Fracture Flashcards
(23 cards)
How to report on X-ray
- Patient details, penetration, view
- Site of fracture - what bone, what part of the bone
- Type of fracture - transverse, oblique, spiral
- Simple or comminuted
- Displaced or not
- Angulated or not
- Bone of normal consistency or not
What does ORIF mean?
Open reduction, internal fixation
plates and screws
CRIF?
Closed reduction, internal fixation
less common
k-wires percutaneously and intermedullary fixation of long bones with wires or IM nails
Simple fracture
= bone split into 2 pieces
Comminuted fracture
= bone split into 3 or more pieces
In simple fractures, what should be done to the fracture site?
Compression
Allows healing without callus formation
Problem with intracapsular hip fractures rather than extracapsular?
Disruption to blood supply - medial circumflex femoral artery
First thing to do with an open fracture
Assess - primary and secondary survey, assess neurovascular status of the limb
Then what do you do before treating the open fracture
Remove gross contamination, photograph
First thing to treat the open fracture
Dress with saline soaked gauze
After gauze on open fracture
Splint limb, usually in backslab IV Abx (asap and every 8 hours until wound debridement)
Open fracture in theatre
Within 24 hours on day list
Wound washout and debridement
Stabilisation
Principles of treating any fracture
Reduce
Stabilise (preserve blood flow)
Rehabilitate
Causes of pathological fracture
Osteoporosis Osteomalacia Osteopenia Tumours - primary or secondary Infection Metabolic bone disease Medications
Local factors for delayed union or non-union of bone
Location - eg scaphoid, distal tibia, base of 5th metacarpal at risk bc of blood supply
Stability
Infection
Pattern - segmental fractures higher risk
Systemic factors for delayed union or non-union of bone
Diet Smoking Diabetes HIV Medications eg corticosteroids, NSAIDs
Examples of intracapsular hip fractures
Subcapital
Transcervical
Examples of extracapsular hip fractures
Base of cervical
Intertrochanteric
Subtrochanteric
How to manage extracapsular hip fracture
Fix with DHS or IM nail
Intracapsular garden classification
1 - undisplaced, incomplete. include valgus impacted fractures
2 - undisplaced, complete
3 - partially displaced, complete
4 - completely displaced, complete
Rhyme for treating garden classification hip fractures
1,2 give it a screw, 3,4 austin moore
Intracapsular undisplaced = fix with eg DHS
Intracapsular displaced = hemiarthroplasty or total hip replacement
Criteria for total hip replacement rather than partial
No cognitive impairment
Independently mobile
Indication for IM nail for fixation
Fixation rather than replace, so either undisplaced intracapsular or extracapsular
Pathological fracture
