W14 - FRACTURES AND MGMT

Question 1

and Stability

Answer 1

Transverse (complete stability)
then
oblique, spiral, comminuted

Question 2

Open #

Answer 2

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

Question 3

Tx

Answer 3

> 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

Question 4

Mgmt for no initial immobs/reduction

Answer 4

No support required
or
Support: strapping, elastic bandage, brace

Question 5

Mgmt for initial immobs +/- reduction

Answer 5

Cast
Functional Brace
Traction

Question 6

Principles of Casting

Answer 6

• three point loading
• hydraulics
• rotational control: incl joint above and below

Question 7

Functional Bracing

Answer 7

• long bones
• joints left to mobilise
• stops bending

Question 8

Skin Traction

Answer 8

applied via adhesive / or nonadhesive tape

• blistering/ sloughing
• compartment syndrome

Question 9

Skeletal Traction

Answer 9

• Traction via bone = allows greater force/weight

* common sites: femur, tibia

Question 10

Operative Tx for #

Answer 10

> Ext. Fixation

> Intern. Fixation: intramedullary nailing, screw, plate

Question 11

Common indications for external fixation

Answer 11

Fractures with poor soft tissue conditions
May aid with fragment reduction
Emergency pelvic stabilisation for haemorrhage control
Limb reconstruction

Question 12

Complications in external fixation

Answer 12

Neurovascular injury
Pin tract infection
Loss of fracture alignment
(Joint contractures)
(Tardy union)

Question 13

Indications for Intramedullary Nailing

Answer 13

Long bone diaphyseal #

• tibial
• femoral
• humeral
• paediatric
• minimal # exposure, joints free, incisions remote from #

Question 14

Internals Fixation Screw and Plates: advs and risks

Answer 14

Usually incision over and exposure of fracture

• accurate # reduction
• access for bone grafting
• allows early joint mobilisation

Risk of:
devasc., wound problems, infection

Question 15

Purpose of screws

Answer 15

Different types

= fix 2 pieces of bone together: compression or fixation in position

Question 16

Plate Types

Answer 16

Compression plates = squeeze bones together

Neutralisation = resist rotating forces

Buttress = stop collapse

Strut/ Bridging = no opening #, akin to external nail

Question 17

Indications for C-spine

Answer 17

Assuming injury in  
Dangerous mechanism 
Reduced conscious level
Injury above clavicles 
Neurological signs

Question 18

Primary Survey Vs Secondary Survey

Answer 18

1º Survey - Detects and treats immediate threats to life

2º Survey - Identification of all injuries and more detailed history

Question 19

Open # Dx and Mgmt

Answer 19

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

Question 20

Patterns

Answer 20

transverse
+ short oblique

comminution

segmental (broken @ 2 sites)

w/ bone loss

Question 21

Soft Tissue Injury Patterns

Answer 21

1. Skin loss = cannot close wound
2. Degloving - stripping of skin
3. Muscle injury producing devitalised muscle
4. Inj. to major arteries of leg

Question 22

Surgical Debridement and Fixation Indications

Answer 22

COLOUR - perfusion

CONTRACTION - alive v dead

CONSISTENCY

CAPACITY TO BLEED

*experienced surgeons

Question 23

Dislocation vs Subluxation

Answer 23

Dislocation = complete joint disruption
Subluxation = partial dislocation – not fully out of joint

Question 24

Common Dislocations & Signs

Answer 24

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

Question 25

Definition of Deformity

Answer 25

movement of distal fragment with respect to supposedly stationary proximal fragment

• DISPLACEMENT
• ANGULATION
• ROTATION
• AXIAL DEFORMITY