Management of Specific Fractures Flashcards

Question

What are the ideal conditions for fracture healing? How long does fracture healing take?

Answer 1

Minimal fracture gap No movement if direct bone healing or some movement if indirect bone healing Patient physiological state - nutrients, growth factors, age, diabetic, smoker

Answer 2

Pre-defined time-frame expectations e.g. most fractures heal ~6months Pump up those with nutrients before procedures Increased risks = diabetes, smoking Children (pardiatric patients) heal 2x quicker than adults - follow-ups planned accordingly (like 1 week later, to ensure you target the window of opportunity to align a future displacement) Lower limb fractures taking twice as long as upper limb fractures to heal

Answer 3

Bone, i.e. outside their fracture state, remodels based on external stimuli (forces placed upon the bone) So in a child, the femur will heal bent due to body weight - remodelling occurs due to axial loading Periosteum on the concave side will make more bone while on the convex side, bone will be resorbed

Answer 4

Non-union = failure of bone to heal within an expected time frame: - May be due to atrophy (usually result of physiological problems e.g. smoking, diabetes, malnutrition) = healing completely stopped with no Xray changes OR - Hypertrophic = too much movement causing callus healing = too much callus formed (on the sides of the bone called elephant foot) = does not unite to form a hard callus Malunion = bone healing occurs but outside of the normal parameters of alignment - so bone healing is taking place in the wrong place Names of different fracture healing complications include: malunion, atrophic non-union, hypertrophic non-union (horse hoof), hypertropic non-union (elephant foot), pseudoarthrosis

Answer 5

Resuscitate = save the patient's life, then worry about the fracture Reduce = bring bone back together in an acceptable alignment so soft tissue is no longer being violated by jagged edge of broken bone = reduced pain and also prevents further blood loss Rest = hold the fracture in position to prevent distortion or movement how fracture in great / acceptable position to prevent distortion or movement Rehabilitate - get function back and avoid stiffness - prevent muscle atrophy during the time frame of bone healing = physiotherapy v. important

Answer 6

Functional limitations = depending on where the injury is, cannot walk, cannot use an arm, etc. Support needs = transport, catheters, daily needs from limitations VTE (venous thromboembolism) prophylaxis Required wider MDT support

Answer 7

PRICE - protect, rest, ice, compress, elevate Non-operatively use circumferential, plaster or fibreglass casts If an area cannot be cast - use a splint Or use traction = important in long bones e.g. femur, humerus = sticky thing attached onto limb and weights attached to end hanging off = gravititation weight too - realigns the fracture

Answer 8

Swelling - acute injuries tend to swell Pushes against structures within body - blood flow can be compromised Leads to compartmental syndrome

Answer 9

MUA + K-wire = reduces with patient under anaesthesia = useful in children due to thick periosteums preventing fracture aligment from holding in place (displacement common) ORIF = Open Reduction Internal Fixation IM nail = intramedullary nails = useful for long bone fractures - insufficient soft tissue coverage for extramedullary methods but can be very dangerous since you can disrupt the physiology of a patient External fixation = - Mono/biplanar = sits within one or two planes = goes in from outside the skin - apply rods on the outside and build a construct that allows for stability of the fracture pattern = used often in open fractures where there is poor soft tissue coverage OR - Multiplanar = ring fixation = when other methods have failed and patient is non-compliant with intramedullary methods = use of computer tomography to say where to place the pins = multiplanar construct thats more stable

Answer 10

History and examination - tenderness / limb / pain / swelling Obtain x-ray of affected region, ensure in at least 2 different planes

Answer 11

``` Projection = at least 2 views / planes Patient details Technical adequacy Obvious abnormality Systematic review of X-ray Summarise ```

Answer 12

NHS number | 2 people may have the same name