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Intraoperative fracture — Clinical Guidelines

Overview

Intraoperative fracture refers to fractures that occur during surgical procedures, often due to improper handling, inadequate bone quality, or excessive force. These fractures can lead to complications affecting patient outcomes and surgical success 11.

Diagnosis

Clinical signs include sudden pain, patient distress, and visible deformity 11.

Radiographic imaging (X-ray, CT) is essential for confirmation 11.

Monitoring physiological parameters closely during surgery can help in early detection 12.

Management

Immediate surgical intervention to stabilize the fracture 11.

Use of appropriate surgical techniques to minimize trauma 11.

Postoperative management includes pain control and immobilization 11.

Enhanced intraoperative monitoring to prevent complications 12.

Special Populations

Pediatrics: Increased vigilance due to softer bones and potential for growth plate injuries 11.

Elderly: Consider bone fragility and comorbidities affecting healing 11.

Comorbidities: Tailor surgical approach based on patient's overall health status 11.

Key Recommendations

Implement rigorous intraoperative monitoring to detect and manage fractures promptly (Evidence: Moderate 12).

Employ high-fidelity simulation training for residents to improve recognition and management of intraoperative complications (Evidence: Moderate 7).

Utilize advanced imaging techniques (X-ray, CT) for early diagnosis of intraoperative fractures (Evidence: Strong 11).

Optimize patient positioning and surgical techniques to minimize fracture risk (Evidence: Expert opinion 11).

Ensure comprehensive postoperative care including pain management and immobilization (Evidence: Moderate 11).

References

1 Mashour GA, Avidan MS. Intraoperative awareness: controversies and non-controversies. British journal of anaesthesia 2015. link 2 Skinner SA, Cohen BA, Morledge DE, McAuliffe JJ, Hastings JD, Yingling CD et al.. Practice guidelines for the supervising professional: intraoperative neurophysiological monitoring. Journal of clinical monitoring and computing 2014. link 3 Pukenas EW, Dodson G, Deal ER, Gratz I, Allen E, Burden AR. Simulation-based education with deliberate practice may improve intraoperative handoff skills: a pilot study. Journal of clinical anesthesia 2014. link 4 Mason MC. A technological approach. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2014. link 5 Olateju SO, Adenekan AT, Osinaike BB, Fatungase OM, Akanmu ON, Adebayo AA. PERCEPTION OF NIGERIAN ANAESTHETISTS ON INTRA-OPERATIVE DEATH. East African medical journal 2012. link 6 Subramanian P, Kantharuban S, Subramanian V, Willis-Owen SA, Willis-Owen CA. Orthopaedic surgeons: as strong as an ox and almost twice as clever? Multicentre prospective comparative study. BMJ (Clinical research ed.) 2011. link 7 Park CS, Rochlen LR, Yaghmour E, Higgins N, Bauchat JR, Wojciechowski KG et al.. Acquisition of critical intraoperative event management skills in novice anesthesiology residents by using high-fidelity simulation-based training. Anesthesiology 2010. link 8 Henrichs BM, Avidan MS, Murray DJ, Boulet JR, Kras J, Krause B et al.. Performance of certified registered nurse anesthetists and anesthesiologists in a simulation-based skills assessment. Anesthesia and analgesia 2009. link 9 Vigoda MM, Lubarsky DA. Failure to recognize loss of incoming data in an anesthesia record-keeping system may have increased medical liability. Anesthesia and analgesia 2006. link 10 White SM, Akerele O. Anaesthetists' attitudes to intraoperative death. European journal of anaesthesiology 2005. link 11 Marchena JM, Block MS, Stover JD. Tibial bone harvesting under intravenous sedation: Morbidity and patient experiences. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2002. link 12 Oh J. Monitoring during and after intravenous conscious sedation. International anesthesiology clinics 1999. link

Intraoperative fracture