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Joints, bones and skin > Bones and fractures > Flashcards

Bones and fractures Flashcards

1
Q

What is ultrasound useful to check for in RA?

A

Soft tissue swelling
Osteoporosis
Joint space narrowing
Marginal erosions

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2
Q

What find in initial phase of RA on USS?

A

Synovitis

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3
Q

What is seen on USS of RA in late stages of the disease?

A

Erosive arthropathy )periarticular eroisons and marginal)
Osteoporosis
Symmetrical
Concentric joint space narrowing
Preference for PIP + MCP (2nd +3rd)
Subluxation adn deformity (ulnar deviation)
Boutienniere and swan neck deformities
Carpal instability

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4
Q

What are synovitis signs?

A

Soft tissue swelling
Juxt-articular osteopaenia

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5
Q

General approach to large joint X-rays

A

Check patient demographic details (Name, DOB and hospital number)
Check type of joint image done (comment on projection of the image)
Check whether entire region has been covered
Is the XR adequate?
Bone density (normal/ increased or decreased/ lucency)
Look at joint spacing

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6
Q

Increased density in sclerotic processes or decreased in osteopaenia and lucency would be sign of what

A

Malignancy

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7
Q

What is an osteochondral defect?

A

Focal area of damage to cartliage and bone

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8
Q

Fracture Xrays approach

A

Describe the radiograph
Type of fracture?
Where is the fracture?
Is it displaced?
Is anything else going on?

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9
Q

What is angulation in fractures

A

Distal portion of bone in different direction

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10
Q

What is rotation of fracture on X ray

A

-Rotation of the distal fragment, distraction

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11
Q

What is impaction of a fracture?

A

Fracture resulting increased or decreased bone length

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12
Q

What is translation of bone in fractures?

A

Movement of fractured bones away from each other

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13
Q

What can cause a clavicle fracture

A

FOOSH
Direct trauma to shoulder

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14
Q

What is the most important thing to asses with a fracture

A

Neurovascular status

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15
Q

When is surgery ORIF used in clavicle fracture?

A

Lateral fractures, open fractures, NV compromise, bilateral, multiple trauma

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16
Q

What is general management for non complicated or severe breaks?

A

Immobilisation + analgesia + physio

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17
Q

What patients get a proximal humerus fracture?

A

Elderly, osteoporosis, FOOSH

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18
Q

What assess for in fractures

A

Deformity
Bruising
Muscular damage eg rotator cuff issues - proximal humerus
NV status
Dislocation

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19
Q

When is a radiograph used to investigate humeral shaft fracture?

A

Spiral fracture

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20
Q

What fractures do you get the fat pad sign with?

A

Radial head fracture, from a FOOSH

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21
Q

What is the terrible triad for elbow fracture?

A

Posterior elbow dislocation, radial head fracture and coronoid fracture

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22
Q

What motor symptoms does a radial head fracture cause?

A

Inability to fully extend elbow + reduced range of pronation and supination

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23
Q

What motor symptoms does a radial head fracture cause?

A

Inability to fully extend elbow + reduced range of pronation and supination

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24
Q

When do you not do an ORIF in children?

A

When danger of interrupting the growth plate - not in children

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25
Q

What is Monteggias fracture?

A

Ulnar (proximal) fracture and radial head dislocation

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26
Q

What is Galeazzis fracture?

A

Radial shaft fracture and ulnar dislocation

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27
Q

Why do some bones break in multiple places after force?

A

Ring structures - polo mint snaps in multiple places

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28
Q

Who is likely to get Colle’s fracture

A

Elderly, osteoporotic + postmenopausal women

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29
Q

Symptoms of a Colles fracture

A

Wrist pain + swelling + restrictred ROM + dinner fork deformity

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30
Q

Treatment for Colles fracture

A

Immediate reduction using anesthetic block + pre + post XRs to check, immobilisation and physio
Surgery if conservative measures not worked - K wired, bone grafting, ORIF

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31
Q

What causes a scaphoid?

A

Fall onto dorsiflexed hand - FOOSH
Not seen in extremes of age

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32
Q

Symptoms of scaphoid fracture

A

Wrist pain with restricted ROM
Tenderness on gripping and wrist extension
Tenderness aound anatomical snuffbox

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33
Q

Symptoms of scaphoid fracture

A

Wrist pain with restricted ROM
Tenderness on gripping and wrist extension
Tenderness aound anatomical snuffbox

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34
Q

Treatment for scaphoid fracture

A

Immobilisation in spica cast + PHYSIO
Surgical management with K wires

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35
Q

Boxers fracture symptoms

A

MCP pain + swell, deformity is displaced, may be bite marks or knuckle flattening

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36
Q

Treatment for Boxers fracture

A

Conservative - immobilisation - buddy strapp with reduction if needed + physio

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37
Q

When do you offer surgery for fractures?

A

Displacement, deformity, communition, angulation, instability

38
Q

What is Bennetts fracture?

A

Thumb MCP base intra-articiular with displacement

39
Q

Symptoms of Bennetts fracture

A

Thumb base pain + swelling + decreased ROM with instability

40
Q

What is important with investigations for Bennetts fracture?

A

Repeat radiographies in 2 weeks

41
Q

Bennetts fracture management

A

Conservative (Closed reduction with analgesia, immobilization in Bennet’s cast and physio), Surgery (If instability, ORIF and K wires)

42
Q

Symptons/signs of pelvic fractures?

A

Pain and bruising in pelvic region, instability, flank/perianal/urogenital swelling, bruising, bleeding, high-riding prostate on PR

43
Q

Investigations pelvic fracture

A

Pelvic radiograph - inlet and outlet views + oblique
CT - definitive

44
Q

Treatment pelvic fracture

A

ALTS assess + resus, pelvic stabilisation using external fixator - prevent clot disruption
Radiological mebolisation
Surgery for unstable pelvic fractures and acetabular disruption
50% mortality

45
Q

Mortality NOF 2 months after fixation

A

High mortality 30%

46
Q

Signs of NOF

A

Trauma hostroy, hip pain with no weight bearing possible, external rotation and shortening of leg

47
Q

Investigations for NOF

A

Hip nad pelvic radiographs - look at shentons line

48
Q

Treat NOF

A

ALTS assess + resus
DVT prophylaxis
Surgery - extracapsular (reduction + dynamic hip screw), intracapsular (non-displaced would be internal screw fixation + displaced is hemi arthroplasty or total hip arthroplasty)

49
Q

What is a dangerous complictaion of NOF fracture?

A

Avascular necrosis + blood supply to femoral neck compromise
Especially in intracapsular as leaves ligamentum teres as only source

50
Q

Where is concerning for considerable blood loss?

A

Pelvic, femoral shaft fractures
On the floor and 4 more -
Long bones/limbs
Abdomen
Pelvic
Chest
Heaad

51
Q

Signs femoral shaft fractures

A

Pain, deformity and bruising to thigh
Assess soft tissues of leg (sciatic nerve + peripheral circulation)

52
Q

Treatment femoral shaft fracture

A

Resus then fracture splinting
Surgery indicated

53
Q

What causes tibial plateau

A

Direct compression injury - femoral condyle impacting on tibial plateua
Often fall from height

54
Q

Signs tibial plateua injury

A

Knee pain, swelling )haemarthrosis) + deformity with ass ligament injury

55
Q

Where are Weber fractures?

A

Ankle joint

56
Q

Causes of Weber fractrue

A

Indirect - inversion of ankle ass with ligmaent damage and dislocation. Lateral malleolar
A,B or C

57
Q

What causes talus fractures?

A

Forced dorsiflexion, high energy trauma - RTA or fall from heigh tor low energy eg sprain -> avulsion. Below the knee plaster or ORIF

58
Q

What causes calcaneum fracture

A

Fall onto heel, common bilaterally
High energy such as fall from height
Ass spine, pelvis and tibial plateau injury

59
Q

What is RICE

A

Rest Ice compression Elevation

60
Q

What causes a metatarsal fracture

A

Inversion injury (avulsion)
Direct injury causes complete fracture, can get shaft, stress and neck fractures

61
Q

Common fractures in children

A

Greenstick
Buckle fracture
Supracondylar fracture
Pulled elbow
Distal forearm - MUA

62
Q

What criteria is used to classify fractures in children?

A

Salter Harris criteria

63
Q

What does Salter Harris criteria stand for?

A

Straight across
Above
Lower or beLow
Two or Through
ERosure of growth plate

64
Q

When to suspect NAI in children

A

Fully dependent child/non ambulatory with fracture
Injury and history inconsistent
Delay in seeking medical attention
Multiple fractures
Senior - seek help if any suspicions
Injuries to: both sides of the body, soft tissue, with particualr patterns, untreated

65
Q

What can cause pathological fractures

A

Tumour
Bone cysts
Metabolic disorders

66
Q

How do you assess a closed frature?

A

Assess NV status
Assess soft tissues
Splint
Back slab

67
Q

What extra do you need to do when treating an open fracture?

A

Open: Photograph before dress
Tetanus booster
IV antibiotics

68
Q

Patient assessment in emergency fracture

A

Masive haemorrhage
AW + C spine
Breathing
Disability - GCS, neurology + abdo exam
Exposure - avoidance of hypothermia

69
Q

Approach to fractures

A

Anatomy - which part, side of which bone?
Fracture type - open/closed, transverse, obliwue, spiral comminuted
Number of fragments
Displacemet - translation, angulation, rotation, shortening, distraction
Joint involvement - intra or extrarticular
Ass dislocation
NV assessment

70
Q

Initial management of fracture patients

A

IV access
Analgesia
Bloods - prepare for theatre
Resus

71
Q

Analgesia for fractures

A

Stepwise:
-Paracetemol
-NSAIDs
-Codeine
-Tramadol
-Morphine

72
Q

What bloods do you do to prepare a patient for theatre

A

FBC
U+Es
Group and save
Cross match

73
Q

Resus for fracture patients

A

Fluids
Blood components
Major trauma
Transufion pack

74
Q

Why are postmenopausal women more at risk of fractures?

A

Decreased bone mineral density + increased fracture risl

75
Q

What can reduce the risk of osteoporisis and fracture in postmenopausal women

A

HRT
Calcium/vit D supplementation

76
Q

How does number of pregnancies affect fracture risk?

A

Reduces risk of hip and lower spinal fracture (NOT wrist)
Increased oestrogen and load on lower skeleton
Increases per preganancy

77
Q

Factors htat influence bone density

A

Menopause
Parity
Age
Sex
Genes
Nutrition
Exercise
Race - caucasian or south east asian particuarly at risk, smoking

78
Q

What is the opposite of a Colle fracture?

A

Smiths fracture

79
Q

Early complications of fractures

A

Bleeding - internal and extermal
Injury to nerves, vessels, internal organs
Compartment syndrome
Infection
Fracture blisters
Pressure sores

80
Q

Late complications of fractures

A

Infection - osteomyelitis
Mal-union/non-union
Growth disturbance
Joint stiffness
Complex Regional Pain Syndrome (CRPS)
Avascular necrosis
Myositis ossificans

81
Q

Late complications of fractures

A

Infection - osteomyelitis
Mal-union/non-union
Growth disturbance
Joint stiffness
Complex Regional Pain Syndrome (CRPS)
Avascular necrosis
Myositis ossificans

82
Q

What is Compartment syndrome

A

Pressure inside a comparmtent increases due to accumulation of blood or fluid trapped in this compartment, restricts blood flow to area and potentially damages nerves and muiscles nearby

83
Q

What does excruciating pain on passive stretching of muscle compartment signify?

A

Early sign of compartment syndrome

83
Q

What does excruciating pain on passive stretching of muscle compartment signify?

A

Early sign of compartment syndrome

83
Q

What does excruciating pain on passive stretching of muscle compartment signify?

A

Early sign of compartment syndrome

83
Q

What does excruciating pain on passive stretching of muscle compartment signify?

A

Early sign of compartment syndrome

83
Q

What does excruciating pain on passive stretching of muscle compartment signify?

A

Early sign of compartment syndrome

84
Q

How do you treat compartment syndrome

A

Immediate surgical decompression - fasciotomy. Otherwise can lead to ischaemia and necrosis of tissue.

85
Q

What is myositis ossificans?

A

When bone tissue grows where its not supposed to eg soft tissue, ligaments, muscle, after trauma -> restricted ROM, hard lump

86
Q

Signs of basal skull fracture

A

Battles sig n
CSF leaking out of ears and nose
Haemotympanum

87
Q

How quickly does a NOF need surgery and why?

A

24 hours - 50% mortality, retrun to optimum asap

Joints, bones and skin (31 decks)

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