Assessment of Fractures Flashcards
give some examples of types of fracture
complete transverse oblique spiral comminuted incomplete bowing buckle greenstick growth plate injury
possible sites of fracture in a bone?
diaphysis
metaphysis
epiphysis
possible displacement of a fracture?
angulation translation rotation distracted impacted
what is the likely pattern of injury based on?
age of the patient
mechanism of injury
open vs closed fracture?
open has the potential for bacterial infection etc and contamination
what is the risk with compartment syndrome?
loss of function
what is fight bite and what can it cause?
cut at the MCP joint from hitting someone due to teeth
causes inoculation of bacteria from mouth into joint
can cause septic arthritis which can lead to loss of function of the joint
what is compartment syndrome?
results from interstital pressure increase in closed osseofascial compartments
causes microvascular compromise
risk factors for compartment syndrome?
tibial fracture
forearm fractures
IV drug users - lying comatose for prolonged time
anticoagulation and trivial trauma
may not involve a fracture (e.g can just be a blow to the anterior compartment etc)
burns
what is the most commonly affected compartment in the leg?
anterior
therefore deep fibular nerve likely to be affected
what can be a symptoms of damage to deep fibular nerve?
numbness in 1st and 2nd toe
presentation of acute compartment syndrome?
disproportionate pain
pain on passive stretch of muscles in involved compartment (plantar flex for anterior comprtment, dorsiflex for posterior compartment etc)
paresthesiae
how is compartment syndrome managed?
immediate release of all dressings/ casts
do not elevate, keep parallel to the heart
refer for surgery immediately
compartment syndrome surgery?
emergency fasciotomy
common features of ankle fracture/instability?
bruising and tender on both sides
what is the order of injury to the ankle in a rotational injury?
syndesmotic ligament between tibia and fibula
then spiral fracture
deltoid tear
dislocation of the talus?/tibia?
trifocal fracture?
3 places
- Weber C fracture of the ankle
treatment for weber C fracture?
needs surgery
classification of hip fractures?
intracapsular - can damage blood supply
extracapsular - no damage to blood supply
comorbidities with hip fracture?
anticoagulation
recent medication changes
missed injury
cognitive impairment (dementia, delirium etc)
when is an MRI needed for hip pain?
If extreme hip/groin pain with reluctance to weight bear and pain when pressing knees upwards but x rays are normal
most commonly used prosthesis for hip for elderly?
Thompson hemiarthroplasty - titanium alloy
commonly used hip prosthesis in younger patients?
hybrid
treatment of intracapsular fracture in young people?
reduction with screws
dangerous area for hip fracture?
subtrochanteric fracture as holds almost entire body weight
where is fracture likely to occur if a prosthetic hip is present?
at the site where the solid prosthesis in the middle of the bone ends and the normal, softer bone starts
options for tibial fracture?
reduce and plaster cast
add a plate (surgical)
add a frame - infection risk from outside pins
intramedullary nail (surgical)
what are the risks with bisphosphonate treatment?
stress fractures
- slightly sclerotic
- very transverse
how can the risk with bisphosphonates be managed?
take a 5 year break from treatment to assess bone density
distal intra-articular radius fracture treatment?
volar locking plate (expensive)
can also use wires which is cheaper
priorities with extreme open fracture?
ABCDE
stop the haemorrhage (comes first is extensive)
splint the extremity
document vascular and neural status
how can you reduce a large haemorrhage?
tourniquet
apply wool and pressure
- don’t clamp the artery as it can cause problems with vessel reconstruction
how do you document an injury?
location size incised, lacerated etc? degloving? capillary fill? pulses tendon action
what is a flexion distraction injury?
AKA chance fracture
spine failing in tension
disruption of PLC - posterior ligamentous complex
usually occurs in young people due to hyperextension of the cervical spine over a seatbelt
