common fractures Flashcards
what are some common lower limb and pelvis fratures?
Ankle fractures Tibial Shaft Fractures Tibial Plateau fractures Femoral Shaft Fractures Pelvic Fractures
how do ankle fractures commonly occur?
inversion injury with rotational force applied to the foot
what is the classification of ankle fractures?
Weber A, Weber B, Weber C
what would you classify a fracture in the blue area?
Weber A fracture (below joint line- stable)
what would you classify a fracture in the green area?
Weber B fracture
what would you classify a fracture in the purple area?
Weber C fracture (above joint line- unstable)
management of ankle fractures?
conservative:
-cast or mono boot
operative:
-open reduction internal fixation (ORIF)
what do tibial shaft fractures increase risk of?
compartment syndrome
what type of tibial shaft fractures are there?
Spiral
Transverse
Oblique
Comminuted
management for tibial shaft fracture?
conservative:
-above the knee cast
operative:
- IM nailing
- open reduction internal fixation
what causes tibial plateau fracture?
in young- high energy injuries
in old- low energy injuries in osteoporotic bone
what are risks associated with tibial plateau fracture?
- neurovascular injury of popliteal structure/common perineal nerve
- compartment syndrome
what type of fracture are soft tissue injuries of knee joint structures associated with?
tibial plateau fracture
management for tibial plateau fracture?
conservative:
-above knee cast
operative:
- Open Reduction Internal Fixation (ORIF)
- External Fixator
- Delayed Total Knee Replacement
management for femoral shaft fracture?
conservative:
-not typically used
operative:
- IM nail
- plate fixation: ORIF
what is management for pelvic fractures?
initial= pelvic binder
conservative
operative
what are common fractures of upper limb?
Distal Radius Fractures Forearm Fractures Olecranon Fractures Humeral Shaft Fractures Proximal Humeral Fractures
what is a common cause of distal radius fracture?
FOOSH
Fall on outstretched hand
what are the different distal radius fractures?
Colles
Smiths
Bartons fractures
what are Colles distal radius fracture?
Colles fracturesare common extra-articular fractures of the distal radius that occur as the result on an outstreteched hand. Consists of a fracture of the distal radial metaphyseal region with dorsal angulation and impaction, but without the involvement of the articular surface.
what are smiths distal radius fracture?
Smith fractures, are fractures of the distal radius with associated volar angulation of the distal fracture fragment(s). Classically, these fractures are extra-articular transverse fractures and can be thought of as areverse Colles fracture.
what are Barton distal radius fractures?
Barton fractures extend through the dorsal aspect to the articular surface but not to the volar aspect . There is usually associated dorsal subluxation/dislocation of the radioocarpal joint.
management for distal radius fracture?
conservative:
-cast/splint
operative:
-ORIF/MUA + K-wires/Ex-fix
if there is a fracture in the radius there is usually a fracture in the ulna.
True or False?
True
Usually if there is a fracture of one bone, often there is an injury of the other
what are examples of forearm fracture patterns?
Monteggia
Galeazzi fracture dislocations
Nightstick fracture
what is a Monteggia fracture?
Monteggia fracture-dislocationsconsist of a fracture of the ulnar shaft with concomitant dislocation of the radial head.
what is Galeazzi fracture?
Galeazzi fracture-dislocationsconsist of a fracture of the distal part of theradiuswith dislocation of the distal radioulnar joint and intact ulna
what’s a nightstick fracture?
Nightstick fracturesare isolated fractures of the ulna- typically transverse and located in the mid-diaphysis and usually resulting from a direct blow. It is a characteristic defensive fracture
management of forearm fractures?
conservative:
-cast
operative:
-ORIF
what is an olecranon fracture?
common injury from falling onto the elbow
management of olecranon fracture?
conservative:
-cast
Operative:
- tension band wiring/ORIF
- plate fixation
what risks does a humeral shaft fracture have?
radial nerve
what causes humeral shaft fracture?
-direct trauma to the arm
what is a humeral shaft fracture?
fall resulting in oblique, or spiral fractures in the humeral bone
what is the management for humeral shaft fractures?
conservative:
- humeral brace/U slab cast
- IM nail/ORIF plate fixation
what is a proximal humerus fracture?
common injury to humerus, typically low energy of osteoporotic bone from a fall
risk associated with proximal humerus fracture?
damage to axillary nerve
what is the management for proximal humerus fracture?
conservative:
-collar + cuff
Operative:
-ORIF/replacement
what’s 1st degree nerve injury?
neurapraxia
what is neuropraxia?
Temporary conduction block / demyelination
Should resolve within 28 days
what is 2nd degree nerve damage?
axonotmesis
what is axontmesis?
Nerve cell axon dies distally from point of injury = Wallerian degeneration
Structure of nerve (endoneurial tubes) intact
Regenerates at 1mm per day
what is 3rd degree nerve damage?
neurotmesis
what is neurotmesis?
Nerve transected – rare with # or dislocation
No recovery without surgery
what is malunion?
fracture has healed in non anatomic position
how does malunion present?
Pain
Stiffness
Loss of Function
Deformity
what is non union?
when the fracture doesn’t heal
what increases chances of atrophic non union?
Poor blood supply to fracture site Fracture gap too big and no movement Systemic disease Smoking Medicines – steroids, NSAIDs, bisphosphonates infection!!
what increases chances of hypertrophic non union?
- Too much movement at fracture site
- Abundant callus response but failure union
-Infection
what are the two ways in which fractures may heal and what is more common?
-primary or secondary
secondary bone healing occurs in majority of fractures
when would primary bone healing occur?
-in minimal fracture gap (less than 1mm hairline fracture)
describe primary bone healing
-bones bridge the gap with new bone from osteoblasts
describe secondary bone healing?
- fracture occurs
- haematoma occurs with inflammation from damaged tissue
- macrophages and osteclasts remove debris and resorb the bone ends
- granulation tissue forms from fibroblasts and new blood vessels
- chondroblasts form cartilage (SOFT CALLUS)
- osteoblasts lay down bone matrix (type 1 collagen)
- calcium mineralisation produces immature woven bone (HARD CALLUS)
- remodelling occurs with organisation along lines of stress into lamellar bones
fracture—->swelling —->soft callus (2-3 weeks)—-> hard callus (6-12 weeks)–> remodelling
