Basics of Fracture Management Flashcards
1
Q
What does treatment of a fracture depend on?
A
- Stability of fracture
- Patient factors
- Fitness, other injuries etc
- Closed vs open
2
Q
How stable are the following fractures:
- transverse
- oblique
- spiral
- communited
- oblique
A
- Complete stability
- Transverse
- No stability to shortening
- Oblique
- Spiral
- Communuted
- Potential stability
- Oblique
- <45 degrees, as they move towards transverse fractures
- Oblique
3
Q
When is an oblique fracture considered stable?
A
- <45 degrees, as they move towards transverse fractures
4
Q
What is an open fracture?
A
Open fractures = direct communication between external environment and the fracture
5
Q
What are the 2 main ways that open fractures differ from closed fractures?
A
- Higher energy of injury
- Higher risk of infection
6
Q
What system is used to classify open fractures?
A
Gustilo grading
7
Q
Describe Gustilo grading?
A
8
Q
Describe the management of open fracture?
A
- Tetanus and antibiotic prophylaxis
- Photograph, cover and stabilise limb
- Surgical emergency
- All operations within 24 hours
- Some operations within 6 hours
- Wound excision, skin is left open to allow going back and reviewing, skin closed by 5-7 days, stabilise fracture definitively
9
Q
Describe the general treatment of fracture?
A
- Initial
- Immobilisation
- Pain relief
- Assessment
- Clinical
- Fracture, circulation, neurological, closed vs open
- Radiological
- Clinical
- Definitive treatment
- No reduction required
- Reduction required
- LA, GA, other
- Maintenance of position
- Conservative
- No immobilisation
- Strapping
- Brace
- Immobilisation
- Cast
- Cast principles are three point loading, hydraulics (stops soft tissue bulging out by circumferential constraints) and rotational control by including joint above and below
- Functional bracing
- For long bones
- Stops shortening and bending, allowing joints to be free to mobilise
- Traction
- Applies axial force to tighten soft tissue and align bone, producing closed reduction
- Left on provides continuing maintenance reduction
- Usually done by skin traction
- Danger of blistering and compartment syndrome
- Can use skeletal traction to put more weight on
- Allows greater force
- Common sites are femur and tibia
- Cast
- No immobilisation
- Operative
- External fixation
- Means to fix bone from outside
- Uses pins or wires passed through skin and bone, attached to external frame
- Additional wires can be used to pin fragments together, not attached to frame
- Indications include
- Fractures with poor soft tissue conditions
- Where distraction through fixator may help with fragment reduction
- Emergency pelvic stabilisation for haemorrhage control
- Limb reconstruction
- Fixator types are unilateral, multilateral or circular
- Possible complications
- Neurovascular injury
- Pin tract infection
- Loss of fracture alignment
- Internal fixation
- Intramedullary nailing
- Indication is long bone fractures
- Usually used in tibia, femoral, humeral and some paediatric
- Technique is
- Patient positioned > fracture reduced > incision at entry point and x-ray guided wire inserted > canal reamed > nail passed > bone locked onto nail
- Indication is long bone fractures
- Screws and plates
- Used for bones other than long bones
- Different types of screws, cortical vs cancellous
- Different sizes of screws depending on bone size
- Plates are fixed outside of bone with screws, they load share with bone, initially taking more weight
- Different plate types includes
- Compression – squeeze bone together
- Neutralisation – resist rotating forces (spiral fractures)
- Buttress –stops collapse
- Strut/bridging
- Intramedullary nailing
- External fixation
- Conservative
10
Q
Describe the initial treatment of fracture?
A
- Immobilisation
- Pain relief
11
Q
What is fracture reduction?
A
Repairing the fracture to correct alignment
12
Q
What are conservative options for maintanence of position in fracture management?
A
- Conservative
- No immobilisation
- Strapping
- Brace
- Immobilisation
-
Cast
- Cast principles are three point loading, hydraulics (stops soft tissue bulging out by circumferential constraints) and rotational control by including joint above and below
-
Functional bracing
- For long bones
- Stops shortening and bending, allowing joints to be free to mobilise
-
Traction
- Applies axial force to tighten soft tissue and align bone, producing closed reduction
- Left on provides continuing maintenance reduction
- Usually done by skin traction
- Danger of blistering and compartment syndrome
- Can use skeletal traction to put more weight on
- Allows greater force
- Common sites are femur and tibia
-
Cast
- No immobilisation
13
Q
What can be used for maintanence of position that allows mobilisation?
A
- Strapping
- Brace
14
Q
What can be used for maintenance of position but does not allow mobilisation?
A
Cast
Functional bracing
Traction
15
Q
What are the cast principles?
A
- Cast principles are three point loading, hydraulics (stops soft tissue bulging out by circumferential constraints) and rotational control by including joint above and below
