"The Solution to Pollution is Dilution"

The in the title quote was originally used in environmental and industrial post-WW2 industries to explain how dumping of waste and chemicals would ok as long as they were sufficiently diluted. In other words, toxins are less toxic in lower concentrations. One of the orthopedic consultants today quoted the same quote in regards to wound management and I got a flashback to those high school geography lessons, but he has a point!

"The Solution To Pollution Is Dilution"

Quite simply in the wound management the more you clean a wound the cleaner it will be. Each wash will wash away some of the bacteria and dirty material. So when cleaning a wound with saline or other sterile liquids remember this! Its a simple concept, but very effective. 

Orthopedics: Fractures and Bone Healing

There is a lot of things to consider when a pt comes into the ER with a fracture. Do you know when you to treat with an OPEN or CLOSED reduction?

Bones can heal either by 'Healing Per Primam' or secondary healing with callus formation (much more common).
Healing per primam is direct healing of bone with tunneling of osteoclasts and migration/colonization of the tunnel with osteoblasts (no callus formation).

Secondary healing/callus formation stages:

1. Hematoma 
2. Granulation tissue 
3. (Soft callus) Cartilaginous callus formation 
4. (Hard Callus) Bony callus and cartilaginous remnants (lammellar bone deposition)
5. Remodelling to original bone contour 

Stephen Pearson strain theory, classification of fracture with regards to healing:

> Narrow simple line  > OPEN reduction

Requires absolute stability, usually a surgical fix with plates and screw so there is zero movement of bone fragments. healing per primam

e.g. this type of healing is ideal for fractures where we don't want a callus for example, joint fractures, fractures of the epiphysis (a callus would restrict movement). 

> Wide complex line  > CLOSED reduction

Requires relative stability, fix fracture with plaster cast or erfix etc. healing is by secondary bone healing with callus formation.

e.g. comminuted fractures, fractures with gaps and mutiple fragments.