Re-written by: Daniel Habashi General Principles Of Fractures Treatment

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

Individual Patient Obtain access (I’m guessing it’s 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

Examination Pulse Measure capillary filling Observe respiration Palpate the head, chest, abdomen and limbs

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

Primary Survey A- Airway maintenance B- Breathing and oxygenation C- Circulation and control of bleeding D – Disability E – Exposure and avoidance of hypothermia

Disability Glasgow Coma Scale (GCS)

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

Chest Injuries Tension Pneumothorax Sucking chest wounds Flail chest Cardiac Tamponade Massive haemothorax

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)

How Fractures Happen A single traumatic incident Repetitive stress Bla bla bla ;)

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)

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 that’s something we don’t really have to know cuz he’s not really going into too much detail bout them

Principles Of Treatment Anatomical reduction Stable internal fixation Preservation of blood supply Early mobilization

Implant types Pin and wire fixation Screw fixation Plate and screw fixation Intramedullary And 1 more type...

Fracture healing Primary Secondary Haematoma Inflammation Callus A kind of bone that forms from a haematoma(? That’s what he said ) Consolidation Remodelling

Open fractures - Classification TypeWound Size Grade 1<1cm inside cut Grade 2>1 cm Grade 3>1cm extensive soft tissue swelling Grade 3A>1cm adequate bone covering Grade 3B>1cm periosteal stripping, contamination Grade 3CRequires vascular repair

Open fractures Wound debridement Antibiotic prophylaxis Stabilization of the fracture Early wound covering

Complications Of fractures Early: Visceral injury Vascular injury Nerve injury Compartment syndrome Haemarthrosis Infection Gas gangrene Fracture blisters Plast and pressure sores

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

Compartment Syndrome Pain Paraesethesia Pallor Paralysis Pulslessnes

Volkmann’s 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