ALS Lecture 5 - Diagnosis and Management of Fractures and Soft Tissue Injuries DONE Flashcards
if fracture is suggested clinically, but radiographic film appears negative, patient should initially be treated as though
a fracture was present
radiography is performed before
attempted reduction (except when delay is harmful)
open/compound
skin breached by bone
closed/simple
fracture not exposed
directions of fracture lines
transverse, oblique, spiral, comminuted
comminuted fracture
shards of bone
complete fracture
straight through bone
incomplete fracture
does not go right through bone
avulsion fracture
tendon pulled, brings small chunk of bone with it
impaction fracture
forceful collapse of one fragment of bone into or onto another
pathologic fracture
due to underlying disease (e.g. osteoporosis, tumour deposits)
stress fracture
small, undisplaced, due to repeated stress, common in sportspeople
label the different types of fracture diagram
done
crepitus
sensation/noise when joint is moved (clicking, creaking, grating, popping, etc)
infection as a fracture complication is associated most with
open fractures
haemorrhage can be a fracture complication because there is
rich blood supply to skeleton
risk of haemorrhage is greatest in which fractures?
pelvis or shaft of femur
compartment syndrome
serious, acute emergency, pressure increases, restricts blood flow
signs of compartment syndrome
pain, paraesthesia
treatment of compartment syndrome
complete fasciotomy
avascular necrosis is particularly a risk with these fractures
head of femur, talus, scaphoid, lunate, capitate
fat embolism syndrome
fat in circulation after long bone fracture or major trauma
immobilisation complications
pneumonia, DVT, PE, UTI, ulcers, infection, muscle atrophy
subluxation
partial loss of continuity between 2 surfaces
dislocation
complete loss of continuity between 2 surfaces
fracture dislocation
fracture and disruption of articulation
DEXA scan assesses
bone density
DEXA scans generate a
T-score
normal T-score
>
- 1
osteopenia
- 1 to - 2.5
osteoporosis
< - 2.5
x-rays benefits
easy, inexpensive, great for most fractures
fracture line is most visible on x-ray when it is
parallel to x-ray beam
fracture line is invisible on x-ray when it is
90 degrees to x-ray beam
x-rays must always be
done in multiple planes
normal x-ray doesn’t
100% rule out fracture so if risk is high enough use another imaging technique
radionucleotide bone scanning is very good at detecting which type of fractures?
stress, occult
label the diagrams of x-ray, CT and radionucleotide bone scanning
done
gold standard for fractures
CT
MRI disadvantages
expensive, time consuming, limited bone detail, can’t be used if have metal (e.g. pacemakers)
MRI advantages for fractures
most advanced, non-invasive
US used in
soft tissue injury (e.g. Achilles tendon)
US benefits
no radiation, quick, cheap, can see joint movement in real time
sprains
ligamentous injury
tendinitis
tendon inflammation due to over use
common tendinitis sites
rotator cuff, Achilles tendon, radial wrist and elbow
bursitis
painful inflammation of a bursa
common bursitis sites
olecranon, subacromial, greater trochanter of femur, prepatellar bursa
undisplaced fracture
bones remain aligned
displaced fracture
bone shifted so ends not in alignment
spiral fracture
usually rotational injury
label the fracture pictures
done
stages of bone healing (6)
- haematoma
- inflammatory phase
- resorption of heamatoma
- remodelling
- mineralisation
- reabsorption of callus
stage 1 of bone healing, haematoma
ruptured vessels across fracture line, haematoma bridges fragments
stage 2 of bone healing, inflammatory phase
granulation tissue forms on fracture surfactes
stage 3 of bone healing, resorption of haematoma
first continuity between fragments, pro-callus, no structural rigidity
stage 4 of bone healing, remodelling
callus formed on periosteal and endosteal surfaces, biological splint
stage 5 of bone healing, mineralisation
callus mineralised by deposition of calcium phosphate
stage 6 of bone healing, reabsorption of callus
original fracture surfaces develop bony union
fractures are easier to see after about 10days of injury because the bone surrounding the fracture becomes
less dense due to resorption
types of abnormal union
delayed, malunion, non-union, pseudoarthrosis
delayed union
longer than normal for that location
malunion
residual deformity
non-union
failure to unite
pseudoarthrosis
non-union results in false joint
principles of definitive fracture management (5)
- open wound management
- reduction and stabilisation
- splinting/bandaging/casts
- surgery
- rehabilitation
reduction done for
not every fracture, every dislocation
open fixation includes
pins and plates for life, external or internal
in any open wound we must consider and exclude
nerve injury
grading muscle strains (1-3)
- pain only (few fibres)
- pain, weakness (significant fibres)
- pain, weakness, loss of function (very large tear)
managing soft tissue injuries
POLICE
POLICE
protect, optimal loading, ice, compression, elevation
optimal loading
right movement for injury
optimal loading is important as it ensures our
tendons are mainly type 1 collagen
type 1 collagen can only be made if the
tendon is stimulated properly by optimal loading§
