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Sports and Exercise Medicine iBSc > Fracture Management > Flashcards

Fracture Management Flashcards

1
Q

What fractures common in contact sports

A

Head and neck injuries

Fractures in C spine- can have bleed in brain

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2
Q

Vital signs and levels of consciousness for ATLS Prehospital assessment- Step 1

A

Glasgow Coma Scale score <13 (or equal)
Systolic BP <90mmHg
Resp Rate <10 or 29 breaths/min (<20 in infants <1 year)

any of these yes –> trauma centre

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3
Q

ATLS Prehosp assessment Step 2 if vitals okay

A

If any of these yes, take to trauma centre:

  • penetrating injuries to head, neck, torso and extremities proximal to elbow + knee
  • Chest wall instability or deformity e.g. flail chest
  • Two or more proximal long bone fractures
  • Crushed, degloved, mangled, or pulseless extremity
  • Amputation proximal to wrist or ankle
  • Pelvic fractures
  • Open or depressed skull fracture
  • Paralysis
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4
Q

Flail chest

A

Multiple ribs broken together and they can move independently of rest of torso- don’t ventilate effectively

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5
Q

ATLS Prehosp assessment if Step 2 okay

A

If any of these, trauma centre:

  • Falls- adults >20 feet/6m, children >10 feet/3m
  • High risk motor vehicle crash
  • Auto vs pedestrian/bicyclist thrown, run over, or with significant impact
  • motorcycle crash
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6
Q

ATLS Prehosp assessment special patient considerations

A

If any below, trauma centre:

  • Older adults- risk injury/death increases after 55
  • Children
  • Anticoagulant use and bleeding disorders
  • Burns
  • Pregnancy >20 weeks
  • EMS provider judgement
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7
Q

20% of patients that have calcaneal fracture have an associated…

A

Fracture in spine

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8
Q

Fall over 6 metres

A

Take to trauma centre regardless of anything

Likely to be damage you can’t see

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9
Q

ATLS Principles- Airway and C spine

A

Make sure C spine isn’t broken- if it is and you move can cause transection of spinal cord
–> immobilise C spine first
Is patient maintaining own airway?
Gumshield? Broken teeth?

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10
Q

ATLS- Breathing

A

Respiratory rate

Equal chest expansion

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11
Q

ATLS- Circulation

A

Signs for shock
Pulse
BP

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12
Q

ATLS- Disability

A

GCS

Pupils

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13
Q

ATLS- Exposure

A

Look for long bone deformity

Any obvious bleeding

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14
Q

Immobilisation of Upper limb

A 
Broad arm Sling
Collar and cuff
Humeral brace
Back slab
Splints
Vertura Splint
Mallett Splint
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15
Q

Broad arm sling UL

A

offloads all upper limb so arm doesn’t pull down- good for any collar bone or AC joint injuries, or forearm if heavy if its in a cast

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16
Q

Collar and cuff UL

A

sling wrapped around neck and wrist- weight of arm pulls down and pulls fractures of humerus down and outs into place

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17
Q

Humeral brace UL

A

humeral shaft fractures- keeps everything lined up

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18
Q

Back slab UL

A

half of a plaster – supports joint- not full plaster as allows for inflammation and growth of injury so as to not cut off blood supply

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19
Q

Zimmer splint UL

A 
Keeps finger in safe position
o	Posi (position of safe immobilisation) or Edinburgh position= wrist extended to 45 degrees, carpa-metacarpal joints at 90 degrees, interphalangeal joint neutral (0 degrees)- at this position collateral ligaments are under maximum tension, are taught- important as means doesn’t go stiff
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20
Q

Stiffness

A

One of most difficult things to treat
Apart from hand, elbow joint one of most notorious for getting stiff
Don’t want to keep someone with elbow at 90 degrees for more than you have to as otherwise will never straighten arm again

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21
Q

Vertura splint UL

A

Wrist comfy

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22
Q

Mallett splint UL

A

mallett injury is where FDP tendon can take small tuft of bone with it- so this keeps it back up in right position

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23
Q

Immobilisation Lower limb

A 
Box splint
Cricket pad splint
Kendrick splint
Backslab
Boots/shoe
Heal bearing shoe
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24
Q

Box splint LL

A

Stable lower limb splint

Keeps everything together in right position

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25
Cricket pad splint LL
Keep knee in extension | Good for patella
26
Kendrick splint LL
Traction splint Important if have fracture of long bones in leg and want to keep them under tense and traction Helps stop bleeding Can lose 4L of blood in femur
27
Greater trochanter
Insertion for gluteus medius
28
Weber A ankle injury
Fibular fracture below level of syndosmosis | Combination of ligaments and intra-osseus membrane that keeps tibia and fibula together
29
Heal bearing shoe
Keeps foot flat throughout gait cycle | During toe off foot will extend in the middle and puts pressure on metatarsals --> this will stop this from happening
30
Bone Healing pathways
Primary and Secondary pathways | Which pathway used depends on stability of fracture site and location
31
Strain
The percentage of change in length of the material in relation to original length Change in length/original length
32
Stress
Force per unit area
33
Sheer stress
On joint surfaces, opposing directions to each other
34
Tensile stress
Pull stuff away
35
Compressive stress
Push
36
Yield strength
The lowest stress that produces a permanent deformation in a material
37
Stability
Ability to maintain its original configuration
38
Bone Healing strain
<2% change in bone length= Primary 2-10%= Secondary >10%= Won't heal
39
Osteoclasts
Bone cells that break down bone tissue
40
Osteoblasts
Bone cells that create new bone tissue
41
Cutting cone
Bone remodelling unit At the front is osteoclasts, behind it is osteoblasts laying down layers of bone In middle, Haversian canal
42
Cortical bone
On outside Thick and compact Up and down stress
43
Travecular bone
Centre | Withstands stress in different irections
44
Osteonal Remodelling
Primary bone healing Gap at fracture site must be less than 1mm Process of fully formed osteons bridging a fracture gap may take months <2% strain- has to be absolutely stable with almost no movement at fracture site
45
Secondary bone healing
1. Haematoma formation 2. Fibrocartilaginous callus formation 3. Bony callus formation 4. Bone remodelling
46
2dary bone healing- Step 1
Fracture leads to haematoma formation at fracture site | Up to 1 week from injury
47
2dary bone healing- Step 2
1 week to 1 month after injury Strain/movement at the fracture site stimulates multipotent cells in the periosteum to differentiate into osteoprogenitor cells which produce bone without first forming cartilage (external callus) Bridging callus forms fibrocartilage which become calcified and is then replaced by bone
48
2dary bone healing- Step 3
1-4 months Soft calcified chondral callus becomes hard mineralized osteoid callus At this point, fracture is united, solid and pain free
49
Primary bone healing overall
``` No callus Absolute stability No movement Biological process- osteoid cutting cone/haversion Gap <1mm Strain <2% ```
50
Secondary bone healing overall
``` Inflammation phase --> soft callus --> hard callus --> bone remodelling Biological process- callus formation Gap >1mm Strain 2-10% Relative stability required ```
51
Fracture fixation Aim
Restoring function Normal function- normal ROM, pain free, stable Restoring anatomy Reduction (length, rotation, angulation)
52
What happens if don't fix fracture
Malunion/deformity | Post traumatic arthritis
53
Intra-articular fractures
Requires absolute stability Aim is to restore joint anatomy to restore function Do not want callus formation/post traumatic arthritis (pain free) Usually fixed with plates and screws
54
Extra-articular fractures
Requires relative stability Callus formation will not affect functional outcome Any modality that will maintain reduction
55
Plate fixation
Can use plate to bridge fracture, to stop rotation
56
Intramedullary nailing
Don't need to open all up- just top | Important to respect soft tissue envelope- e.g. don't disrupt blood supply
57
Screw fixation
Use screw to get absolute stability as can compress fracture | Screw converts rotation force into longitudinal force
58
External fixator
When soft tissue too inflamed to operate yet
59
K wire fixation
Wire stays until bone heals
60
Absolute stability methods
Aim- primary bone healing Plate and screw fixation Screw fixation alone
61
Relative stability methods
``` Aim- secondary bone healing Intramedullary nail K wire fixation Plaster Sling External fixator Plate fixation ```
62
Risk of treating a fracture
``` Pain Infection Bleeding Damage to nerves, tendons, blood vessels, fracture of bones Non-union Mal union Failure of metalwork Stiffness ```
63
Non-union
An arrest in the fracture repair process
64
Non-union types
 Septic (secondary to infection)  Hypertrophic (callus but not bridging)  Pseudoarthritis (new joint)  Atrophic (disruption to blood supply)
65
Collar bones and non-union
o 15% of collar bone fractions go into non-union if conservative treatment done, if do surgery only 5% go into no-union
66
Failure of metalwork
Whole point is to hope biological process finishes and is done before the metalwork fails If non-union, metal ends up taking all of force and eventually fails

Sports and Exercise Medicine iBSc (13 decks)

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