Fracture Management Flashcards Preview

Acute Management > Fracture Management > Flashcards

Flashcards in Fracture Management Deck (45):
1

 

 

What are the 4 stages of fracture management?

4 R's

  • Resuscitate
  • Reduce
  • Retain
  • Rehabilitate

2

 

 

What would you want to cover in a fracture assessment?

 

  • Who/What/When/where/why
  • Other injuries
  • Neurovascular status
  • Complications
  • Social and smoking history

3

 

 

What option are available to reduce a fracture?

 

  • Open reduction
  • Closed manipulation
  • Traction

4

 

 

What is involved in open reduction?

 

 

Surgical procedure where fracture is reduced 

5

 

 

When is open reduction considered for a fracture?

 

  • When anatomical reduction is required
  • Associated neurovascular damage

6

 

 

What is involved in closed manipulation?

 

 

Manipulation of closed fracture in ED or under GA

7

 

 

When is closed manipulation considered for managing a fracture?

 

 

Extra-articular fractures where adequate and ecceptable reduction can be achieved

8

 

 

When is traction used to manage a fracture?

 

 

Aid reduction, analgesia and in patients who are unsuitable for anaesthesia

9

 

 

When is external fixation used to retain a fracture?

 

  • Contaminated open wounds
  • Severe open fractures
  • Severe associated soft tissue injury

10

 

 

When is internal fixation used to retain a fracture?

 

  • Comminuted or displaced fractures
  • Intra-articular fractures
  • Bones not able to be reduced by other methods
  • Associated with joint incongruity

11

 

 

What are intramedullary methods of internal fixation?

 

  • Intramedullary nail 
  • K-wires

12

 

 

When would you consider using an intramedullary nail to retain a fracture?

 

 

Long bone fractures - femur/tibia/humerus

13

 

 

When are K-wires used for internal fixation?

 

 

Fracture fragments or for intramedullary fixation of small bones

14

 

 

What are different methods of extramedullary internal fixation methods?

 

 

Plates and screws

15

 

 

Why are plates and screws used for internal fixation?

 

  • Bridge comminuted fractures
  • Compress simple fractures around joints
  • Support areas of thin cortex
  • Secure tension side of fracture

16

 

 

What are different methods for retaining a fracture?

 

  • External fixations
  • Internal fixations
  • Conservative Immobilisation

17

 

 

What are examples of splint casts?

 

  • PLaster/fibre-glass backslab
  • Aluminium/wire/heat mouldable plastic splints

18

 

 

What is a splint?

 

 

Non-circumferential immobiliser

19

 

 

Why should you use a splint/backslab in an acute fracture?

 

 

Allow for swelling

20

 

 

What are examples of sustained traction?

 

  • Collar and cuff arm sling
  • Skinng traction
  • Traction splint
  • Skeletal traction

21

 

 

If you managed an acute fracture with a backslab/splint, what would you do in terms of follow up?

 

 

1 week post injury - full circumferential cast 

22

 

 

What are important aspects to consider for long-term management and rehabilitation?

 

  • Physio
  • Weight bearing status 
  • Smoking status
  • Analgesia
  • Antibiotic prophylaxis
  • VTE prophylaxis
  • Cause of fracture

23

 

 

What are immediate complications that can occur due to a fracture?

 

  • Haemorrhage
  • Arterial damage
  • Surrounding structure damage
  • Fat embolus

24

 

 

What are early (within a few weeks) complications of a fracture?

 

  • Wound/prosthesis infection
  • Loss if position/fixation
  • VTE
  • Chest infection
  • Compartment syndrome

25

 

 

What are late complications (months-years) of fracture?

 

  • Malunion
  • Non-union
  • Delayed union
  • Osteoarthritis
  • Avascular necrosis

26

 

 

What are features of compartment syndrome?

 

  • Pain out of proportion with the injury
  • Exacerbated by passive stretching of the limb
  • Consider 6 P's

27

 

 

How long does it take for callus to form?

 

 

6 weeks - remove temporary fixations at this point

28

 

 

How long does it take for full fracture healing?

 

 

12 weeks

29

 

 

When are repeat X-ray performed?

 

  • Post op
  • After cast application

30

 

 

What fractures are at risk of avascular necrosis?

 

  • Head of femur
  • Scaphoid waist
  • Neck of talus

31

 

 

How would you manage a clavicular fracture?

 

 

Broad arm sling or polysling

32

 

 

How would you manage a proximal humerus fracture?

 

 

Collar and cuff sling

33

 

 

How would you manage a distal humerus fracture?

 

 

Above elbow backslab/cast

34

 

 

How would you manage a mid-humerus fracture?

 

 

Collar and cuff sling and U-slab cast, or functional brace

35

 

 

How would you manage a colles fracture?

 

  • Closed manipulation under haematoma block
  • Colles backslab/cast

36

 

 

What is a colles backslab/cast?

 

 

Below elbow cast/backslab with wrist flexed and ulnar deviated

37

 

 

How would you manage a scaphoid fracture?

 

  • Futuro splint +/- thumb extension
  • Thumb spica/splint if definitive

38

 

 

How would you manage a displaced intracapsular NOF fracture in someone over the age of 60?

 

 

THR or hemiarthroplasty

39

 

 

How would you manage a displaced/undisplaced intracapsular fracture in someone < 60?

 

 

Cannulated screws

40

 

 

How would you manage an intertrachanteric extracapsular NOF fracture?

 

 

Dynamic hip screw/gamma nai

41

 

 

How would you manage a subtrochanteric extracapsular NOF fracture?

 

 

Intramedullary nail

41

 

 

How would you manage a femur/tibial fracture?

 

 

Intramedullary nail

42

 

 

How would you manage a lateral malleolar fracture?

 

 

Below knee backslab/cast or aircast boot or stirrup brace 

43

 

 

How would you manage a bumalleolar/trimalleolar/lateral malleolar fracture which disrupts the syndesmosis?

 

 

Surgical fixation

44

 

 

What analgesia whould you avoid in fracture management?

 

 

NSAIDs - interfere with bone healing