, often the best option: quick return to fxn, displaced intra-articular fxs, down side is cost, complications including infection
Casting is TOC for what? Types of casts/splints?
- Rx of choice for undisplaced, stable, and some reduced fxs
- plaster of paris or fiberglass:
plaster easier to mold,
fiberglass more durable - may splint initially - safer than a cast in acute setting: volar splint forearm and wrist, sugar tong splint for ankle
- diaphyseal fxs: include jts above and below fx
- complications of casting: pressure sores, N/V compromise, compartment syndrome, disuse atrophy, jt stiffness
Surgical options for fxs?
- pins and wires: reduction of fx, pin fixaion, and cast, cerclage and tension band wiring
- plates and screws: initially thick and unbending, now contoured to specific bones and locking plates
- external fixators: for unstable injuries and contaminated fxs
- intramedullary devices: for long bone fxs, options for cross locking screws, gamma nails for unstable hip fxs
- replacements: hip, shoulder, radial head
Common fxs in kids? Salter Harris classification?
- usually heal much faster than adults - potential for remodeling
- unique fxs due to nature of young bone:
buckle (torus), greenstick, plastic deformation, growth plate injury, apophyseal avulsion - Salter:
1 undisplaced
2 physis + metaphysis
3 physis + epiphysis
4 across physis
5 crush injury
Tx for clavicular fxs?
- most (70%) are mid shaft: stable: sling or figure of 8, if displaced, angulated or over riding fx may need surgery
- in kids: 90% in middle 3rd, if younger than 10: majority are non displaced, if older than 10 than majority are displaced
- distal 3rd: behave like AC separations, if undisplaced: conservative tx, otherwise may need surgical repair
- prox 3rd: rare, beware of internal injuries - high energy injury (think about internal injuries as well)