Tx of Fx Flashcards
What are the three phases of fracture healing?
Reactive phase: fracture and inflammation, granulation tissue formation
Reparative phase: cartilage callus formation
Remodeling phase: trabecular bone is replaced with compact bone
WHAT ARE SOME COMMON CONDITION THAT IMPAIR HEALING?
DM, arteriovascular disease, anemia, vitamin deficiencies, tobacco use, chronic alcohol abuse, Meds: NSAIDs, glucocorticoids, cipro
Evaluation of the Fx
-what should you check/think?
What are some complications of fractures?
- where is the deformity?
- open or closed injury?
- check joints above and below the fracture
- Minimum 2 x-ray views of the injured part (“one view is no view”)
Complications
- pelvic and femoral fx can have significant blood loss
- injuries to other structures (nerves, vessels)
- acute compartment syndrome
- increased risk of venous thrombosis with major trauma
- fat embolism syndrome
- complex regional pain syndrome
- late: osteomyelitis, non/mal union, post traumatic arthritis
Common injury patterns (what gets broken)
- Outstretched hand
- fall off a roof
- Outstretched hand: scaphoid, radial head, wrist, proximal humerus
- fall off a roof: os calcis (calcaneus), tibial plateau, TL compression Fx
How do you acutely stabilize a fracture?
Definitive treatment?
Acute stabilization
- evaluate the patient
- immobilize the fracture (splint)
- provide analgesia: ice, elevation, immobilization, pain meds
Definitive treatment
-create conditions in which the body will heal the fracture while the pt is a s functional as possible
Fractures:
-treatment options
Treatment
- minimal treatment: rib fractures, torus fractures, metacarpal fractures, toe fractures
- immobilization with cast, splint, brace
- traction…not used much anymore
- fracture reduction (open or closed)
- surgical fixation
- -pins and wires
- -plates and screws
- -external fixators (for unstable injuries and contaminated fractures)
- -intramedullary devices (gamma nails)
- -replacements (hip, shoulder, radial head)
What is the treatment of choice for undisplaced, stable, and some reduced fractures?
What is the treatment for diaphyseal fractures?
Casting
Casting but include the joint above and below the fracture
What is the growth plate fracture classification used for children?
Salter Harris Classification!
1: undisplaced
2: physis and metaphysis
3: physis and epiphysis
4: across the physis
5: crush injury
Clavicular fractures
- MC site on the clavicle
- tx of stable
- tx of displaced, angulated, over riding
MC site is mid shaft (middle third)
Tx of stable: sling or figure 8 splint
Tx of displaced: may need surgery
Adult shoulder fractures
- often due to what MOI?
- tx of impacted or non-displaced
- when to refer
Often due to
-falling from STANDING height
Tx
-conservative (sling, limit activities, pain meds)
Refer if
-anatomic neck, complex fracture, dislocations
Distal Forearm Fractures in Children
- When do they need ortho referral?
- tx of stable fractures
- tx of colles fracture
Refer if
- neurovascular compromise
- open fracture
- gross deformity
- displaced Satler Fx
Stable fractures tx
-casts and braces
Colles fractures tx
-ranges from splint to pinning to plating
Metacarpal fractures
- usually due to what MOI
- tx
Base of thumb fractures
-tx
Usually due to direct trauma (punching a wall)
tx
- depends on displacement, angulation, rotation
- shelf brace or taping of fingers
Base of thumb
-tx depends on stability, test stability`
Vertebral compression fractures
- what is Dowager’s hump?
- tx
Dowager’s hump
-osteoporotic vertebral compression fractures
tx
- pain relief and correction of osteoporosis
- bracing for pain relief and increased activity
- surgery for neuro compromise or unresponsive pain
- -vertebroplasty
Pelvic Fractures
- concerns about this type of fracture
- who is this commonly seen in?
Hip fractures
- t/f, significant source of morbidity and mortality
- tx of choice
Pelvic Fractures
Concerns
-beware of blood loss and injuries to other organs
Can see pubic rami or sacral fractures with minimal trauma in the osteoporotic
Hip fractures
-True, 1/3 die within 6 months
tx
-surgery (it decreased morbidity, relieves pain, allows for function)
Femoral neck fx
-tx
Intertrochanteric Hip Fractures
-tx
Subtrochanteric hip fx
-tx
Femoral neck fractures
tx
-replacement is better than pinning because the fracture/pin can interrupt blood supply and has a high complication rate
Intertrochanteric Hip Fx
tx
-plate and screws, but can lose significant blood (type and screen pre op)
Subtrochanteric hip fx
tx
-unstable injury: intramedullary device (rod type thing), can have significant blood loss
Tibial Shaft Fx
- distal metaphysis fx MC MOI
- mid shaft fx MC MOI
- spiral, oblique, or distal fxs MC MOI
- tx
Ankle Fractures
- Dx
- tx of stable injury, unstable
Distal metaphysis
-usually low energy fx
Mid shaft fx
-high energy injury (MVA)
Spiral, oblique, distal fx
-rotational injury
Tx
- need referral to ortho
- many will require surgery, may be able to splint until then
Ankle Fx
- Dx: AP, lateral, and oblique Xrays
tx: - stable can treated conservatively
- unstable: surgery
- -surgery is mandatory if there is ankle joint separation (look at mortice)
Foot fracture
- dx
- tx
Dx
- palpate for occult injuries!
- AP, lateral, oblique xrays
Tx
- conservatively
- -short leg walking cast or boot, stable toe fx can be taped
Metastatic Fractures
-tx
tx
- stabilize fracture, remove tumor
- -bone cement
- early lesion (pre fracture) may respond to radiotherapy
Stress fracture
- cause
- dx
- tx
Cause
- repetitive stresses applied to a bone (rate of absorption exceeds that of a deposition)
- -can start as a dull ache and build to sharp pain
Dx
-often not seen on xray… MRI or bone scan id suspicious
Tx
-most respond to decreased activity and immobilization
What are some fractures that suggest child abuse?
- metaphyseal corner fractures
- fractures of the ribs, sternum, scapula, spinus process
- multiple fracture in various stages of healing
- bilateral acute long bone fractures
- skull fractures in children younger than 18 months
When to refer…
- any open injury
- neurovascular compromise
- high energy injuries
- excessive pain… possible compartment syndrome
- fracture that is significantly angulated or displaced
- fractures with known bad outcomes like hip, scaphoid, displaced long bone fxs
- whenever a parent or pt has concern!
