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MUSCULOSKELETAL > 1b Management of Specific Fractures > Flashcards

1b Management of Specific Fractures Flashcards

1
Q

What should you assess when assessing a fracture?

A

Pain
Swelling
Crepitus
Deformity
Collateral Damage = nerve / vessel

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2
Q

What investigations can be done to see a fracture?

A

XR
CT
MRI

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3
Q

What are the two types of fractures which describe the number of pieces the fracture has?

A

simple / multi-fragmentary

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4
Q

What are the three types of fractures which describe the pattern of fracture?

A

Transverse / oblique / spiral

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5
Q

What is translation?

A

Movement of the fracture in the lateral or medial direction

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6
Q

What is angulation?

A

When the fracture moves to become valgus / varus deformed

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7
Q

What are the two different types of fracture healing?

A

Direct fracture healing and indirect

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8
Q

What is the difference between direct and indirect fracture healing?

A

Direct fracture healing
Anatomical reduction
Absolute stability/compression
No callus

Indirect fracture healing
Sufficient reduction
Micromovement
Callus

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9
Q

What are the three main steps of indirect fracture healing?

A

Inflammation
Repair
Remodelling

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10
Q

What are the cells involved in the inflammation part of indirect fracture healing?

A

Neutrophils
Macrophages

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11
Q

What does the inflammation part of indirect fracture healing involve?

A

Haematoma formation
Release of cytokines
Granulation tissue and blood vessel formation

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12
Q

What happens in the repair phase of indirect fracture healing?

A
  1. Soft callus formation
  2. Hard callus formation
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13
Q

What type of collagen is the soft callus made from?

A

Type II collagen - cartilage

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14
Q

What type of collage is the hard callus made from?

A

Type I collagen = bone

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15
Q

Explain what happens in the remodelling stage of fracture healing

A

Callus responds to activity, external forces, functional demands and growth

Excess bone is removed

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16
Q

What is Wolff’s Law?

A

Bone grows in response to forces which are placed on it

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17
Q

What mechanism does primary bone healing occur through?

A

Intramembranous healing

Occurs when the bone is fixed in placed, when the ends of the fracture are anatomically aligned and there is absolute stability, so there is no need for a callus to form

Also known as DIRECT HEALING

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18
Q

What mechanism does secondary bone healing occur through?

A

Endochondral healing

Occurs in response to the periosteum and external soft tissues

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19
Q

From what stage in the healing process can visible signs of healing be seen?

A

Signs of healing visible on XR from 7-10 days

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20
Q

How is secondary bone healing (indirect) done?

A

Place an intramedullary nail through the bone to hold them in place and allow the callus to form

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21
Q

What is the range of time in which it takes for a fracture to heal?

A

3-12 weeks

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22
Q

What are the general principles of fracture management?

A

Reduce
Hold
Rehabilitate

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23
Q

What are the two methods of reducing fractures?

A

Open / closed - hold the bone in place, just a matter of whether you open the skin to do so

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24
Q

What are the methods of holding in fracture management?

A

plaster
external fixation
internal fixation

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25
Q

What are the methods of internal fixation?

A

Intra or extra medullary fixation

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26
Q

What are the types of external fixation?

A

Monoplanar / multiplanar

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27
Q

What are the general (early or late) fracture complications?

A

Fat embolus - fat from bone marrow of broken bone seeps into bloodstream

Infection/Sepsis - bacteria can enter body during surgery to reduce fracture

PE

Prolonged immobility (UTI, chest infections, sores)

DVT - decreased anti-coagulation factors in vessels around the bone can lead to DVT

28
Q

What are the specific (i.e. at the site of fracture) fracture complications?

A

Neurovascular injury

Muscle/tendon injury

Non union/ mal-union

Local infection

Degenerative change (intra-articular)

29
Q

What is meant by non union / mal union?

A

Non-union = Failure of bone healing within an expected time frame

Mal-union = Bone healing occurs but outside of the normal parameters of alignment

30
Q

What is atrophic non-union fracture healing?

A

healing completely stopped with no XR changes, often physiological (smoker, diabetic)

31
Q

What is hypertrophic non-union fracture healing?

A

too much movement, causing callus healing

32
Q

What are the causes of a fractured neck of femur (NOF fracture)?

A

Osteoporosis (older)
Trauma (younger)
Combination of both

33
Q

What are the two classifications of NoF fractures?

A

Intracapsular or extracapsular

34
Q

What are the types of NoF fractures?

A

Supcapital
transcervical
Basicervical

All intracapsular

35
Q

What is shentons line?

A

a line formed by the outlines of the upper margin of the obturator foramen and the inner margin of the neck of the femur, in which broken continuity of which infallibly indicates displacement or trouble in the hip region.

36
Q
  • Is an intracapsular or extracapsular fracture more likely to have an interrupted blood supply and what does this increase risk of?
A

Intracapsular - therefore the risk of avascular necrosis is higher in these types of NoF fractures.

37
Q

Whether you fix or replace the NoF depends on what?

A

Location, displacement and age

38
Q

If the NoF is extracapsular, how would you manage it?

A

Internal fixation (plate, screws or nails)

39
Q

If the NoF is intracapsular, how would you manage it?

A

if undisplaced - less risk to blood supply and AVN → still fix with screws

If displaced (i.e. bone fragments have moved apart) - 25-30% risk of AVN → replace head of femur in older patients; fix if young

If displaced intracapsular fracture:
young (less than 65) = fix with screws

Older and fit = total hip replacement

Older and unfit = hemiarthroplasty

40
Q

A patient, age >55 yrs, has a displaced intracapsular NoF fracture, walks > mile a day and has minimal comorbidities. How would you manage this fracture?

A

Total hip replacement - In a total hip replacement (also called total hip arthroplasty),the damaged bone and cartilage is removed and replaced with prosthetic components.

Replace both the acetabulum and the head of the femur.

(the more mobile the patient the more likely you are to do a THR)

41
Q

What is a dislocated shoulder?

A

When the ball of the humerus comes out the glenoid of the shoulder

42
Q

Describe the presentation of shoulder dislocation?

A

Variable Hx but often direct trauma

Pain

Restricted movement

Loss of normal shoulder contour

43
Q

What should the clinical examination of a patient with a shoulder dislocation involve?

A

Assess neurovascular status - axillary nerve

44
Q

What motion should be avoided in the management of shoulder dislocation?

A

Vigorous manipulation or twisting manipulation

To avoid fractures

45
Q

what is the best way to manage a shoulder dislocation?

A

Use traction-counter traction +/- gentle internal rotation to disimpact humeral head

46
Q

if alone, what method should be used to manage a shoulder dislocation?

A

Stimson method - lie on bed and let arm hang into place

47
Q

What medication can be given to patients to relax them when manageing a shoulder dislocation?

A

Entonox - gaseous nitrous oxide

Benzodiazepines - GABA enhancers

48
Q

What is a Hill-Sachs lesion/defect?

A

The humeral head ‘collides’ with the anterior part of the glenoid, causing a lesion, bone loss, defect and deformity of the humeral head

This may cause a change or loss of range of motion, feelings of instability and pain

49
Q

What is a Bankart lesion?

A

Lesion of the anterior part of the glenoid labrum of the shoulder

This injury is caused by repeated anterior shoulder subluxations

It is essentially a fleck of bone that has come off the glenoid due to the shoulder dislocation

50
Q

What can a bank art lesion lead to?

A

Recurrent shoulder dislocation

51
Q

What are the three types of management of distal radius fracture?

A

Cast / splint
MUA / K wire
ORIF

52
Q

In what situation is MUA / k wire used?

A

For extra-articular fractures, but have instability, particularly in children, MUA in theatre with K-wire fixation can be used

53
Q

What is ORIF?

A

Open reduction internal fixation with plate and screws

54
Q

What is a common part of the wrist to break?

A

Scaphoid

55
Q

what is a common part of the leg / knee to fracture?

A

Tibial Plateua fracture

56
Q

Why is the proximal tibia important in movement?

A

comprises a key weight bearing surface as part of the knee joint, articulating with distal femur

57
Q

What can cause a tibial plateau fracture?

A

any extreme valgus / varus force or axial loading across the knee can cause a tibial plateau fracture

58
Q

How are tibial plateau fractures managed?

A

Surgery - restoration of articular surfaces using a combination of plates and screws

59
Q

Explain how any valgus/varus force or axial loading can cause a tibial plateau fracture.

A

This forces will impact the femoral condyles causing the comparatively soft bone of the tibial plateau to depress or split.

60
Q

When is the management of tibial plateau fracture non-operative?

A

Only for true undisplaced fractures with good joint line congruency assessed on CT or high fidelity imaging.

61
Q

What are the three bones fractured in a trimalleolar fracture?

A
  1. medial malleolus
  2. posterior malleolus
  3. lateral malleolus
  4. Fracture of the fibula (lateral malleolus)
  5. Fracture of tibia (medial malleolus)
  6. Fracture of back of tibial plafond (posterior malleolus)
62
Q

What is the commonly fractured bone in an ankle fracture?

A

Fibula

63
Q

What is the non-operative management for an ankle fracture?

A

Non-weight bearing below knee cast for 6-8 weeks, can transfer into walking boot and then physiotherapy to improve range of motion/stiffness from joint isolation.

64
Q

What is the operative management for an ankle fracture?

A

oft-tissue dependent - patients need strict elevation as injuries often swell considerably

Open reduction internal fixation (ORIF) +/- syndesmosis repair using either screw or tightrope technique.

Syndesmosis screws can be left in situ but may break after some time so therefore can be removed at a later date if necessary.

65
Q

What is lipohaemarthrosis?

A

Lipohaemarthrosis results from an intra-articular fracture with escape of fat and blood from the bone marrow into the joint

66
Q

What is the first priority in the management of a patient with a suspected fracture following a road traffic acid involving two cars each travelling at 60 miles per hour?

A

Resus

MUSCULOSKELETAL (13 decks)

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