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A - MSRA MSK [11] > [26] Fracture Complications > Flashcards

[26] Fracture Complications Flashcards

1
Q

What are the general complications of fractures?

A

Tissue damage
Complications of anaesthesia
Complications of prolonged bed rest

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2
Q

What may result from tissue damage in fractures?

A

Haemorrhage and shock
Infection
Muscle damage leading to rhabomyolysis

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3
Q

What complications of anaesthesia may occur?

A

Anaphylaxis
Damage to teeth
Aspiration

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4
Q

What complications might be caused by prolonged bed-rest?

A 
Chest infection
UTI 
Pressure sores
Muscle wasting
DVT and PE 
Decreased bone mineral density
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5
Q

What are the immediate specific complications of fractures?

A

Neurovascular damage

Visceral damage

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6
Q

What are the early complications of fractures?

A

Compartment syndrome
Infection
Fat embolism leading to ARDs

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7
Q

When is infection as a complication of fractures worse?

A

When associated with metalwork

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8
Q

What are the late complications of fractures?

A 
Problems with union
Avascular necrosis
Growth disturbance
Post-traumatic osteoarthritis
Complex regional pain syndromes
Myositis ossificans
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9
Q

Is severance of a nerve common in fractures?

A

No, it is rare

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10
Q

What is a more common mechanism of nerve injury in fractures?

A

Stretching over the bone edge

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11
Q

What does the Seddon classification of neurological complications of fractures despite?

A

Three types of injury - neuropraxia, axonotmesis, and neurotmesis

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12
Q

What is neuropraxia?

A

Temporary interruption of conduction without loss of axonal continuity

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13
Q

What is axonotmesis?

A

Disruption of nerve axon leading to distal Wallerian degeneration

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14
Q

What is preserved in axonotmesis?

A

The connective tissue framework of the nerve

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15
Q

What is the result of the connective tissue framework of the nerve being preserved in axonotmesis?

A

Regeneration can occur, an d recovery is possible

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16
Q

What is neurotmesis?

A

Disruption of the entire nerve fibre

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17
Q

What management is required in neurotmesis?

A

Surgery

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18
Q

What is the prognosis of neurotmesis?

A

Recovery is not usually complete

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19
Q

What nerve palsy can be caused by anterior shoulder dislocation?

A

Axillary nerve

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20
Q

What nerve palsy can be caused by humeral surgical neck fracture?

A

Axillary nerve

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21
Q

What will be found on examination in axillary nerve palsy?

A

Numb chevron

Weak abduction

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22
Q

What nerve palsy can be caused by fracture of humeral shaft?

A

Radial nerve

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23
Q

What will be found on examination in radial nerve palsy?

A

Waiter’s tip

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24
Q

What nerve palsy can be caused by elbow dislocation?

A

Ulnar nerve

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25
What will be found on examination in ulnar nerve palsy?
Claw hand
26
What nerve palsy can be caused by hip dislocation?
Sciatic nerve
27
What will be found on examination in sciatic nerve palsy?
Foot drop
28
What nerve palsy can be caused by fractured neck of fibula?
Fibular nerve
29
What nerve palsy can be caused by knee dislocation?
Fibular nerve
30
What will be found on examination with fibular nerve palsy?
Foot drop
31
What aspect of the anatomy makes compartment syndrome possible?
Osteofacial membranes divide the limbs into separate compartments of muscles
32
How does compartment syndrome occur following a fracture?
Oedema following the fracture causes an increase in compartment presure, leading ot decrease venous drainage and therefore a further increase in compartment pressure
33
What happens if compartment pressure > capillary pressure?
Ischaemia and muscle infarction
34
What can muscle infarction in compartment syndrome lead to?
Rhabdomyolysis and ATN | Fibrosis leading to Volkmann's ischaemic contracture
35
How does compartment syndrome present?
Pain > clinical findings Pain on passive muscle stretching Warm, erythematous, swollen limb Increased cap refill time and weak/absent peripheral pulses
36
How is compartment syndrome managed?
Elevate limb Remove all bandages and split/remove cast Fasciotomy
37
What is delayed union?
When fracture union takes longer than expected
38
What is non-union?
When fracture fails to unite
39
What are the causes of problems with fracture union?
``` Ischaemia Infection Increased interfragmentary strain Interposition of tissue between fragments Intercurrent disease ```
40
What might cause ischaemia of fracture site?
Poor blood supply | Avascular necrosis
41
Give two examples of intercurrent disease that might cause problems with fracture union?
Malignancy | Malnutrition
42
What are the classifications of fracture non-union?
Hypertrophic | Atrophic
43
How does the bone look in hypertrophic non-union?
Bone end is rounded, dense, and sclerotic
44
How does the bone look in atrophic non-union?
Bone looks osteopenic
45
How are problems with union managed?
Optimise biology | Optimise mechanics
46
How can biology be optimised in bone union problems?
Manage infection Improve blood supply Bone graft if necessary
47
How can mechanics be optimised in bone union problems?
Open reduction and internal fixaiton
48
What is malunion?
When the bone has healed in an imperfect position
49
What is the problem with malunion?
Poor appearance and/or function
50
What is avascular necrosis?
Death of bone due to deficient blood supply
51
What are the common sites of avascular necrosis?
Femoral head Scaphoid Talus
52
What is the consequence of avascular necrosis?
Bone becomes soft and deformed, leading to pain, stiffness, and OA
53
What will be found on x-ray in avascular necrosis?
Sclerosis and deformity
54
What is myositis ossificans?
Heterotropic ossification of muscle at sites of haematoma formation
55
What does myositis ossificans result in?
Restricted, painful movement
56
Where does myositis ossificans commonly affect?
The elbows and quadriceps
57
How can myositis ossificans be managed?
Can be excised surgically
58
What is Pellegrini-Stieda disease?
A form of myositis ossificans
59
What is Pellegrini-Steida disease?
Calcification of the superior attachment of the MCL at the knee following traumatic injury
60
What is complex regional pain syndrome type 1?
A complex disorder of pain, sensory abnormalities, abnormal blood flow, sweating, and trophic changes in superficial and deep tissues
61
Is there any evidence of nerve injury in complex regional pain syndrome type 1?
No
62
What are the causes of complex regional pain syndrome type 1?
``` Fractures Carpal tunnel release Operations for Dupuytren's Zoster MI Idiopathic ```
63
When does complex regional pain syndrome type 1 present?
Weeks or months after the event
64
Where is affected in complex regional pain syndrome type 1?
Not the traumatised area that is affected, but a neighbouring area
65
What are the symptoms of complex regional pain syndrome type 1?
``` Lancing pain Hyperalgesia Allodynia Vasomotor symptoms Skin symptoms Neuromuscular symptoms ```
66
What are the vasomotor symptoms of complex regional pain syndrome type 1?
Hot and sweaty, or cold and cyanosed
67
What are the skin symptoms of complex regional pain syndrome type 1?
Swollen, or atrophic and shiny
68
What are the neuromuscular symptoms of complex regional pain syndrome type 1?
Weakness Hyper-reflexia Dystonia Contractures
69
How is complex regional pain syndrome type 1 managed?
Usually self-limiting | Should refer to pain team, who might treat with amitryptilline or gabapentin. Sympathetic nerve blocks can also be tried
70
What is complex regional pain syndrome type 2?
Persistent pain following injury caused by nerve lesions
71
When might fractures lead to abnormal bone growth?
In children, when there is damage to the physis (growth plate)
72
What categories growth plate injuries?
The Salter-Harris classification
73
What is Salter-Harris 1?
Straight across the growth plate
74
What is Salter-Harris 2?
Through the growth plate horizontally and then up vertically
75
What is Salter-Harris 3?
Through the growth plate horizontally then down vertically
76
What is Salter Harris 4?
Through the growth plate vertically
77
What is a Salter Harris 5?
Crush injury
78
Give an example of a Salter Harris 1?
SUFE
79
What is the prognosis of Salter Harris 1?
Good - normal growth if good reduction
80
What can result from a Salter Harris 4?
Union across the physis may interfere with bone growth
81
What can result from Salter Harris 5?
Physis injury leading to growth arrest

A - MSRA MSK [11] (38 decks)

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