W14 - FRACTURES AND MGMT Flashcards
and Stability
Transverse (complete stability)
then
oblique, spiral, comminuted
Open #
There is a direct communication between the external environment and the fracture.
- higher risk of infection
- higher energy injury
- Gustilo Grading: I, II, IIIA,B,C
- tetanus and abx
- within 24hrs
Tx
> Immobilisation & pain relief
+Assessment of circulation, neuro, radiological
> Reduction / Nil Reduction
+ Maintenance of position: strapping, brace vs pins and operative
> Conservative: no immobs + strapping, brace;
- immob: cast, bracing, traction
> Operative: pins, fixators, rods, screws and plates
Mgmt for no initial immobs/reduction
No support required
or
Support: strapping, elastic bandage, brace
Mgmt for initial immobs +/- reduction
Cast
Functional Brace
Traction
Principles of Casting
- three point loading
- hydraulics
- rotational control: incl joint above and below
Functional Bracing
- long bones
- joints left to mobilise
- stops bending
Skin Traction
applied via adhesive / or nonadhesive tape
- blistering/ sloughing
- compartment syndrome
Skeletal Traction
- Traction via bone = allows greater force/weight
* common sites: femur, tibia
Operative Tx for #
> Ext. Fixation
> Intern. Fixation: intramedullary nailing, screw, plate
Common indications for external fixation
Fractures with poor soft tissue conditions
May aid with fragment reduction
Emergency pelvic stabilisation for haemorrhage control
Limb reconstruction
Complications in external fixation
Neurovascular injury Pin tract infection Loss of fracture alignment (Joint contractures) (Tardy union)
Indications for Intramedullary Nailing
Long bone diaphyseal #
- tibial
- femoral
- humeral
- paediatric
- minimal # exposure, joints free, incisions remote from #
Internals Fixation Screw and Plates: advs and risks
Usually incision over and exposure of fracture
- accurate # reduction
- access for bone grafting
- allows early joint mobilisation
Risk of:
devasc., wound problems, infection
Purpose of screws
Different types
= fix 2 pieces of bone together: compression or fixation in position
Plate Types
Compression plates = squeeze bones together
Neutralisation = resist rotating forces
Buttress = stop collapse
Strut/ Bridging = no opening #, akin to external nail
Indications for C-spine
Assuming injury in Dangerous mechanism Reduced conscious level Injury above clavicles Neurological signs
Primary Survey Vs Secondary Survey
1º Survey - Detects and treats immediate threats to life
2º Survey - Identification of all injuries and more detailed history
Open # Dx and Mgmt
Not always a break in the skin, but usually (e.g. fragments of bone from pelvis penetrating the rectum)
Type 1 - Wound <1cm, clean, simple
Type 2 - Wound >1cm, adequate skin coverage, simple
Type 3 - Extensive dmg, complex
3a - Adequate periosteal coverage
3b - Requiring flap/graft
3c - Vascular injury requiring repair
> MDT approach
Tetanus and Abx prophylaxis
At fixation = Cefuroxime / Augmentin / Clindamyacin
Rpt examination
Patterns
transverse
+ short oblique
comminution
segmental (broken @ 2 sites)
w/ bone loss
Soft Tissue Injury Patterns
- Skin loss = cannot close wound
- Degloving - stripping of skin
- Muscle injury producing devitalised muscle
- Inj. to major arteries of leg
Surgical Debridement and Fixation Indications
COLOUR - perfusion
CONTRACTION - alive v dead
CONSISTENCY
CAPACITY TO BLEED
*experienced surgeons
Dislocation vs Subluxation
Dislocation = complete joint disruption Subluxation = partial dislocation – not fully out of joint
Common Dislocations & Signs
SHOULDER - ant., post.
- squared off
- locked in internal rotation
ELBOW - post.
*olecranon prominenct post.
HIP - post.
*short leg, flexed, internal rot., adduction
KNEE - anteropost.
* loss of normal contour
ANKLE - lat.
- externally rotated
- prominent med malleolus
SUBTALAR JOINT - lat common
* lateral displaced os calcis
