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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
Q

What will be found on examination in ulnar nerve palsy?

A

Claw hand

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26
Q

What nerve palsy can be caused by hip dislocation?

A

Sciatic nerve

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27
Q

What will be found on examination in sciatic nerve palsy?

A

Foot drop

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28
Q

What nerve palsy can be caused by fractured neck of fibula?

A

Fibular nerve

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29
Q

What nerve palsy can be caused by knee dislocation?

A

Fibular nerve

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30
Q

What will be found on examination with fibular nerve palsy?

A

Foot drop

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31
Q

What aspect of the anatomy makes compartment syndrome possible?

A

Osteofacial membranes divide the limbs into separate compartments of muscles

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32
Q

How does compartment syndrome occur following a fracture?

A

Oedema following the fracture causes an increase in compartment presure, leading ot decrease venous drainage and therefore a further increase in compartment pressure

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33
Q

What happens if compartment pressure > capillary pressure?

A

Ischaemia and muscle infarction

34
Q

What can muscle infarction in compartment syndrome lead to?

A

Rhabdomyolysis and ATN

Fibrosis leading to Volkmann’s ischaemic contracture

35
Q

How does compartment syndrome present?

A

Pain > clinical findings
Pain on passive muscle stretching
Warm, erythematous, swollen limb
Increased cap refill time and weak/absent peripheral pulses

36
Q

How is compartment syndrome managed?

A

Elevate limb
Remove all bandages and split/remove cast
Fasciotomy

37
Q

What is delayed union?

A

When fracture union takes longer than expected

38
Q

What is non-union?

A

When fracture fails to unite

39
Q

What are the causes of problems with fracture union?

A 
Ischaemia
Infection
Increased interfragmentary strain
Interposition of tissue between fragments
Intercurrent disease
40
Q

What might cause ischaemia of fracture site?

A

Poor blood supply

Avascular necrosis

41
Q

Give two examples of intercurrent disease that might cause problems with fracture union?

A

Malignancy

Malnutrition

42
Q

What are the classifications of fracture non-union?

A

Hypertrophic

Atrophic

43
Q

How does the bone look in hypertrophic non-union?

A

Bone end is rounded, dense, and sclerotic

44
Q

How does the bone look in atrophic non-union?

A

Bone looks osteopenic

45
Q

How are problems with union managed?

A

Optimise biology

Optimise mechanics

46
Q

How can biology be optimised in bone union problems?

A

Manage infection
Improve blood supply
Bone graft if necessary

47
Q

How can mechanics be optimised in bone union problems?

A

Open reduction and internal fixaiton

48
Q

What is malunion?

A

When the bone has healed in an imperfect position

49
Q

What is the problem with malunion?

A

Poor appearance and/or function

50
Q

What is avascular necrosis?

A

Death of bone due to deficient blood supply

51
Q

What are the common sites of avascular necrosis?

A

Femoral head
Scaphoid
Talus

52
Q

What is the consequence of avascular necrosis?

A

Bone becomes soft and deformed, leading to pain, stiffness, and OA

53
Q

What will be found on x-ray in avascular necrosis?

A

Sclerosis and deformity

54
Q

What is myositis ossificans?

A

Heterotropic ossification of muscle at sites of haematoma formation

55
Q

What does myositis ossificans result in?

A

Restricted, painful movement

56
Q

Where does myositis ossificans commonly affect?

A

The elbows and quadriceps

57
Q

How can myositis ossificans be managed?

A

Can be excised surgically

58
Q

What is Pellegrini-Stieda disease?

A

A form of myositis ossificans

59
Q

What is Pellegrini-Steida disease?

A

Calcification of the superior attachment of the MCL at the knee following traumatic injury

60
Q

What is complex regional pain syndrome type 1?

A

A complex disorder of pain, sensory abnormalities, abnormal blood flow, sweating, and trophic changes in superficial and deep tissues

61
Q

Is there any evidence of nerve injury in complex regional pain syndrome type 1?

A

No

62
Q

What are the causes of complex regional pain syndrome type 1?

A 
Fractures
Carpal tunnel release
Operations for Dupuytren's
Zoster
MI
Idiopathic
63
Q

When does complex regional pain syndrome type 1 present?

A

Weeks or months after the event

64
Q

Where is affected in complex regional pain syndrome type 1?

A

Not the traumatised area that is affected, but a neighbouring area

65
Q

What are the symptoms of complex regional pain syndrome type 1?

A 
Lancing pain
Hyperalgesia
Allodynia
Vasomotor symptoms
Skin symptoms
Neuromuscular symptoms
66
Q

What are the vasomotor symptoms of complex regional pain syndrome type 1?

A

Hot and sweaty, or cold and cyanosed

67
Q

What are the skin symptoms of complex regional pain syndrome type 1?

A

Swollen, or atrophic and shiny

68
Q

What are the neuromuscular symptoms of complex regional pain syndrome type 1?

A

Weakness
Hyper-reflexia
Dystonia
Contractures

69
Q

How is complex regional pain syndrome type 1 managed?

A

Usually self-limiting

Should refer to pain team, who might treat with amitryptilline or gabapentin. Sympathetic nerve blocks can also be tried

70
Q

What is complex regional pain syndrome type 2?

A

Persistent pain following injury caused by nerve lesions

71
Q

When might fractures lead to abnormal bone growth?

A

In children, when there is damage to the physis (growth plate)

72
Q

What categories growth plate injuries?

A

The Salter-Harris classification

73
Q

What is Salter-Harris 1?

A

Straight across the growth plate

74
Q

What is Salter-Harris 2?

A

Through the growth plate horizontally and then up vertically

75
Q

What is Salter-Harris 3?

A

Through the growth plate horizontally then down vertically

76
Q

What is Salter Harris 4?

A

Through the growth plate vertically

77
Q

What is a Salter Harris 5?

A

Crush injury

78
Q

Give an example of a Salter Harris 1?

A

SUFE

79
Q

What is the prognosis of Salter Harris 1?

A

Good - normal growth if good reduction

80
Q

What can result from a Salter Harris 4?

A

Union across the physis may interfere with bone growth

81
Q

What can result from Salter Harris 5?

A

Physis injury leading to growth arrest

A - MSRA MSK [11] (38 decks)

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