Orthopaedics - General Traumatology (Ny!)

Front 1

Conservative treatment is based:
- on fracture reduction, fixation and retention
- after fixation removal subsequent physiotherapy to restore function
- fixation in a plaster cast
- analgesics to relieve pain, application of ice

Back 1

Conservative treatment is based:
- on fracture reduction, fixation and retention+
- after fixation removal subsequent physiotherapy to restore function+

Front 2

Conservative treatment of fractures is characterized by:
- indirect (secondary) healing with callus formation
- is indicated for the majority of pediatric fractures
- longer period of treatment, due to the plaster fixation
- cannot carry out physiotherapy

Back 2

Conservative treatment of fractures is characterized by:
- indirect (secondary) healing with callus formation+
- is indicated for the majority of pediatric fractures+

Front 3

For primary direct healing of fractures is typical:
- non forming of the periosteal and endosteal callus
- occurs after perfect anatomical reduction and stable internal fixation
- must be ensured by plaster of Paris
- does not occur in older patients

Back 3

For primary direct healing of fractures is typical:
- non forming of the periosteal and endosteal callus+
- occurs after perfect anatomical reduction and stable internal fixation+

Front 4

Typical advantages of the conservative method of treatment are:
- possibility of adequate therapy if contraindication of surgery for medical reasons
- non-interference in internal environment of the body
- occurrence of fewer complications
- less painful treatment for the patient

Back 4

Typical advantages of the conservative method of treatment are:
- possibility of adequate therapy if contraindication of surgery for medical reasons+
- non-interference in internal environment of the body+

Front 5

Typical disadvantages of the conservative method of treatment are:
- tendency toward frequent displacement of some fractures
- discomfort of patients due plaster or other fixation
- cannot be used for active patients middle-aged
- higher incidence of long lasting effects after fractures

Back 5

Typical disadvantages of the conservative method of treatment are:
- tendency toward frequent displacement of some fractures+
- discomfort of patients due plaster or other fixation+

Front 6

Among the most serious complications of conservative therapy include:
- compartment syndrome, Volkmann's ischemic contracture, plaster sores
- deep venous thrombosis (DVT), pulmonary embolism PE
- weight of plaster
- injuries of visceral organs

Back 6

Among the most serious complications of conservative therapy include:
- compartment syndrome, Volkmann's ischemic contracture, plaster sores+
- deep venous thrombosis (DVT), pulmonary embolism PE+

Front 7

Prevention of venous thromboembolism is performed:
- of all hospitalized patients in bed
- patients with plaster fixation of the lower limbs
- only of patients with a history of PE or DVT
- only of patients with diabetes

Back 7

Prevention of venous thromboembolism is performed:
- of all hospitalized patients in bed+
- patients with plaster fixation of the lower limbs+

Front 8

The essence of treatment with the skeletal traction consists in:
- achieving gradual reduction of fracture by continuous traction
- long-term traction serves also to retention of reduced fracture (up to bone union)
- traction improves blood circulation in the limb fracture
- long-term bed rest

Back 8

The essence of treatment with the skeletal traction consists in:
- achieving gradual reduction of fracture by continuous traction+
- long-term traction serves also to retention of reduced fracture (up to bone union)+

Front 9

Absolute indications for surgical treatment are:
- fractures with neuro-vascular injury
- open fractures grade II. and grade III. (Gustilo-Anderson)
- unstable fractures and significantly displaced fractures
- all fractures of polytraumatised patients

Back 9

Absolute indications for surgical treatment are:
- fractures with neuro-vascular injury+
- open fractures grade II. and grade III. (Gustilo-Anderson)+

Front 10

Surgical treatment of fractures is characterized by:
- anatomical reduction and gentle surgical technique
- stable fixation and early, active mobilization
- direct access to the injured bones through muscles
- use the maximum amount of osteosynthesis material to achieve stability

Back 10

Surgical treatment of fractures is characterized by:
- anatomical reduction and gentle surgical technique+
- stable fixation and early, active mobilization+

Front 11

Treatment of infection after internal fixation of fracture consists in:
- radical surgical revision (debridement), conversion to external fixation
- lavage and targeted systemic administration of antibiotics
- oral antibiotics, local wound care
- ensuring position in plaster, analgesics and antibiotics

Back 11

Treatment of infection after internal fixation of fracture consists in:
- radical surgical revision (debridement), conversion to external fixation+
- lavage and targeted systemic administration of antibiotics+

Front 12

Nonunion (pseudoarthrosis) is characterized by:
- occurring as typical complication only after conservative treatment
- occurrence in both conservative and surgical treatment, classify non-union of bone after 6 months treatment of fracture
- distinguish nonunion into hypervascular (vital) and avascular (avital) type (mechanical or biological problem)
- standard treatment algorithm is: blockade of sympathetic, pharmacotherapy (Protazin, Plegomazin, Secatoxin, calcitonin, calcium), followed by hydrotherapy

Back 12

Nonunion (pseudoarthrosis) is characterized by:
- occurrence in both conservative and surgical treatment, classify non-union of bone after 6 months treatment of fracture+
- distinguish nonunion into hypervascular (vital) and avascular (avital) type (mechanical or biological problem)+

Front 13

The main clinical symptoms of compartment syndrome are:
- severe pain in the affected area, out of proportion with the injury and no response to analgesics (opioids)
- increased pressure in the leg (greater than 30-40 mm Hg)
- peripheral edema (fingers), color changes and limited mobility, then whole limb edema
- no palpable pulsating arteries, impaired motor function

Back 13

The main clinical symptoms of compartment syndrome are:
- severe pain in the affected area, out of proportion with the injury and no response to analgesics (opioids)+
- increased pressure in the leg (greater than 30-40 mm Hg)+

Front 14

Compartment syndrome is:
- set of symptoms, resulting from increased pressure in a closed anatomical space (compartment, loge), leading to local ischemia
- increase the pressure above 30–40 mmHg in the space defined by the skeleton and muscles or intermuscular septa
- long-term compression of muscles, then accumulation of myoglobin in the kidney can cause renal failure
- primary nerve injury (failure occurs after injury and not changed in time)

Back 14

Compartment syndrome is:
- set of symptoms, resulting from increased pressure in a closed anatomical space (compartment, loge), leading to local ischemia+
- increase the pressure above 30–40 mmHg in the space defined by the skeleton and muscles or intermuscular septa+

Front 15

Pathophysiology of compartment syndrome:
- is an increase of pressure in the compartment (bleeding, inflammation, burns)
- reduction in the compartment's volume (tight bandage, plaster incorrect fixation, scarring of the skin)
- is caused by a failure of the arterial supply and venous collapse
- increased pressure must last at least 48 hours to cause damage

Back 15

Pathophysiology of compartment syndrome:
- is an increase of pressure in the compartment (bleeding, inflammation, burns)+
- reduction in the compartment's volume (tight bandage, plaster incorrect fixation, scarring of the skin)+

Front 16

Determine the diagnosis of compartment syndrome:
- is a clinical diagnosis, taken from history of patient and clinical symptoms
- additional investigations: oximetry, measurement pressure in compartment
- is present tight bandage or plaster and peripheral edema
- no palpable pulse in the peripheral arteries

Back 16

Determine the diagnosis of compartment syndrome:
- is a clinical diagnosis, taken from history of patient and clinical symptoms+
- additional investigations: oximetry, measurement pressure in compartment+

Front 17

Treatment of compartment syndrome is based on:
- reduction of tissue pressure before irreversible ischemic changes (up to 6 hours)
- removing causes of compartment syndrome: removal of plaster, the timely implementation of fasciotomy
- pharmacotherapy (anti-edematous therapy, enzyme therapy, vasodilators, analgesics)
- positioning of limbs in a raised position above the level of the heart to control the soft tissue

Back 17

Treatment of compartment syndrome is based on:
- reduction of tissue pressure before irreversible ischemic changes (up to 6 hours)+
- removing causes of compartment syndrome: removal of plaster, the timely implementation of fasciotomy+

Front 18

Fasciotomy is indicated if:
- present clinical signs, pressure in compartment more then 30–40 mmHg (for children more than 30 mmHg)
- suspicion of compartment syndrome and primary fracture treatment can be carried out with preventive fasciotomy
- operative treatment of fracture is indicated
- occurs primary injury of nerve and acute arterial occlusion

Back 18

Fasciotomy is indicated if:
- present clinical signs, pressure in compartment more then 30–40 mmHg (for children more than 30 mmHg)+
- suspicion of compartment syndrome and primary fracture treatment can be carried out with preventive fasciotomy+

Front 19

Typical example of Sudeck syndrome (Complex regional pain syndrome) is:
- disability of upper limb after insignificant soft tissue trauma
- fracture in the forearm after the removal of "tight" plaster
- after common ankle fracture, treatment with walking cast
- after treatment of fracture of the femoral neck with skeletal traction

Back 19

Typical example of Sudeck syndrome (Complex regional pain syndrome) is:
- disability of upper limb after insignificant soft tissue trauma+
- fracture in the forearm after the removal of "tight" plaster+

Front 20

Complex regional pain syndrome (CRPS), formerly Sudeck's atrophy we divide into:
- acute phase (reduced sympathetic activity), dystrophic phase (increased sympathetic activity), atrophic stage (irreversible)
- CRPS type I (reflex sympathetic dystrophy) and CRPS type II (causalgia)
- acute (to 6 months) and chronic
- juvenile and adult form

Back 20

Complex regional pain syndrome (CRPS), formerly Sudeck's atrophy we divide into:
- acute phase (reduced sympathetic activity), dystrophic phase (increased sympathetic activity), atrophic stage (irreversible)+
- CRPS type I (reflex sympathetic dystrophy) and CRPS type II (causalgia)+