Trauma fractures Flashcards
4 common sights for internal blood loss?
abdomen
chest
pelvis
long bones
what is the biggest risk in open fractures
bone infection leading to osteomyelitis
1st thing to do to an open fracture is?
photographed then irrigated
what should an open fracture be dressed with?
saline soaked swabs
what prophylaxis should be given to an open fracture?
Abx + tetanus
what is performed in theatre on an open fracture wound?
aggressive debridement
how is an open fracture stabilised?
external/internal fixation
what is a fracture defined as?
loss of continuity of the cortex of the bone
simple fracture is
bone fractured in 2 pieces
segmental fracture is
a fracture at 2 levels in the same bone
undisplaced fracture is
fractured bone with its anatomy entirely unchanged
comminuted fracture is
bone in 3 or more pieces
name 5 causes of pathological fractures
- multiple myeloma
- bone tumours
- metabolic bone diease
- infection
- RA
when should you CT a fracture?
- complex fractures
- planning surgery
what is compartment syndrome?
excessive pressure in a closed fascial muscle compartment
what are the early clinical signs of compartment syndrome?
patient complains of excessive pain that is not responding to analgesia, and severe pain on passive stretch of the muscles involved
what happens to the muscles in compartment syndrome?
necrosis
how to manage compartment syndrome (3)?
- Release any dressings/casts which may be causing external compression
- position the limb level to the heart
- Contact a senior doctor for an emergency fasciotomy
what is the post operative management following emergency fasciotomy to manage compartment syndrome?
physiotherapy + occupational therapist review
wound requires re dressing
monitoring in the community by the local district nursing team
what are the late clinical signs of compartment syndrome?
paraesthesia
pulselessness
name 2 complications of fractures?
- Delayed union
- Compartment syndrome
what is delayed union defined by?
failure to reach bony union at 6 months post injury
what is compartment syndrome?
when the pressure within the fascial compartment exceeds the perfusion pressure within the compartment causing ischaemia of the tissues within the compartment
3 features of a fracture/injury that should make you consider compartment syndrome
- does not respond to analgesia
- associated with skin mottling
- severe pain on passive stretch
