Unit 6c: Fracture Management Flashcards
What are the 3 aims of fracture management? (in order of priority)
Save life
Treat pain
Restore function
Roughly how much blood is lost in a femoral fracture?
1 litre
Roughly how much blood can be lost in a pelvic fracture?
Up to 3 litres
How is pain usually managed in a fracture?
Strong opiates
Splintage
How does splintage reduce pain in a fracture?
Reduces the muscle spasm that occurs around a mobile fracture
What is reduction?
A process whereby the original anatomical shape of the bone is more or less restored
What process follows reduction?
Holding
What are the 2 types of reduction?
Open
Closed
What are the 3 methods of external fixation?
Plaster of Paris (and its derivatives)
raction
External fixator
What are the 3 methods of internal fixation?
Plates and screws
Pins and wires
Roads and nails
What type of loading are splints good for?
Bending forces after reduction
What types of loading are splints not good for?
Torsional and compression forces
What type of fractures are splints only suitable for?
Relatively stable fractures (e.g. transverse diaphyseal fractures)
What is the chemical name for Plaster of Paris?
Calcium Sulphate
What is a danger when applying Plaster of Paris to patient if care is not taken?
Heat damage as the calcium sulphate
What makes up a hard coated bandage?
Bandage coated with calcium sulphate ‘held on’ by starch
What makes up a loose coated bandage?
Dust calcium sulphate hemihydrate onto a bandage so there is a weak association between bandage and plaster
What is used as an accelerator to speed up setting of Plaster of Paris?
Starch
What are examples of retarders added to slow down Plaster of Paris setting?
Alum
Borax
What effect to long alabaster crystal have in Plaster of Paris?
Give finished cast a hard quality
What influences the interlocking of the 2 types of crystal in Plaster of Paris?
How wet the plaster material is at the time of application
What is the hydraulic theory of Plaster of Paris?
Encasing the limb in a rigid exoskeleton provides support to the soft tissues which in turn support the broken bone
Other than support how does Plaster function?
Gives a gentle 3 point fixation system - giving a periosteal hinge
What 3 dimensions do casts have to control the position of a broken bone in?
Length (prevent shortening)
Position (prevent tilt)
Rotation
In externally applied splint which dimension is hardest to control?
Rotation
What are the disadvantages of casting?
If prolonged joints become stiff and muscles waste - prolonging rehab
Can prolong hospital stay from immobilisation (especially in the elderly)
How can immobilisation and prolonged hospital stay be overcome in casting?
Combination of careful moulding and application of hinges incorporated into the cast (known as functional or cast bracing)
Describe a femoral brace
Upper third of femoral component is gently squared off - slightly distorts soft tissues but not enough to crete pressure points
Knee is freed by the use of hinges
When should braces be applied?
After the first 2 or 3 weeks when the soft tissue has settled down and there is no swelling
What are the 2 classes of new materials developed as an alternative to Plaster of Paris?
Isoprene rubbers or polycaprolactone sheets
Glass fibre or artificial fibre and polyurethane composites
How do the properties of polycaprolactone/isoprene sheets vary with temperature?
They are ductile at fairly low temperatures (allows moudling)
Firm at room temp but flexible enough to be gently adjustable
What is the main downside to polycaprolactone/isoprene sheets?
Expensive - require pirchase of an oven and skill development
What are fibre/polyurethane composites made of?
Bandages made of glass fibre or fabric which is impregnated with a urethane monomer and a catalyst
What desirable properties do fibre/polyurethne composites have when exposed to warmth and moisture?
Very light
Extremely strong
Flexible
Why are fibre/polyurethane composites not very useful as a primary splintage material?
They are conforming rather than being very mouldable - difficult to use on unstable and swollen limbs
What two groups can muscles be generally categorised as?
Agonists and antagonists
In traction of the lower limb what load is generally required to achieve effective holding?
10 N per 100 N of body weight
How is a counter force achieved to prevent pulling the patient out of bd in traction?
Tilting the bed backwards - using weight of the body and frictional resistance between the patient and bed
What are the 2 methods of applying the load to the limb in traction?
Skin traction
Skeletal traction
How is the load applied in skin traction?
Via a foam or sticky bandage applied to the skin
What loads can be used for skin traction?
Up to 50 N
How is the load applied in skeletal traction?
Via a pin inserted through the bone
What is the advantage of skeletal over skin traction?
Can apply large loads
Load can be precisely relative to the long axis of the bone
What is the prinicpal disadvantage of skeletal traction?
Risk of causing bone infection at the pin-bone interface
What are the 3 ways to use the principle of traction?
Static (fixed) traction
Dynamic traction
Balanced traction
How does static traction work?
Load is applied to the limb and attached to a splint so that the splint itself provides the counter force
Example of static traction
Thomas Splint
Why is static traction only acceptable for a week or two?
Immobility prevent joint movement - does not induce axial movement at the fracture site - leads to muscle disuse
What is static traction mainly used for and why?
Treating children’s fractures - they don’t cope well with complicated traction and their fractures heal quickly
How does dynamic traction differ from static traction?
Patient is encouraged to use their joints and load is arranged so the net pull is maintained along the axis of the bone
What are the 2 functions of pulleys in dynamic traction?
Alter the direction of the force by being statically mounted on bed frame
Alter the magnitude of the traction by being mounted on the limb or “free floating” within the traction cord system
Why are free floating pulley systems useful?
Physio - very weak muscles can be exercised without the full weight of the limb in early treatment
What is the principle use of balanced traction?
To offset pressure effects cause by the splints
Example of balanced traction
Thomas splint - apply small load to the splint as a whole to draw the presssure off the groin area
What are the clinical complications of traction associated with?
Having to lie in bed for long periods of time
What are the complications of traction without a very actie physio program?
Bed sores
UTI
Disuse atrophy of muscle and bone
Why is traction not used very often?
It requires prolonged hospitalisation (3 months or more)
Which 2 methods of holding are best for low energy injuries? why?
Traction and plaster (they require reasonable soft tissue support)
What factors should be considered when deciding the best method of fracture manageemnt?
The patient
The injury
The facilities available
The skills of the surgeon
