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Flashcards in AO_chapters Deck (202)
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preop management of fx patient

ABCDairway, breathing, circulatory, other disabilitiesSPO2, auscult, IV access/fluids, imaging, full ortho neuro PE


benefits to pain mgmt for fx patient

decrease anxiety/stress and it's associated hormonal and metabolic derrangementsprovide patient comfort


most effective analgesic time period

PRIOR to onset of pain (surgery)


advantages of multimodal pain therapy

selectivity to target multiple sites of pain pathadditivite/synergismreduced dosingreduced toxicity


define neuroleptanalgesia

combo of neuroleptic drug (ace) and analgesia (opioid)


infection rate of CLEAN ortho procedures



most common isolate causing ortho infxn

Staph intermedius


host risk factors for sx infection

age (>8yrs) obesitydistant infection, endocrinopathyinadequate skin prepprolonged axpropofol


intraop risk factors for sx infection

sx > 90 mexcessive electrocauterybreak in asepsisbraided/multifilament sutureimplants


use of periop prophy Ab decreases rate of infxn_______

use of periop prophy Ab decreases rate of infxn 4 fold in clean procedures.


traditional recommendation for prophy Ab in clean procedure

in clean procedures generally NOT indicated UNLESS>90m surgerymetal implants usedextensive ST damagecefazolin--bactericidal given IV 30 min prior to sx


AO fracture classification

1 humerus2 RU3 femur4 tib/fib1=prox2=shaft3=distalA= single fxB= wedge/butterflyC=complex


open fracture classification

I. bone penetration thru skin (small puncture hole/laceration < 1 cm); CLEANII. > 1cm laceration with fracture communicating with skin; mild ST traumaIII. A severe comminution; hi energy, ST flaps but available for wound coverageIII. B severe comminution; hi E; bone exposure; periosteum strippedIII. C severe comminution; hi E; bone exposed with damage to arterial blood supply


physeal fracture classification

Salter HarrisI growth plate II growth plate metaphysealIII growth plate epiphyseal (intraarticular)IV metaphyseal/epiphyseal (intraarticular)V compressionVI asymmetric compression


objectives for fracture repair

reduction/alignmentrigid stabilization/immobilizationmaintain blood supplyearly return to normal function


mechanical and biological factors for fractures

mx: fx configuration, reconstruction or not, concurrent ortho injurybx: age, fracture location, ST injury


pros/cons to open vs closed reduction of fx

open: visualization, bone grafting, anatomical recon BUT incr sx time and ST injury/blood supplyclosed: preserve ST/blood supply, decr contamination BUT at the expense of fracture alignment/recon


Three ways of fracture planning

direct overlaybone specimenintact contralateral bone


major benefit of fully reconstructed boney column

shares the wt bearing load of the limb during fx healing


review of post op radiograph criteria

4 AsA=appositionA=alignment (50% is necessary to prevent delayed union)A=apparatusA=activity


rehabilitation goals

prevents musculoskeletal disabilitydecreases healing timefacilitates restoration of normal function


rehab includes

cryotherapy--ICE in acute < 72 hr period; vasoconstrict, min fluid/edema, decr nerve conduction, encourage muscle relax; w compression decr temp by 27 deg Cheat therapy-- > 72 hr period, vasodil (NOT in nerve patient); incr metabolismmassage--incr local circulation, decr muscle spasm, attentuate edema, brkdown scar tissuetherapeutic exercise--pROM; maintain normal joint motion, sensory awareness, blood flow improvement; build strength, agility/coordinationtherapeutic US--treats chronic scare and adhesions NM stimulation--creates artificial contraction


types of massage

EFFLEURAGE--superficial/light strokingPETRISSAGE--kneadingTAPOTEMENT--percussion/tapping


biological fracture healing goals

flexible fixationeliminate anatomic reconstructioncreate axial alignmentless surgical traumaindirect bone healing w calluspreserve blood supply


role of screw

interfrag compressionfixing of a splinting device (plate, nail, fixator)


difference btwn cancellous and cortical screws

cancellous screws1. larger outer diameter (thinner inner core)2. deeper thread3. larger pitchused in metaphyseal and epiphyseal bone


cortical screw

used in diaphysisas size increases strength increasesscrew diameter should not exceed 40% of bone diameter


3.5 mm cortical screw characteristics

2.4 core diameter (use 2.5 drill bit)3.5 thread diameter6 mm head hexagonal recess


T/F self tapping screws can be used as lag screws

FALSE; avoid self tapping screws to be used in lag fashion bc may cut a new hole/threads


what is a shaft screw

cortical screw with short threads and a shaft that has a diameter equal to that of a threadused as a lag screw in diaphyseal bone