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YR3S2- anesthetics > wk 9- bone healing/ complications > Flashcards

wk 9- bone healing/ complications Flashcards

1
Q

timelines for rehab (stage 1)

A

stage 1 (<3 weeks)
-pain control
-wound protection
-maintaining correction/alignment
-restricted activities

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2
Q

timelines for rehab (stage 2)

A

stage 2 (3-12 weeks)
-return to footwear
-reduced levels of activity
-low level rehab to maintain structures (proprioception/strengthening, etc)

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3
Q

timelines for rehab (stage 3)

A

stage 3 (3-18 months)
- rehab/ return to activity

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4
Q

complications with rehab/healing process

A

-infection

-scar

deep scars -compress on nerves and alter tendon function

superficial scars -compress on superficial nerves and comestically unappealing

-non union/malunion

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5
Q

medical complications are what

A

complications that occur within 30 days post op

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6
Q

when do pulmonary complications mostly occur

A

1 day post op

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7
Q

when do urinary complications occur

A

2 days post op

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8
Q

when do wound complications occur

A

3 days post op

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9
Q

when do DVT complications occur

A

4 days post op

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10
Q

what is dehiscence

A

a gapping of the wound resulting in increased scarring

caused by infection, absorbable sutures if alot of inflammatory process occurring, moving around and opening up a wound, etc

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11
Q

treatment of dehiscence

A

remove affected sutures
debride sloughy tissue
antiseptic dressing
steri strips/taping to reduce pressure on wound
resuture

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12
Q

what type of sutures typically have a reaction on the skin

A

absorbable

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13
Q

how do absorbale sutures dissolve

A

a low grade inflammatory process breaks them down

if its exaggerated, then they break down quicker

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14
Q

if theres a superficial suture reaction how to treat

A

remove sutures
antisptic dressing
allow to heal by secondary intention
hydrocortisone cream

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15
Q

what is a seroma

A

collection of serious fluid between epidermis and dermis

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16
Q

how to treat seroma

A

basically like a blister

treat with aspiration and compression dressings

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17
Q

what is a hypertrophic scar

A

excessive granulation tissue and deposition of collagen within wound margins

18
Q

keloid scar

A

excessive deposition of dermal collagen well beyond wound margins

people with darker skin tones are more susceptible

19
Q

scar treatment during operation

A

radiation therapy
avoid absorbable sutures
steroid injection under suture line

20
Q

post op scar treatment

A

steroid injection/hydrocortisone cream- slows down collagen formation and scar formation

US
silicine gel sheeting
excision
cryotherapy
laser
interferon

21
Q

why is it so important to assess someones imumune status and prior surgeries when about to conduct another?

A

infection at a different site (eg nail surgery caused an infection) can result in an infection through haemtomous spread to an area of high vascularity like where a joint replacement has occurred

22
Q

DVT causes

A

virchows triad

  1. stasis
  2. endolethieal trauma/abnormality
  3. hypercoaguable state

can cause pulmonary embolism or venous insufficiency

23
Q

risk stratification- DVT

A

high-
surgery
fracture
clotting factors
previous DVT/family history

mod-
pregnancy, stroke, CHF

low-
bed rest/immobility
obesity
female/oral contraception
varicose veins
smoking

24
Q

osseous post op complications

A

union problems
infection
metal work irritation
AVN

25
Q

delayed union is what

A

fracture not healed or signs of union in reasonable time approx 4 months, can take longer than this but need to monitor

26
Q

what can cause delayed union

A

smoking
local ischaemia/lack of blood supply
inappropriate mobilisation

27
Q

non union

A

after approx 8-9month

will often form a false joint - fibrocartilaginous interface

this isnt a bad thing if its still rigid, no pain, complications

28
Q

contraindications of immobilisation

A

previous DVT
neuromuscular disease
inability to use crutches
lack of blood supply

29
Q

aims of immobilistion after surgery

A
  1. maintain aseptic environment
  2. maintain alignment of surgery
  3. provide compression
    in the first 48-72 hours
30
Q

jones compression application

A

surgical dressing if required

cast padding (2 layers)

elastic bandage for compression

cast padding

elastic bandage for more compression

thin layer of taping/cast padding material

then synethic or plaster material

designed for swelling in first 3 days before a rigid cast or mobilisation

31
Q

post foot surgery immobilisation

A
  1. jones compression cast (short term first 3-4days)
  2. back slab, below knee cast
  3. aircast boot 10-12 weeks post op
32
Q

post trauma/injury immobilisation

A
  1. jones compression cast (short term 3-4days)
  2. below knee cast, backslab, soft cast, moon boot
33
Q

rigid cast types

A

fibreglass cast or
back slab

34
Q

how long should you apply a rigid cast for after 2-3 day compression - surgical setting

A

no signs of swelling or infection

rigid cast is on for about 6 week period for immobilisation and alignment

35
Q

fracture types

A

comminuted
non comminuted (oblique, spiral, traverse, partial)
avulsion
impaction
incomplete (greenstick or torus)
infartion
chip
stress
pathologic
bone bruise

36
Q

stability of fractures from most stable to least

A

tranverse, oblique, spiral, comminuted

37
Q

transverse and oblique fractures can be what

A

stable fractures and can be closed, reduced and immobilised as treatment

38
Q

spiral and comminuted fractures are

A

unstable fractures that are difficult to reduce without open reduction and internal fixation of the bone

39
Q

if a fracture is in a joint what treatment is best

A

surgery- open reduction and internal fixation

40
Q

how to do reductions for fracture

A

increase the deformity
distract
reverse the deformity and realign
maintain correction with immobilisation

can be performed open or closed

41
Q

digital fractures occur mostly through what MOA

A

stub or crush injury

42
Q

treatment for digital fractures

A

buddy splints and post op shoe

or

surgery if intrarticular or large unstable fragments

YR3S2- anesthetics (9 decks)

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