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MSK II > Bone Injuries > Flashcards

Bone Injuries Flashcards

1
Q

What are the different types of fractures?

A 
Transverse
Oblique
Spiral
Comminuted (major trauma - several pieces of bone)
Segmental
Torus
Greenstick (if goes through growth plate then can affect growth)
Avulsed
Impacted
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2
Q

Describe the Salter Harris classification (I-V)

A

Type 1: # through the growth plate

TYPE 2: # through physis and metaphysis (MOST COMMON)

Type 3: # through physis and epiphysis
Type 4: # through epiphysis, physis, metaphysis

Type 4: impaction # (WORST PROGNOSIS)

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3
Q

What are the OARs?

A

XR indicated if there’s pain @ malleoli/5th MT/navicular + any of these findings:
Pain at lateral/medial malleolus OR navicular/5th MT
Inability to WB 4 steps immediately after injury or in ED

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4
Q

OAR sensitivity/specificity

A

OAR is good to rule OUT a # 99% SENS

but if there IS pain - it could be fracture but could also be lot of other things - LOW SPECIFICITY 35%

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5
Q

Ottawa Knee Rules

A

XR indicated if:

  1. Age > 55
  2. Tenderness head of fibula
  3. Tenderness of patella
  4. Cant bend knee >90º
  5. Cant WB in ED or right after injury > 4 steps

Again - high sensitivity + lower spec (45%)

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6
Q

XRs - pros and cons?

A

Pros:

  • cheap
  • good resolution/accessible
  • standard investigation

Cons:

  • poor sensitivity to detect subtle pathology
  • radiation
  • not good for soft tissues
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7
Q

What is the rule of twos in XRs?

A

Views - take 2 views 90º to each other
Joints - visualize 2 joints
Sides - if damage to growth plate?
Times - if monitoring change

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8
Q

Fracture Healing process: Inflammation

A

Step 1: INFLAMMATION

  • right after # - haematoma forms (good for stability)
  • inflammatory exudate
  • fibrin and collagen fibrils present in haematoma - haematoma replaced by granulation tissue
  • osteoclasts remove the bony necrosis from fracture
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9
Q

Fracture healing process: Soft Callus

A
  • osteoblasts are stimulated
  • bone growth starts away from # gap
  • capillaries grow into callus
  • fragments no longer moving freely
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10
Q

Fracture healing process: Hard Callus

A
  • intramembranous bone formation
  • ossification of soft tissues in gap
  • bone callus grows PERIPHERAL to central
  • endochondral ossification (soft tissue replaced by woven bone)
  • fragments now firmly united
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11
Q

Fracture healing process: Remodelling

A
  • lamellar bone replaces woven bone
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12
Q

What are radiographic and clinical signs of good fracture healing/union?

A

XR:

  • bony continuiity
  • callus formation

Clinical signs:

  • no pain on palpation
  • no pain on angulation
  • no mobility between fragments
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13
Q

What factors affect healing?

A

Age
Fracture type (ie severity of #)
Blood supply
Infection

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14
Q

How long (roughly) does it take for a fracture to heal?

A

(Perkin’s timetable):
UL spiral # - 3 weeks
LL - 6 wks
LL transverse - 6 wks

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15
Q

What are the general principles to be addressed when managing a #

A

Reduce (align the fragments)
Immobilize (immob/stabilize)
Mobilize (treat assoc impairments to prevent joint stiffness elsewhere?)

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16
Q

Name 5 complications (at least) from #

A

Stiffness
- d/t immobs - immob causes loss of sarcomeres and shortened mm on contracted side

Deformity
- causes abnormal biomechanics, OA, poor function of limb

Non/Mal-union
- Risk factors = high energy injuries, smoking, blood supply, little soft tissue (eg. tibia has little tissue around it)

Vascular Damage:

  • Direct -arterial injury
  • Secondary - compartment syndrome

Nerve Injury, Growth disturbance, Infection, OA

Fat embolism - reduce risk by EARLY STABILIZATION of bone #; can go to lungs/brain - hypoxaemia/cerebral ischemia

17
Q

Colles Fracture

A

MOI - FOOSH

Presentation: hx of trauma/swelling/pain/deformity/osteoporosis in women?

Management: open or closed, immobs (6/52), rx joint stiffness, mm strength etc

18
Q

Stress fracture - hip and groin

A

MOI: sudden change in training regimen

Presentation: worse with activity, better with rest, assoc with eating disorders/amenorrhea; common in PUBIC RAMUS/FEMORAL NECK

Management: rest+graded RTS

19
Q

Femoral shaft fractures

A

MOI - high energy; transverse, oblique, comminuted, spiral; may also have other fractures

Management: ORIF, plates/screws/intramedullary screw

20
Q

Patella fractures

A

MOI - fall/direct blow to knee
Types of patella fractures - transverse (MOST COMMON), lower pole, stellate, vertical, minimally displaced

Management: ORIF - scews, pins, wires

21
Q

Supracondylar fractures of the knee

A

just above the knee
MOI - high energy trauma
Management - ORIF

22
Q

Tibial plateau fracture

A

MOI - direct blow, fall, rotational force
Management: ORIF if displaced; 6 weeks NWB (so immob will cause stiffness); healing can be 10-12 weeks)

Implications: Valgus deformity/OA/knee stiffness

23
Q

Tibial shaft fractures

A

MOI - low or high energy

  • transverse/oblique/comminuted/spiral
  • poor soft tissue coverage - so may develop ulcers from cast?
  • poorer healing potential than femoral shaft
  • if there’s a rotational force - then tibia/fibula # at different levels; if direct blow - then tibia/fibula # at same level

Management:
Closed or ORIF + immobs

24
Q

What is the Danis-Weber Classification for ankle fractures?

A

Type A - infrasyndesmotic
Type B - transsyndesmotic
Type C - suprasyndesmotic (WORST+most complex - NWB for 10 weeks; screw through tib/fib for 10wks)

25
Q

Management for ankle fractures

A

6 weeks cast

PT intervention - advice is as good as rehab - Moseley et al (2015)

26
Q

Calcaneal Stress fracture

A

MOI - usually assoc with running
Presentation - tender post calc; ++ squeeze test
Management: reduce load; heel pads if needed

27
Q

Navicular Stress Fracture

A

MOI - common in jumping, sprinting, hurdling; d/t traction from tib post? impingement of tarsal bones?
Presentation - point tenderness
Management: Reduce load, cast/brace 6/52 + rehab post immob

28
Q

Jones fracture

A

Avulsion of 5th MT

MOI - inversion injury
Management - closed reduction, boot, WBAT

29
Q

Stress fracture, 2/3 MT

A

MOI - walking/marching

Management - boot

30
Q

Lisfranc injury

A

Tarsometarsal dislocation

MOI - low energy - twist/fall or high energy - fall from a height

Management - ORIF (lot of screws put in which can cause significant pain over time) or conservative - 6-8wks

  • can result in OA/ankle fusino/chronic pain

MSK II (7 decks)

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