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Trauma + Orthopaedics > 1: Principles Of Fracture Management > Flashcards

1: Principles Of Fracture Management Flashcards

1
Q

What is a fracture

A

partial or complete disruption in continuity of the bone

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2
Q

What are 3 classes of fracture

A
  • Stress
  • Traumatic
  • Pathological
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3
Q

What are stress fractures

A

Multiple low velocity injuries results in several hairline fractures to the bone

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4
Q

What is a pathological fracture

A

Abnormal bone (eg. malignancy or osteoporosis) that fractures on minimal trauma

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5
Q

What are 6 risk factors for poor healing

A
  • Old age
  • Diabetes
  • Smoker
  • NSAIDs
  • Corticosteroids
  • Osteoporosis
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6
Q

What is an oblique fracture

A

Fracture lies obliquely to the long bone

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7
Q

What is a comminuted fracture

A

When there are more than two fragments

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8
Q

What is a segmental fracture

A

When there are more than two fractures in a long bone

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9
Q

What is a transverse fracture

A

Fracture lies horizontal to long bone

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10
Q

What is a spiral fracture

A

Severe oblique fracture. With rotation along the long axis

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11
Q

What is an open fracture

A

Fracture where a fragment of bone breaks through skin

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12
Q

What is a Colle’s fracture

A

Fracture of the wrist that has 3 features (can be remembered by ‘TOD’)
Transverse fracture of the radius
One initial proximal to the carbo-metacarpal joint
Dorsal displacement and angulation of the distal radius fragment

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13
Q

What is a Smith’s fracture

A

Transverse fracture of the radius with volar angulation and displacement

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14
Q

What is a Monteggia’s fracture

A

Dislocation of the PROXIMAL radio-ulna joint and associated fracture of the ulna

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15
Q

What is a Galeazzi’s fracture

A

Dislocation of the DISTAL radio ulna joint with associated radial shaft fracture

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16
Q

What is a Bennet’s fracture

A

Fracture of the first carpo-metacarpal joint

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17
Q

What is a Boxer’s fracture

A

Fracture of the 5th MCP joint

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18
Q

What is a Pott’s fracture

A

Bi-malleolar fracture

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19
Q

What is Barton’s fracture

A

Fracture of the distal radius wit radio-carpal dislocation

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20
Q

What is an open fracture

A

Disruption in cortex of the bone associated with an overlying laceration

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21
Q

What system is used to classify open fractures

A

Gustillo-Anderson

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22
Q

In the Gustillo-Anderson classification, what is Grade I

A
  • Low energy trauma

- Less than 1cm laceration

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23
Q

In the Gustillo-Anderson classification, what is Grade 2

A
  • Low energy trauma

- More than 1cm laceration

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24
Q

In the Gustilo-Anderson Classification what is Grade 3A

A
  • Adequate soft tissue coverage
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25
Q

In the Gustilo-Anderson Classification what is Grade 3B

A
  • Inadequate soft tissue coverage
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26
Q

In the Gustilo-Anderson Classification what is Grade 3C

A
  • Associated arterial injury
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27
Q

What Gustily-Anderson classification will an open fracture caused by high energy trauma be

A

Grade 3 (automatically)

28
Q

How should a fracture be managed (General principles)

A
  1. Antibiotics for all open injuries
  2. Reduce
  3. Hold
  4. Rehabilitate
29
Q

If a high-energy traumatic fracture how should it be managed (General principles)

A
  1. Resuscitate (ATLS)
  2. Reduce
  3. Hold
  4. Rehabilitate
30
Q

What is reduction of a fracture

A

restoring the anatomical alignment of a fracture or dislocation

31
Q

What is the aim of reducing a fracture

A
  • Reduce pressure on soft-tissues (reducing swelling)
  • Reduce pressure on nerves that could lead to neuropraxia
  • Reduce pressure on blood vessels that may cause ischaemia
  • Reduce tamponade of bleeding at fracture site
  • Promote healing
32
Q

How is reduction achieved (General principle)

A

Apply force equal and opposite to the force which caused the fracture

33
Q

What are the two types of reduction

A

Open reduction

Closed reduction

34
Q

In an emergency what type of reduction is often used

A

Closed reduction

35
Q

What is open reduction

A

Taken to operating theatre. Fracture is visualised and internally reduced with instruments

36
Q

What should be given prior to reduction

A

Analgesia

37
Q

What is the preferred method of analgesia for reduction of fractures

A

Local nerve block

38
Q

What does ‘hold’ refer to in general principles of fracture management

A

Immobilisation of the fracture to enable healing

39
Q

What are the most common methods to immobilise a fracture

A
  • Plaster cast

- Splint

40
Q

What is a rare (old-fashioned) method to immobilise a fracture

A

Traction

41
Q

When may traction be required in ‘holding phase’ of management

A

If an unstable fracture (eg. muscles pull on fracture sites causing it to be unstable) - subtrochanteric fracture, pelvic fracture

42
Q

What type of cast should be applied in the first 2W of a fracture and why

A

Back-slab. (NEVER apply a circumferential cast in the first two weeks)

43
Q

What will happen if a circumferential cast is applied within the first 2W following fracture

A

oedema and expansion of the tissues will be compressed in the cast and may lead to compartment syndrome

44
Q

How is the ‘length’ of a cast decided

A
  • If risk of axial instability (fracture can rotate along long-axis) then joint above AND below
  • If no risk, just the joint distal to the injury
45
Q

What has replaced traction

A

Internal and external fixation

46
Q

In which population may traction be used

A

cHILDREN

47
Q

What fractures are repaired by open reduction and internal fixation (ORIF)

A

fractures involving joint articulations

48
Q

What are 6 indications for ORIF

A
  1. Articular fractures
  2. Unstable fractures
  3. Open fractures
  4. More than two fractures in one limb (segmental fracture)
  5. Identical bilateral fractures
  6. Failed medical management
49
Q

What are 4 methods of internal fixation

A
  • Intra-medullary nails
  • Kirschner wires
  • Plates
  • Screws
50
Q

What is the benefit of plates

A

Provide strength and stabilise fractures involving articular fractures

51
Q

What are intra-medullary nails

A

screw into the medulla of bones

52
Q

What are Kirschner wires

A

flexible stabilisation wire used as a temporary measure in internal fixation before definitive fixation

53
Q

When are external fixation used

A

when there is soft-tissue damage to the trauma site (burns, loss of skin, loss of bone) as they are less disruptive

54
Q

How is external fixation achieved

A

Pins/Wires/Rods are placed away from the zone of injury in various configurations to provide stabilise. Pins/Wires are placed through bone and connected using rods and clamps

55
Q

What does rehabilitation involve

A

Need for patients to undergo PT and progressive loading following a fracture

56
Q

What are 5 immediate complications of a fracture

A
  • Organ injury
  • Internal bleeding
  • External bleeding
  • Nerve or skin injury
  • Vessel injury causing secondary ischaemia
57
Q

What are 4 local late complications of a fracture

A
  • Skin necrosis
  • Pressure sores
  • Infection
  • Delayed union
58
Q

What are 4 general late complications of a fracture

A
  • Fat embolism
  • PE
  • Pneumonia
  • Arthritis
59
Q

Where to fat emboli occur from

A

Bone marrow

60
Q

What day do symptoms from fat emboli often present

A

2-3d

61
Q

What type of injury is neuromuscular disruption common

A

Knee dislocation

62
Q

What is the most common complication of fractures

A

Infection

63
Q

What is delayed union

A

When a fracture has not healed within the expected time frame

64
Q

What is non-union

A

No evidence of fracture healing

65
Q

What is mal-union

A

When a fracture has not haled in expected anatomical alignment increasing the risk of contractures, loss of function and increased risk of secondary OA

66
Q

What are 3 common fractures in the elderly

A
  • NOF
  • Colle’s
  • Vertebrae (wedge)

Trauma + Orthopaedics (11 decks)

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