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BMSc - Orthopaedic Medicine > Common Fractures > Flashcards

Common Fractures Flashcards

1
Q

What are the 7 signs of fracture?

A 
pain
deformity 
loss of function 
crepitus 
discolouration/bruising  
tenderness
swelling
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2
Q

How are fractures investigated?

A 
examination 
Xray 
CT 
Ultrasound 
Radioisotope Scanning
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3
Q

How does radioisotope scanning work in fracture investigation?

A

radio labelled phosphate is taken up by injured bone faster than others so can be seen brighter on X-ray

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4
Q

How is a fracture described?

A

which bone one which side?
where is it broken?
open/closed?
What shape? spiral, oblique, transverse etc
How many fragments?
Position of the distal fragment? (displacement, rotation and angulation)

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5
Q

What is a pathological fracture?

A

A fracture which has occured due to underlying pathology of the bone itself e.g. brittle bones, tumour, osteoporosis

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6
Q

How much blood can be lost from:

a) an unstable pelvic fracture?
b) femoral fracture

A

a) 6 units

B) 3 units

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7
Q

How can pain be relived following a fracture?

A

Pain relief drugs - morphine

splint age/traction

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8
Q

Why is special care required in open fractures?

A

Wounds are contaminated and so the risk of infection is high. Debridement must take place

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9
Q

What kind of conditions may influence bone quality?

A

osteoporosis

brittle bones

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10
Q

What is fracture reduction?

A

restoration of normal position - fractures must be reduced and then held there until it heals naturally

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11
Q

How is closed reduction performed?

A

traction of the distal fragment and then relocation into the proximal fragment by manipulation

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12
Q

When is open reduction performed?

A

When closed reduction is unsuccessful

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13
Q

Name 4 methods of holding bone together:

A

casting
external fixation
internal fixation
traction

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14
Q

How does cast work?

A

a cast acts as a splint to control joint movement and posture. it is moulded so it exerts 3 point pressure.

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15
Q

What is a functional brace?

A

a plaster cast with hinges between segments so the joint is free but control is maintained

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16
Q

What is external fixation?

A

fixation of a fracture via an external scaffold in a situation where there is extensive soft tissue damage

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17
Q

When is internal fixation used?

A

where a high degree of accuracy is required

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18
Q

What is used in internal fixation?

A

plates, nails, screws, wires

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19
Q

What are the 4 ways internal fixation is done?

A

apposition
interfragmentary compression
interfragmentary compression and onlay device
inlay device

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20
Q

What helps achieve interfragmentary compression?

A

screws

21
Q

What is an onlay device?

A

plate

22
Q

what are the downsides of plates?

A

they inhibit natural bone healing and delay full healing and full load bearing by eliminating micro-movement at the fracture site

23
Q

What is an inlay device?

A

IM nails

24
Q

What kind of bones do IM nails work well in?

A

long bones

25
Q

Why are implants removed?

A

Bone adapts to the loads placed on it and the support given by implants results in bone remodelling and weakening as there is a boundary between loaded and unloaded bone

26
Q

What are the three types of traction?

A

static
balanced
dynamic

27
Q

Why is balanced traction used over static traction?

A

Where static traction is going to cause damage to the body through pressure - balanced traction is balanced by a weight attached to the whole splint which takes the pressure off the skin

28
Q

What is dynamic traction?

A

where joints are still permitted to move but by means of pulleys, the pull is still maintained along the line of the broken bone

29
Q

How does bone heal?

A 
swelling 
callus formation 
bone formation 
bone 
bone remodelling and bone returns to normal
30
Q

How is micro-movement useful in bone healing?

A

micro-movement along the axis of the long bone at right angles to the break stimulates external callus formation

31
Q

will fractures heal if no micro-movement is present?

A

Yes- but slowly and no callus formation takes place

32
Q

In a long bone fracture of low energy, what method of fixation is useful?

A

manipulation and casting

33
Q

What method is used to fix intra-articular fractures?

A

screws and wires

34
Q

In high velocity injuries, which type of fixation is useful

A

external fixation

35
Q

What is a pathological fracture?

A

When bone, subject to normal loading, abnormally fractures

36
Q

Why are fractures in the elderly commonly held using IF techniques?

A

early fixation leads to earlier mobility and functional ability allowing for reduced consequences like bedsores, muscle wasting etc.

37
Q

Name 6 early complications of fracture

A 
blood loss
infection 
fat embolism 
renal failure 
soft tissue injury 
compartment syndrome
38
Q

Name 5 late fracture complications

A 
non-union
delayed union 
mal-union 
growth arrest 
arthritis
39
Q

Name 5 secondary fracture complications (as a consequence of treatment)

A 
plaster disease 
renal stones 
immobility 
infection 
compartment syndrome 
mal-union 
infection
40
Q

What are some signs of fat embolism?

A

tachypnoea
confusion
rash on chest and neck

41
Q

Which protein is found in the kidneys of people after trapped limbs or ischaemic limbs?

A

myoglobin

42
Q

How does compartment syndrome occur?

A

after fracture, bleeding and inflammation inside the fascial sheath causes increased pressure, which blocks of circulation and causes ischaemia and extreme pain out of proportion to the injury

43
Q

How is compartment syndrome treated?

A

remove plaster/dressings/bandages

URGENT FASCIOTOMY

44
Q

What problems can be caused by immobility

A 
hyper coagulability - DVT/PE 
osteoporosis 
renal stones 
stiffness 
muscle wasting 
bedsores
45
Q

Name some reasons for non-union

A 
excess movement 
too little movement 
soft tissue interposition 
poor blood supply 
infection 
excessive traction
46
Q

What is mal-union?

A

where a fracture has been allowed to heal in a position that precludes normal function

47
Q

How can growth arrest occur after a fracture?

A

if the fracture breaches the germinal layer of the epiphyseal growth plate, bone growth may be arrested at the point of breach = deformity

48
Q

How can arthritis be caused after a fracture?

A

if a joint i excessively stressed

if the joint is no longer congruent

a very angulated fracture will put uneven forces on the joint

BMSc - Orthopaedic Medicine (13 decks)

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