Open Fractures & Compartment Syndrome Flashcards Preview

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Flashcards in Open Fractures & Compartment Syndrome Deck (24):
1

What is meant by an open fracture?

Fracture with direct communication to the external environment

2

What are the immediate complications of fractures? (Minutes to hours)

Pain
Neurovascular, skin and muscle damage
Fat embolism
Visceral damage eg pneumothorax in rib fracture

3

What are the early complications of fractures? (Hours to days)

Compartment syndrome
Immobility
Wound infection
VTED

4

What are the late complications of fractures? (Weeks-months)

Stiffness
Complex regional pain syndrome
Malunion
Secondary OA
Chronic osteomyelitis

5

What is meant by compartment syndrome?

What are the possible causes?

Increase in the pressure within a myofascial compartment that exceeds capillary perfusion pressure resulting in muscle ischaemia

Fractures, crush injuries, tight casts or dressings, IVI extravasation, burns, bleeding disorders

6

What are the signs and symptoms of compartment syndrome?

What is the appropriate management?

Pain - out of proportion to injury due to muscle ischaemia - passive stretch test
Pins and needles
Peripheral pulses absent is a very late sign

Compartment pressure monitoring
Fasciotomy

7

How can we measure pressure changes in compartment syndrome?

Compartment pressure monitoring with a probe
More than 40mmHg is highly suggestive or a rise in pressure to within 20mmHg of their diastolic BP

8

What is meant by chronic compartment syndrome?

Chronic exertional syndrome often induced by exercise
Most commonly anterior compartment of the leg in athletes

Resting pressure greater than 15mmHg and greater than 30mmHg during exercise
The pressure is slow to decrease with resting after exercise

9

What is the initial management of an open fracture?

ABCDE assessment following ATLS guidelines - c-spine assessment. Asses neurovasculature supply
IV Abx within 3 hours of the injury and continue for 72 hours or until soft tissue coverage (IV co-amox) consider tetanus prophylaxis
Control bleeding
Dressing - photograph, remove gross contamination, impermeable film cover
Stabilise and reassess
To theatre in 24 hours

10

What are the indications for primary amputation?

4-6 hours of ischaemia
Uncontrollable bleeding
Loss of two muscle compartments
Bone loss more than 1/3 of the tibia

11

The Gustillo classification grades the severity of open fractures at the time of debridement. What is meant by Type 1?

Less than 1cm
Minimal soft tissue injury
Minimal wound contamination

12

The Gustillo classification grades the severity of open fractures at the time of debridement. What is meant by Type 2?

Wound greater than 1cm
Moderate soft tissue injury
Moderate wound contamination

13

The Gustillo classification grades the severity of open fractures at the time of debridement. What is meant by Type 3a?

Severe contamination *
Wound greater than 1cm
Adequate wound covering
No NV injury

14

The Gustillo classification grades the severity of open fractures at the time of debridement. What is meant by Type 3b?

Inadequate wound coverage
Severe contamination
No NV injury
Wound greater than 1cm

15

The Gustillo classification grades the severity of open fractures at the time of debridement. What is meant by Type 3c?

NV injury
Severe contamination
Inadequate wound cover
Wound greater than 1cm

16

What is meant by a greenstick fracture?

Incomplete fracture
Typically in immature bone
One side of the cortex is broken and the other side is only bent

17

What is meant by a torus/buckle fracture?

Axial loading on a long bone leads to a buckle and visible bulge in the cortex
Typically in immature bone

18

What is meant by a Salter Harris fracture?

What are the different types?

Fracture through the epiphyseal growth plate - there are nine types depending on the location of the fracture
Type 1 - transverse fracture through the growth plate
Type 2 - # through growth plate and metaphysis - most common
Type 3 - # through growth plate and epiphysis
Type 4 - # through growth plate, metaphysis and epiphysis
Type 5 - compression # at the growth plate
6-9 are really rare

19

What is the mangled extremity score?

Tool used to predict necessity of amputation after lower extremity trauma
Variables: age, shock, limb ischaemia, soft tissue injury
7 or more is highly predictive (bad)

20

What is meant by complex regional pain syndrome (CRPS)?

What are the two types?

Sustained sympathetic activity characterised by pain out of proportion to physical exam findings
Following trauma, cast immobilisation etc

Type 1 - CRPS without demonstrable nerve lesions, most common
Type 2 - CRPS with evidence of identifiable nerve damage

21

What are the cardinal signs of complex regional pain syndrome (CRPS)?

Exaggerated pain
Swelling
Stiffness
Skin discolouration

22

What are the management options in complex regional pain syndrome (CRPS)?

Non-op - first line:NSAIDs, gentle physiotherapy, vitamin C supplements in type 1
Nerve stimulation if symptoms present mainly in the distribution of one major nerve
Chemical sympathectomy
Op: surgical sympathectomy, surgical decompression

23

What are the complications of compartment syndrome?

AKI secondary to rhabdomyolysis
Volkmann's ischaemic contracture
In the feet (usually due to calcaneal #), the compartment syndrome can lead to clawing of the toes

24

How many compartments are there in the limbs?

Arm 2
Forearm 4
Thigh 3
Leg 4