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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
What is Monteggias fracture?
Ulnar (proximal) fracture and radial head dislocation
26
What is Galeazzis fracture?
Radial shaft fracture and ulnar dislocation
27
Why do some bones break in multiple places after force?
Ring structures - polo mint snaps in multiple places
28
Who is likely to get Colle's fracture
Elderly, osteoporotic + postmenopausal women
29
Symptoms of a Colles fracture
Wrist pain + swelling + restrictred ROM + dinner fork deformity
30
Treatment for Colles fracture
Immediate reduction using anesthetic block + pre + post XRs to check, immobilisation and physio Surgery if conservative measures not worked - K wired, bone grafting, ORIF
31
What causes a scaphoid?
Fall onto dorsiflexed hand - FOOSH Not seen in extremes of age
32
Symptoms of scaphoid fracture
Wrist pain with restricted ROM Tenderness on gripping and wrist extension Tenderness aound anatomical snuffbox
33
Symptoms of scaphoid fracture
Wrist pain with restricted ROM Tenderness on gripping and wrist extension Tenderness aound anatomical snuffbox
34
Treatment for scaphoid fracture
Immobilisation in spica cast + PHYSIO Surgical management with K wires
35
Boxers fracture symptoms
MCP pain + swell, deformity is displaced, may be bite marks or knuckle flattening
36
Treatment for Boxers fracture
Conservative - immobilisation - buddy strapp with reduction if needed + physio
37
When do you offer surgery for fractures?
Displacement, deformity, communition, angulation, instability
38
What is Bennetts fracture?
Thumb MCP base intra-articiular with displacement
39
Symptoms of Bennetts fracture
Thumb base pain + swelling + decreased ROM with instability
40
What is important with investigations for Bennetts fracture?
Repeat radiographies in 2 weeks
41
Bennetts fracture management
Conservative (Closed reduction with analgesia, immobilization in Bennet’s cast and physio), Surgery (If instability, ORIF and K wires)
42
Symptons/signs of pelvic fractures?
Pain and bruising in pelvic region, instability, flank/perianal/urogenital swelling, bruising, bleeding, high-riding prostate on PR
43
Investigations pelvic fracture
Pelvic radiograph - inlet and outlet views + oblique CT - definitive
44
Treatment pelvic fracture
ALTS assess + resus, pelvic stabilisation using external fixator - prevent clot disruption Radiological mebolisation Surgery for unstable pelvic fractures and acetabular disruption 50% mortality
45
Mortality NOF 2 months after fixation
High mortality 30%
46
Signs of NOF
Trauma hostroy, hip pain with no weight bearing possible, external rotation and shortening of leg
47
Investigations for NOF
Hip nad pelvic radiographs - look at shentons line
48
Treat NOF
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
What is a dangerous complictaion of NOF fracture?
Avascular necrosis + blood supply to femoral neck compromise Especially in intracapsular as leaves ligamentum teres as only source
50
Where is concerning for considerable blood loss?
Pelvic, femoral shaft fractures On the floor and 4 more - Long bones/limbs Abdomen Pelvic Chest Heaad
51
Signs femoral shaft fractures
Pain, deformity and bruising to thigh Assess soft tissues of leg (sciatic nerve + peripheral circulation)
52
Treatment femoral shaft fracture
Resus then fracture splinting Surgery indicated
53
What causes tibial plateau
Direct compression injury - femoral condyle impacting on tibial plateua Often fall from height
54
Signs tibial plateua injury
Knee pain, swelling )haemarthrosis) + deformity with ass ligament injury
55
Where are Weber fractures?
Ankle joint
56
Causes of Weber fractrue
Indirect - inversion of ankle ass with ligmaent damage and dislocation. Lateral malleolar A,B or C
57
What causes talus fractures?
Forced dorsiflexion, high energy trauma - RTA or fall from heigh tor low energy eg sprain -> avulsion. Below the knee plaster or ORIF
58
What causes calcaneum fracture
Fall onto heel, common bilaterally High energy such as fall from height Ass spine, pelvis and tibial plateau injury
59
What is RICE
Rest Ice compression Elevation
60
What causes a metatarsal fracture
Inversion injury (avulsion) Direct injury causes complete fracture, can get shaft, stress and neck fractures
61
Common fractures in children
Greenstick Buckle fracture Supracondylar fracture Pulled elbow Distal forearm - MUA
62
What criteria is used to classify fractures in children?
Salter Harris criteria
63
What does Salter Harris criteria stand for?
Straight across Above Lower or beLow Two or Through ERosure of growth plate
64
When to suspect NAI in children
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
What can cause pathological fractures
Tumour Bone cysts Metabolic disorders
66
How do you assess a closed frature?
Assess NV status Assess soft tissues Splint Back slab
67
What extra do you need to do when treating an open fracture?
Open: Photograph before dress Tetanus booster IV antibiotics
68
Patient assessment in emergency fracture
Masive haemorrhage AW + C spine Breathing Disability - GCS, neurology + abdo exam Exposure - avoidance of hypothermia
69
Approach to fractures
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
Initial management of fracture patients
IV access Analgesia Bloods - prepare for theatre Resus
71
Analgesia for fractures
Stepwise: -Paracetemol -NSAIDs -Codeine -Tramadol -Morphine
72
What bloods do you do to prepare a patient for theatre
FBC U+Es Group and save Cross match
73
Resus for fracture patients
Fluids Blood components Major trauma Transufion pack
74
Why are postmenopausal women more at risk of fractures?
Decreased bone mineral density + increased fracture risl
75
What can reduce the risk of osteoporisis and fracture in postmenopausal women
HRT Calcium/vit D supplementation
76
How does number of pregnancies affect fracture risk?
Reduces risk of hip and lower spinal fracture (NOT wrist) Increased oestrogen and load on lower skeleton Increases per preganancy
77
Factors htat influence bone density
Menopause Parity Age Sex Genes Nutrition Exercise Race - caucasian or south east asian particuarly at risk, smoking
78
What is the opposite of a Colle fracture?
Smiths fracture
79
Early complications of fractures
Bleeding - internal and extermal Injury to nerves, vessels, internal organs Compartment syndrome Infection Fracture blisters Pressure sores
80
Late complications of fractures
Infection - osteomyelitis Mal-union/non-union Growth disturbance Joint stiffness Complex Regional Pain Syndrome (CRPS) Avascular necrosis Myositis ossificans
81
Late complications of fractures
Infection - osteomyelitis Mal-union/non-union Growth disturbance Joint stiffness Complex Regional Pain Syndrome (CRPS) Avascular necrosis Myositis ossificans
82
What is Compartment syndrome
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
What does excruciating pain on passive stretching of muscle compartment signify?
Early sign of compartment syndrome
83
What does excruciating pain on passive stretching of muscle compartment signify?
Early sign of compartment syndrome
83
What does excruciating pain on passive stretching of muscle compartment signify?
Early sign of compartment syndrome
83
What does excruciating pain on passive stretching of muscle compartment signify?
Early sign of compartment syndrome
83
What does excruciating pain on passive stretching of muscle compartment signify?
Early sign of compartment syndrome
84
How do you treat compartment syndrome
Immediate surgical decompression - fasciotomy. Otherwise can lead to ischaemia and necrosis of tissue.
85
What is myositis ossificans?
When bone tissue grows where its not supposed to eg soft tissue, ligaments, muscle, after trauma -> restricted ROM, hard lump
86
Signs of basal skull fracture
Battles sig n CSF leaking out of ears and nose Haemotympanum
87
How quickly does a NOF need surgery and why?
24 hours - 50% mortality, retrun to optimum asap

Joints, bones and skin (31 decks)

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