State the three principles of Fracture Management
Reduce
Hold
Rehabilitate
What is Reduction?
Restoring the anatomical alignment of a fracture/dislocation
Normally done in a closed setting but may be open
Generally requires three people (one to reduce, one to provide countertraction, one to apply plaster)
What is ‘Hold’
Term for immobilising a fracture
When might traction be required with the ‘Hold’ principle
If muscular pull is particularly strong it may naturally displace the fracture
Commonly required for #NOF, Pelvic and Femoral Fractures
Give two principles of Splints/Plasters
- For the first two weeks the plaster is not circumferential (allows for swelling and prevents compartment syndrome)
- If axial instability then the plaster needs to cross the joint above and below
What is Rehabilitation?
Intensive phsiotherapy required by most patients
What are the X-Ray features of OA?
L - Loss of joint space
O - Osteophytes
S - Subchondral Cysts
S - Subchondral Sclerosis
How do intra-articular steroids work for OA?
Typically mixed with local anaesthetic which improves symptoms for a few hours
Will subsequently have a steroid flare which will worsen symptoms for a few days
Describe three surgical managements of OA
Osteotomy - Bone is cut to change its alignment
Arthrodesis - Fusing the joint to prevent movement and pain
Arthroplasty - Replacement or reconstruction of a joint
What is an Open Fracture?
When there is a direct communication between the fracture and the external environment
(Usually through the skin, pelvic ones may be through vagina/rectum)
State the two types of Open Fractures
In to Out - Broken bone has punctured and broken through the skin
Out to In - Penetrating injury also caused fracture
What is the Gustilo-Anderson classification of Open Fractures?
1 - less than 1cm wound and clean
2 - 1 to 10cm wound and clean
3a - Greater than 10cm wound and high energy
3b - Greater than 10cm wound and high energy, with significant tissue loss
3c - All injuries with vascular injury
Give 4 principles of management of Open Fractures
- Involve the correct specialty (3a is Orthopaedics only, 3b involve plastics, 3c involve vascular)
- Realignment and resplinting
- Broad spectrum Abx and Tetanus
- Photograph and dress wound
What is Compartment Syndrome?
Critical pressure increase in a non distensible fascial compartment
Causes include: High energy trauma/Crush Injury/DVT/Tight Casts
Describe three features of Compartment Syndrome pathophysiology
- As pressure increases, veins compress increasing hydrostatic pressure, forcing fluid out further increasing pressure
- Paraesthesia as traversing nerves are compressed
- Ischaemia is Pressure is greater than diastolic
Give 4 clinical features of Compartment Syndrome
- Paraesthesia
- Severe Pain (Disproportionate to injury)
- Affected area may feel tense
- Arterial insufficiency stage - 6P’s
Compartment Syndrome is typically a clinical diagnosis, but suggest two possible investigations
- Upward trending CK levels
- Intracompartmental pressure monitor
Give 3 principles of management for Compartment Syndrome
- Pre Op (High Flow O2, IV Crystalloid Fluids, IV Opioid Analgesia)
- Fasciotomy
- Monitor Renal Function (Rhabdomyolysis, Reperfusion Syndrome)
Define Septic Arthritis
Infection of a joint (can be prosthetic or natural)
Can cause irreversible damage to articular cartilage leading to severe OA
Describe the three modes of infection in Septic Arthritis
Bacteraemia (UTI, Pneumonia)
Direct Inoculation
Spreading from adjacent Osteomyelitis
Give 4 causative organisms of Septic Arthritis
S.Aureus
Streptococci
N.Gonorrhoea
Salmonella
State four risk factors of Septic Arthritis
Age>80
DM
IVDU
Joint Prosthesis
How would Septic Arthritis present?
- 60% have fever
- Single swollen joint causing severe pain
- Often joint is rigid and patient is unable to weight bear
Give four investigations for Septic Arthritis
- Routine Bloods
- Blood Cultures (atleast 2 different samples)
- Joint Aspiration PRE Abx
- XRay
