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-MSK Diseases > 10.3. - Fractures - Seminar > Flashcards

10.3. - Fractures - Seminar Flashcards

1
Q

What is a Fracture?

A

A Break in Structural Continuity of Bone (Crack, Break, Split, Crumpling, Buckle)

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2
Q

Why do Bones fail?

A
  1. High Energy Transfer in normal Bones
  2. Repetitive Stress in Normal Bones (Stress Fracture)
  3. Low Energy Transfer in Abnormal Bones (Osteoporosis, Osteomalacia, Metastatic Tumour etc.)
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3
Q

What are the Key points in the Description of a Fracture?

A
  1. Mechanism & Energy of Injury
  2. Skin & Soft-Tisue Issues
  3. Site
  4. Shape
  5. Communication
  6. Deformity
  7. Associated Injuries
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4
Q

What are the aims of treating a Fracture?

A
  1. Relieving Pain
  2. Restoring Function
    (3. Saving Life?)
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5
Q

What is the Management plan of an Injured Patient?

A
  1. Advanced Trauma Life Support (ATLS)
  2. Emergency Orthopaedic Management (Day 1)
  3. Monitoring of Fracture (Days-Weeks)
  4. Rehabilitation + Treatment of Complications (Weeks-Months)
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6
Q

What is included in Emergency Orthopaedic Management?

A
  1. Life Saving:
  2. a) Reducing a Pelvic Fracture in Haemodynamically Unstable Patients
  3. b) Applying Pressure to reduce Haemorrhage from an Open Fracture
  4. Complication Saving:
  5. a) Early &Complete Diagnosis of the Extent of Injuries
  6. b) Diagnosing &Treating the Soft-Tissue Injuries
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7
Q

What Soft-Tissue Injuries can occur during a Fracture?

A
  1. Skin - Degloving Injuries . Ischaemic Necrosis
  2. Muscles - Crush Injury & Compartment Syndromes
  3. Blood Vessels - Vasospasm & Arterial Laceration
  4. Nerves - Neurapraxias, Axonotmesis, Neurotmesis
  5. Ligaments - Joint Instability & Dislocation
    Note - All require urgent treatment, as they will delay healing
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8
Q

What does the choice of treatment depend on?

A
  1. The type of Fracture
  2. The Bone which has been Fractures
  3. Soft-Tissue Injury
  4. Patient details
  5. Facilities / Abilities of the Surgeon
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9
Q

What is the difference of healing pattens between:

  1. Soft Tissue?
  2. Bone?
A
  1. Soft Tissue heals by replacing the injured tissue with a fibrous Scar
  2. Bone heals by Regeneration of Normal Bone Anatomy (forming a Callus) - Very Vascular, a broken bone will always bleed
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10
Q

What are the 3 phases of Bone Healing?

A
  1. Inflammatory Phase
  2. Reparative Phase
  3. Remodelling Phase
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11
Q

How do Fractures Heal in Nature?

A
  1. Regeneration vs Repair
  2. Phases of Healing by Callus
  3. Rapid Process, but Rehabilitation is Slow (Low Risk)
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12
Q

How do Fractures Heal with Surgery?

A

If Rigid - ORIF + Compression:
1. Primary Bone Healing
2. Slow Process but Rehabilitation is Rapid (High Risk)
If Stable - Nailing or External Fixation:
1. Healing by Callus
2. Rapid Process, and Rehabilitation Rapid (Lesser Risk)

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13
Q

How is Fracture Healing measured?

A
  1. Clinical Examination:
  2. a) Adult - Upper Limb = 6-8 wk; Lower Limb = 12-16 wk
  3. b) Child - Upper Limb = 3-4 wk; Lower Limb = 6-8 wk
  4. Radiologically (Bridging Callus Formation / Remodelling)
  5. Biomechanically (Stiffness)
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14
Q

When is a fracture healed?

A
  1. When the patient can bear weight
  2. When the X-Rays says so
  3. When remodelling is complete
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15
Q

What are the Local Problems of a Fracture?

A 
Early:
1. Neurovascular Damage
2. Skin / Wound Problems
3. Compartment Syndrome
Late:
1. Delayed Union / Nonunion
2. Avascular Necrosis
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16
Q

What are the Local Complications of a Fracture?

A 
Early: Infection
Late:
1. Malunion
2. CRPS Type 1
3. Implant Failure
4. Joint Stiffness
17
Q

What are the Systemic Problems of a Fracture?

A 
Early:
1. Hypovolaemia
2. Crush Syndrome
3. Fat embolism + ARDS
Late: Psychological & Social Aspects
18
Q

What are the Systemic Complications of a Fracture?

A
  1. Bed Rest Complications (including DVT / PE)

2. Tetanus

19
Q

What factors influence Fracture repair?

A
  1. Host - nutritional & hormonal status / drugs / CNS injury
  2. Local Factors - Soft Tissue Injury / Bone Loss / Radiation / Tumour / Distraction / Tissue Interposition / Blood Supply / Infection / Type of Bone / Synovial Fluid
  3. Treatment Method - Mobility at fracture site (Stable vs Rigid Fixation)
20
Q

What are the Bony Problems of Fracture Healing?

A
  1. Delayed Union (healing taking longer than average)
  2. Non-Union (no further progress towards union)
  3. Mal-Union (healed but not in a correct position)
  4. Avascular Necrosis (loss of blood supply)
21
Q

What are the 2 types of Non-Union?

A
  1. Atrophic - Gap at the Fracture Site (infection)

2. Hypertrophic - attempt at healing but the fracture is too mobile

22
Q

What are the Treatment Options?

A
  1. Active Early Movement + Protection
  2. Rest + Elevation / Gravity
  3. Immobilisation by Semi-Rigid Splintage
  4. Functional Brace
  5. Skin / Skeletal Traction
  6. External Fixation
  7. Percutaneous K-Wire Fixation +/- ORIF
  8. ORIF + Tension Band Wiring / Screws / Plate
  9. Internal Fixation + Sliding or Intramedullary Nail / Rod / Screw / Plate
  10. Spinal Rods
  11. Excision of Fracture Fragment +/- Replacement
  12. Amputation
23
Q

What are the problems with treatment (Conservative vs Operative) of Delayed / Non-Union Fractures?

A
  1. Inadequate Immobilisation
  2. Distraction of Fracture by Fixation Device / Traction
  3. Repeated Manipulations
  4. Periosteal Stripping & Soft-Tissue Damage at Operation
  5. Anatomical Vascular Susceptibility
24
Q

What score is used to assess the need for Amputation?

A

Mangles Extremity Severity Score:

  1. Skeletal/Soft Tissue Injury - Energy level (Low = 1; Massive Crush = 4)
  2. Shock (Normotensive = 1; Prolonged = 2)
  3. Ischaemia (None = 0; Advanced = 3
  4. Age (<30 = 0; >50 = 2)

-MSK Diseases (43 decks)

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