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Flashcards in Complications of Fractures Deck (31):
1

List the general complications of fracture

Shock
Crush syndrome
DVT
PE
Fat embolism
Compartment syndrome
Tetanus
Gas gangrene
SIRS

2

What are the 4 types of shock?

Hypovolemic
Neurogenic
Septic
Anaphylaxis

3

Discuss crush syndrome

Caused by death of large muscle bulk due to crushed limb, prolonged tourniquet etc.

Due to release of myoglobin --> ACUTE RENAL FAILURE (elevated CK, lactic acid, creatine)

4

Treatment of crush syndrome

If crush >6h - amputation
Ice
Treat crush
Renal dialysis

5

Clinical signs of DVT

Local tenderness
Swelling
Homan's sign (pain on dorsiflexion)
Febrile
Tachycardia

6

Treatment of DVT

Prophylaxis - early mobilisation, TEDS, SCDs, partial anticoagulation
Established - full chemical anticoagulation

7

Clinical presentation of PE

Pleuritic chest pain
Dyspnoea
Haemoptysis
Cyanosis
Tachycardia
Shock
Rales + friction rubs

8

Treatment of PE

Oxygen - by mask, positive pressure ventilation if decreased PO2
Anticoagulation (heparin)
Pulmonary arteriotomy
IVC umbrella

9

Systemic manifestations of fat embolism

Acute respiratory distress syndrome
Petechial rash
Confusion, coma
Haematuria, lipiduria

10

Most common clinical setting - fat embolism

Multiple fractures
Most commonly femur / pelvis

11

Treatment of fat embolism

Oxygen
IV fluids
Corticosteroids
Heparin

12

5 Ps of Compartment Syndrome

Pain
Pallor
Parasthesia
Paralysis
Pulseless

13

Over what pressure is a fasciotomy indicated

>40mmHg

14

3 compartments of the forearm

Extensor
Superficial flexor
Deep flexor

15

4 components of the leg

Superficial posterior
Deep posterior
Lateral
Anterior

16

What is Volkmann's contracture?

Ischemic contracture of the forearm due to compartment syndrome or arterial injury in forearm or proximally

Secondary to fibrosis of forearm muscles and ischemic neuritis

17

Microbiological appearance - tetanus

Gram positive bacilli with terminal spores

18

MOA: tetanus

Produces exotoxin which is transported by blood and lymphatics
Fixed to anterior horn cells and causes tonic and clonic muscle contracture

19

Treatment of tetanus

Intubation + mechanical ventilation
High dose IV penicillin
Debride dead / contamianted tissue
Hyperbaric chamber

20

Most common organism - gas gangrene

Clostridium welchii

21

What is reflex sympathetic dystrophy?

Nerve injury results in sympathetic overactivity in the hand or foot leading to burning, pain, swelling, increased sweating

22

What are 2 other names for reflex sympathetic dystrophy?

Sudeck's atrophy
Regional pain syndrome

23

Clinical presentation - Reflex Sympathetic Dystrophy

Burning pain (hand / foot)
Swelling
Immobile
Skin sweaty, blotchy, warm
Joint stiffness, deformity

24

List late complications of fracture

Delayed union
Non-union
Malunion
Avascular necrosis
Growth disturbance
Myositis ossificans
Joints stiffness
Arthritis

25

Causes of delayed / non-union

ATROPHIC - due to avascularity / infection
HYPERTROPHIC - due to movement

26

Treatment of delayed / non-union

Bone grafting
Internal fixation of fracture

27

Causes of malunion

Inadequate reduction
Failure to hold adequate reduction

28

In what circumstances would you consider osteotomy for malunion

>15deg angulation
Rotation

29

3 most common injuries leading to avascular necrosis

Fracture neck of femur
Fracture proximal scaphoid
Fracture neck of talus

30

In which 2 locations does myositis ossificans usually occur

Brachialis
Quadriceps

31

Treatment of myositis ossificans

Rest joint in position of function
NSAIDs
Gentle active movement once pain settles
Excise mature bone mass