Common Fractures II Flashcards

1
Q

Cervical Spine Fractures

General
Most common fractured levels

A

Cervical spineis susceptible to injury because it is highly mobile with relatively smallvertebral bodies

Most commonly fractured levels:
C2 (~30%)
C7 (~20%)

Result from:
Direct trauma
Axial loading
Secondary to exaggerated flexion or extension

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2
Q

Cervical Spine Trauma

Nexus criteria (5)

A

Nexus (National Emergency X-Radiography Utilization Study) Criteria
Set of validated criteria used to decide which trauma patients do not require cervical spine imaging
Sensitivity of 99.6% for ruling out cervical spine injury
May not be reliable with patient > 65 years of age

Criteria
Focal neurologic deficit present
Midline spinal tenderness present
Altered level of consciousness present
Intoxication present
Distracting injury present

If none of the above criteria are present, the C-spine can be cleared clinically by these criteria and imaging is not required

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3
Q

Jefferson Fracture

general

A

Fracture (burst fracture) of the first cervical vertebra (C1 or atlas)
33% are associated with a C2 fracture

Usually results from axial loading/compression injury
Diving headfirst into shallow water

Symptoms
Neck pain
Neurological deficit may be present
Most patients are neurologically intact

Open-mouth (odontoid) view is the most revealing

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4
Q
A
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5
Q

Hangman Fracture

general

A

Bilateral fracture in the pars interarticularis of the second cervical vertebra (C2 or axis)

Usually results from a hyperextension injury
Car accidents, diving injuries, or contact sports injuries

What determines stability?
The fracture is stable if the anterior longitudinal ligament and posterior longitudinal ligaments are intact

Symptoms
Neck pain
Neurological deficit may be present
Most patients are neurologically intact

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6
Q

Vertebral Compression Fractures

general

A

Most common type of osteoporoticfracture
Most common sites: T7–T8 and T12–L1

May results from significant force (MVC, fall from a height)
Associated spinal cord injury is often present
> 1 fracture

Signs & Symptoms
Osteoporotic fracture
Often asymptomatic
Non-osteoporotic fracture
Acute pain with bony tenderness at the fracture site
Muscle spasm

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7
Q

Vertebral Compression Fractures

Dx and Tx

A

Diagnosis
Based on physical examination and plain-film x-rays
Wedge-shapedvertebral body:compressionof the superior and/or anterior surface
CT scan should be obtained for significant trauma
MRI should be obtained if neurological symptoms or deficits are present

Treatment
Analgesics
Early mobilization and physical therapy
Kyphoplasty to relieve severe pain

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8
Q
A
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9
Q

Hip Fractures

general and complictions

A

Common fractures of older patients, particularly patients with osteoporosis as the result of minimal force
Trauma in younger

Fracture locations include:
Femoral head
Femoral neck – weakest part of the femur
Intertrochanteric
Subtrochanteric

Complications:
Osteonecrosis of the femoral head
Fracture nonunion
Osteoarthritis

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10
Q

Hip Fractures

S/Sx

A

Groin pain
Increased pain with passive hip rotation and resistance of hip flexion
Inability to ambulate
Shortening and external rotation of the affected leg

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11
Q

hip fx

dx and fx

A

Diagnosis
Based on physical examination and plain-film x-rays
AP pelvis and lateral view of the affected hip
A full femur view is obtained if a fracture is identified
CT or MRI is obtained for hips with negative plain-film x-rays, but high clinical suspicion

Treatment
Open reduction with internal fixation (ORIF)
Nondisplaced and impacted fractures in older patients
All femoral neck fractures in younger patients
Intertrochanteric fractures
Total hip replacement
Displaced femoral neck fractures in older patients

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12
Q

Ankle Fractures

general
Ligaments and stability

A

Common fractures that results from multiple mechanisms of injury
Inversion or eversion of the ankle
Direct blow
Includes:
Medial or posterior malleolus fractures of the tibia
Lateral malleolus fracture of the fibula

May be stable or unstable
Fractures that disrupt ≥ 2 of the ankle ligaments will be unstable
Disruption of the medial deltoid ligament may cause instability

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13
Q

maisoneuve fx

S/Sx

A

Pain and swelling at the injury site initially, then extension diffusely around the ankle

May be unable to bear weight

Tenderness at the proximal fibula
Proximal fibula fracture (spiral fracture) with anunstable ankle injury (widening of the ankle mortise on x-ray), often comprising ligamentous injury (deep deltoid ligament) and/or fracture of the medial malleolus → Maisonneuve fracture

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14
Q

ankle fx

Diagnosis & Treatment

don't need to memorize
A

Diagnosis:
Based on physical examination and plain-film x-rays
AP, lateral, and oblique views of the affected ankle

Treatment:
Depends on the stability of the ankle
Weber classification based on the lateral malleolus
Walking boot
Casting with no weight bearing
Orthopedic consultation
Open reduction with internal fixation (ORIF) – Maisonneuve fracture
Some Weber B fractures
All Weber C fractures

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15
Q

Fractures of the 5th Metatarsal Bone

Zones of the 5th metatarsal:

A

Zone I – Base/Tuberosity
Zone II – Metaphysis
Zone III - Diaphyseal

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16
Q

Fractures of the 5th Metatarsal Bone

general
MOI and S/Sx

A

Can be acute or stress fractures
Forced inversion of the foot and ankle

Signs & Symptoms:
Pain, swelling, and tenderness well-localized to the fracture site
Ecchymosis may be present
Pain is worse with weight bearing

17
Q

Fractures of the 5th Metatarsal Bone

Dx

different zones

A

Based on physical examination and plain-film x-rays

AP, lateral, and oblique views of the affected foot

Zone I fracture – Pseudojones fracture (Dancer’s fracture)
Fracture through the base (tuberosity) of the 5th metatarsal due to plantar flexion and inversion
Common fracture and less serious than other 5th metatarsal fractures

Zone II fracture – Jones fracture
Fracture at the metaphyseal-diaphyseal junction that often occurs with ankle sprains
Higher risk for nonunion due to the zone being avascular

Zone III fracture – stress fracture

18
Q
A

Left: Pseudojones fracture
Right: Jones fracture

19
Q

Fractures of the 5th Metatarsal Bone

Tx of Zone I, II, III

A

Zone I fracture
Weight bearing as tolerated
Walking boot

Zone II or III fracture
Casting with no weight bearing
Orthopedic or podiatry consultation

20
Q

Calcaneal Fractures

General

A

Fractures resulting from great force (axial load)
Falling from a height onto the heels

Often associated with other injuries
Thoracolumbar compression fracture

If not diagnosed and treated properly → long-term disability
~10% are missed at initial presentation in the ER

21
Q

Calcaneal Fractures

S/Sx
Specific sign/test

A

Signs & Symptoms
Tenderness and swelling to the heel and hindfoot
Unable to bear weight

Mondor sign
A hematoma formed that extends distally along the sole of the foot
Pathognomonic finding for calcaneal fracture

22
Q

calcaneous fx

Dx and Tx

A

Based on physical examination and imaging
Axial and lateral views of the affected foot
CT scan is done if:
X-ray is negative, but clinical findings suggest a calcaneal fracture
The Bohler angle is < 20˚=fx
More detail about the fracture is needed

Treatment
Casting with no weight bearing
Orthopedic consultation

23
Q

Calcaneous fx

Bohler angle

A

Determined from the lateral view
Normal angle is 20-40˚
< 20˚ suggests a fracture of the calcaneus

24
Q

Case 1
Describe the fracture(s) (include the involved bone(s), portion of the bone, and type of fracture)

A

Spiral fracture of the right 3rd metacarpal

25
Q
A