intro Flashcards
(23 cards)
how is a fracture defined
when the contiuity of a bone is disrupted due to excessive force , congenital, or overuse
what is the rule of two in xray
liv just twice
2 limbs
2 views
2 joints
2 times
2 injuries
how to read an xray of a fracture
state that its a plain xray
AP/ lateral view
which limb
left or right
which part of limb? proximal distal shaft
type of fracture? segmental , transverse, oblique, comminuted
displacement – comment on the distal part ( medial , lateral , post , or ant)
angulation- did distal segment cause an angle (varus, valgus)
length- shortening or distraction
what are local early signs of fracture complications
open fx
compartment syndrome
neuro injury
infection
implant failure
fx blisters
early systemic complications of fracture
sepsis
thromboembolic- dvt/PE
ARDS- due to fat emboli go thru lung
fat embolism
hemorrhagic shock
late fracture complications
mal or non union
avascular necrosis
osteomyelitis
heterotopic ossification
post traumatic arthritis
complex regional pain symdrome
major orthopedic emergencies
- open fx
- Compartment syndrome
- Septic arthritis
- Any joint dislocation
- Cauda equina syndrome
- Hemodynamic instability following a fx (especially pelvic fxs)
What is the general outline of fracture management?
- Analgesia & imaging
- Reduction: restoration of normal alignment of a fractured bone. Can be open (operative: you expose the bone) or closed (bone unexposed but can be under general anesthesia).
- Stabilization: can be operative via internal/external fixation or non-operative (cast, slap or brace).
- Rehabilitation
How is an open fracture defined?
It is a fx that communicates with the external environment (through skin) or with a body cavity (into the urethra, rectum or bladder); also termed compound fx.
how are open fx classified
thru Gustilo-Anderson classification:
Type I
• Wound <1 cm
• Clean, minimal contamination
• Simple fracture pattern (little comminution)
• Minimal soft tissue damage
Type II
• Wound >1 cm but <10 cm
• Moderate soft tissue damage
• Moderate contamination
• No extensive crushing
Type III (High-energy injuries with extensive damage)
• III A:
• Wound >10 cm, but with adequate soft tissue coverage
• Severe soft tissue injury, but can be closed primarily
• III B:
• Extensive soft tissue loss requiring flap coverage
• Periosteal stripping (bone exposure)
• III C:
• Arterial injury requiring vascular repair
• Limb at risk of amputation
• Often requires complex reconstruction
what do you give for open fx treatment
Antibiotics are administered to patients with open fxs to prevent osteomyelitis, mainly caused by Staphylococcus aureus.
In case of farm/soil contamination, a penicillin is added to protect against Clostridium infection.
what is considered grade 3 regardless of wound size and extent of soft tissue injury
Any shotgun injury, comminuted fx, fx with farmyard/soil/water contamination, exposure to oral flora or fx duration > 8 hrs qualify for grade III immediately
What are the emergency measures in the management of open fractures? in emergency room
- Conduct initial trauma survey to check for other serious injuries.
- If the patient is hemodynamically unstable, resuscitate and control bleeding as appropriate (initially, by direct pressure. Do not blindly clamp/place tourniquets)
- Initiate IV antibiotics as early as possible and for 72 hours (most importantstep).
- Check tetanus status +/- booster
- Provide analgesia m
- Assess soft tissue damage and conduct neurovascular exam.
- Remove gross debris and place sterile saline-soaked dressing on wound.
- Stabilize temporarily using a splint - ↓ pain, ↓ further damage by bony ends and ↓ clot disruption.
What are the emergency measures in the management of open fractures in operating room
- Aggressive debridement and saline irrigation.
- Stabilize with external fixation if needed.
- Keep patient NPO and prepare for OR if ORIF or skin grafting is needed
(take consent, blood workup, ECG, chest x-ray).
What is the purpose behind stabilizing a fracture?
- To prevent further soft tissue injury & maintain alignment.
- To allow mobilization of the involved limb for dressing changes and wound checks.
- To reduce pain.
what should be done before stabilizing a fracture?
reduction
What are the options available for reduction, and how are they performed?
▶ Closed reduction is done without direct exposure of bone (non-surgical) by applying traction on the long axis of bone and reversing the mechanism of injury under IV sedation or general anesthesia.
▶ Open reduction is performed surgically by direct manipulation of fractured bones.
When to choose open over closed reduction? Indications for open reduction internal fixation (ORIF) - NO CAST:
- non union
- open fx
- neuro compromise
- displaced intra articular fx
- salt harris 3,4,5
- poly truama
how can a fracture be stabilized
two ways non-operatively and operatively
non by cast/slap , splint, traction, brace
operatively by external and internal fixation
what are indications for external fixation
severe open fx (IIIB)
fx w severe contamination
infected non union
initial stabilization of soft tissue and bony disruption in poly trauma patient
pelvic fxs
unstable knee, elbow and ankle disloc
when is ORIF contraindicated
active infection or osteomyelitis
severe osteoporosis
severe comminution
severe soft tissue injury
non displaced fx
Using a splint is part of non-operative stabilization of fxs. How can they be beneficial?
- They reduce pain.
- Facilitate transport of patients with fxs.
- Allow soft tissue swelling and reduce risk of compartment syndrome.
- Reduce risk of converting closed fxs to open ones.
- Reduce further damage to skin and neurovascular structures.
Application of a traction can also be used to stabilize a fracture non-operatively. How do they work?
–Application of weight to the involved limb helps regain and maintain the anatomical alignment of fractured bones and decrease or prevent muscle spasms.
–Tractions are applied at a site distal to the fx; in a femoral diaphysial fx for example, the pins are inserted in the distal femur or proximal tibia.
