Re-written by: Daniel Habashi General Principles Of Fractures
Treatment
Slide 2
Management of major injuries Emergency treatment at the scene
of the accident and during transport to the hospital Resuscitation
and the evaluation in the accident department Early treatment of
visceral injuries and cardio-respiratory complications Provisional
fixation followed by definitive treatment of musculoskeletal
injuries Long term rehabilitation
Slide 3
Individual Patient Obtain access (Im guessing its IV) Establish
an airway but protect the cervical spine Ensure ventilation Arrest
haemorrhage and combat shock Give analgesia (morphing, but Fentanyl
is faster and better) Splint fractures Transport
Slide 4
Examination Pulse Measure capillary filling Observe respiration
Palpate the head, chest, abdomen and limbs
Slide 5
Secondary Morality Peak Death from hypoxia or hypovolemic shock
At risk for further damage to cervical spine, thoracolumbar, brain
The Golden Rule (effective Resuscitation) Advanced Trauma Life
Support Programme
Slide 6
Primary Survey A- Airway maintenance B- Breathing and
oxygenation C- Circulation and control of bleeding D Disability E
Exposure and avoidance of hypothermia
Slide 7
Disability Glasgow Coma Scale (GCS)
Slide 8
Blood Loss 1-4 unites from humerus 2-4 Costal and surrounding
region 2-6 from pelvic fractures 2-4 Femoral 2-4 Tibial and that
region
Complications Of Major Trauma Tetanus ARDS Fat embolism
syndrome DIC (disseminated intravascular coagulation) Crush
syndrome (release of enzymes from muscles leading to Renal Failure)
MSOF prevention (Multi System Organ Failure)
Slide 11
How Fractures Happen A single traumatic incident Repetitive
stress Bla bla bla ;)
Slide 12
Mechanism Of Injury Spiral twisting Short oblique Bending
Triangular butterfly fragment Transverse *** some pictures of how
those mechanisms work, but I guess the most interesting is the
butterfly fragment that looks like a horizontally flipped Y shaped
fracture)
Slide 13
The weakest part of the bone is during torsion (forces are in
twisting opposite directions) More and more pictures of how the
fractures are divided, and then further divided and I believe thats
something we dont really have to know cuz hes not really going into
too much detail bout them
Slide 14
Principles Of Treatment Anatomical reduction Stable internal
fixation Preservation of blood supply Early mobilization
Slide 15
Implant types Pin and wire fixation Screw fixation Plate and
screw fixation Intramedullary And 1 more type...
Slide 16
Fracture healing Primary Secondary Haematoma Inflammation
Callus A kind of bone that forms from a haematoma(? Thats what he
said ) Consolidation Remodelling
Slide 17
Open fractures - Classification TypeWound Size Grade 11 cm
Grade 3>1cm extensive soft tissue swelling Grade 3A>1cm
adequate bone covering Grade 3B>1cm periosteal stripping,
contamination Grade 3CRequires vascular repair
Slide 18
Open fractures Wound debridement Antibiotic prophylaxis
Stabilization of the fracture Early wound covering
Slide 19
Complications Of fractures Early: Visceral injury Vascular
injury Nerve injury Compartment syndrome Haemarthrosis Infection
Gas gangrene Fracture blisters Plast and pressure sores
Slide 20
Complications Of Fractures Late: Delayed union Non-union
Avascular necrosis Bed sores Myositis ossificans Tendon lesion
Nerve compression Muscles contracture Joint instability Join
stiffness Algodystrophy RSD osteoarthritis
Volkmanns Ischemia One of the complications of compartment
syndrome Death of the muscle Arterial damage ischemia oedema (or
direct injury leading to that) increased compartment pressure
reduced blood flow and fasciotomy which leads to painful, pale,
pulseless and paraesthetic limb