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Orthopaedics > Common upper and lower limb fractures > Flashcards

Common upper and lower limb fractures Flashcards

1
Q

Classifications of clavicular fractures

A

Allman classifications
Group I; fractures of middle 1/3 (70%)
Group II: distal third (less than 30%)
Group III: proximal third (3%)

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2
Q

Mechanism of injury of clavicle fracture

A

Fall onto shoulder
- traffic accidents
- sports
Less commonly, direct blow from an object

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3
Q

Presentation of clavicle fracture

A

Middle third:
- Pain (well localised, exac. by arm movement)
- cracking or snapping sensation at time of injury
- local swelling around clavicle
- point tenderness +/- crepitus
+/- visible bulge
+/- bone angulation
tenting of skin suggests significant angulation or displacement

Distal third:

  • pain and tenderness around AC joint
  • Cross arm tests (pain inc. if adduct arm across chest)
  • little or no deformity seen on examination
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4
Q

Radiological diagnosis of clavicular fraacture

A

30 DEGREE UPTILT VIEW (so can see clavicle “above horizon”)

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5
Q

Types of distal 3rd (group 2) clavicle fractures

A 
Type I (most common): no displacement
Type II: proximal fragment loses ligamentous attachment (sup. displacement)
Type III: intra-articular - extending into AC joint diff. to diagnose on x-ray
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6
Q

Management of clavicle fracture

A 
Referral to orthoif:
- open
- "floating shoulder"
- displaced
- comminuted
- shortened
- distal type II or III
Conservative manageemt:
- pain relief (e.g. endone)
- intermittent icing first 72h
- sling for 6-12w adult, 3-6w child
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7
Q

Management of scapula fracture

A

operative if glenoid cavity fractured
Otherwise sling and swathe bandage short term immobilisation
most heal completely within 6 weeks

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8
Q

Mechanism of injury of proximal humeral fracture

A

Fall from standing

Direct blow, violent muscle contraction (e.g. seizure)

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9
Q

Clinical features of proximal humeral fracture

A 
Mod-sev pain inc with shoulder movement
Arm held adducted at side
Swelling and ecchymosis
\+/- gross shoulder deformities
focal tenderness at proximal humerus
neurovascular injury (most commonly axillary or subscapular)
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10
Q

Radiology for proximal humerus fracture

A

Shoulder series:

  • AP
  • axillary
  • Scapular Y view
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11
Q

Indications for ortho referral of proximal humeral fracture

A

Fracture of anatomic neck

All displaced or open fractures

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12
Q

Complications of proximal humeral fractures

A

Red. shoulder mobility (range from insignificant to adhesive capsulitis)
Neurovasc, inj (circumflex artery, axillary or supscapular n.)
Non-union
Osteonecrosis of humeral head
Impingement from avulsed fragments

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13
Q

Midshaft humerus fracture mechanism of injury

A

Trauma (direct blow or bending force to humerus)

Less commonly: FOOSH or fall on elbow

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14
Q

Clinical presentation of midshaft humeral fracture

A

Severe mid-arm pain
+/- referred pain to shoulder/elbow
Swelling and ecchymosis
+/- abrasions or lacerations
Significant localised tenderness to palpation
+/- crepitus
Shortening of upper arm (sig. displacement)

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15
Q

Classification of supracondylar fractures

A

Gartland Classification:
I: non-displaced
II: Displaced fracture with intact posterior periosteum, anterior displacement of anterior humeral line
III: displaced fracture with disruption of both anterior and posterior periosteum (no continuity between proximal and distal fracture fragments, S-shaped configuration or pucker sign)

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16
Q

Radiological diagnosis of supracondylar fractures

A

Provide appropriate analgesia should be provided BEFORE x-rays
Splinting advised prior to radiology if severe fracture (e.g. S-shaped)
- anterior humeral line should usually dissect the capitulum
Anterior and posterior fat pads

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17
Q

indications for referral of supracondylar fractures to ortho

A

Open
Neurovascular compromise
Type II or III
Acute compartment syndrome

18
Q

Complications of supracondylar fractures

A 
Vascular injury (common with type I and II)
Volkmann ischaemic contracture (fixed flexion of elbow, pronation of forearm, flexion at wrist, extension of MCPs)
Neurological deficit (medial, radial or ulnar)
Cubitus varus deformity - function preserved
19
Q

Classification of radial head and neck fractures

A

Mason classification
I: non-displaced (displacement less than 2mm)
II: displaced fractures over 2mm
III: comminuted fractures
IV: radial head fracture + elbow dislocation

20
Q

radiology of radial head or neck fracture

A

Does not always show fracture line

Raised anterior and posterior fat pads “sail sign”

21
Q

what is a Monteggia fracture/dislocation

A

Proximal ULNAR fracture with displacement and shortening and dislocation of radial head

22
Q

Mechanism of injury leading to Monteggia fracture

A

Direct blows to ulnar aspect of arm

Fall with hyperpronation or hyperextension

23
Q

Radiology in monteggia fracture/dislocation

A

Radiocapitellar line should usually bisect the capitulum, doesn’t if radial head is dislocated

24
Q

Management of Monteggia fracture/dislocation

A

Reduction of radial head will reduce pain

Always refer to ortho for open reduction and internal fixation

25
Q

Galeazzi fracture-dislocation

A

Distal 1/3 radius fracture + dislocation of distal radio-ulnar joint

26
Q

Classification of galeazzi fracture/dislocation

A

Based on position of distal radius
I: Dorsal displacement
II: Volar displacement

27
Q

Essex-lopretsi fracture/dislocation

A

Proximal radius fracture with dislocation of distal radioulnar joint

28
Q

What is a colles fracture

A

Fracture of distal radial metaphysis with DORSAL angulation and impaction (dinner fork deformity)

29
Q

Epidemiology of Colles fracture

A

most common type of distal radial fracture

most commonly in elderly women with OP

30
Q

Management of Colles fracture

A

Most can be treated with closed reduction and cast immobilisation
Cast from elbow-metacarpal heads
Wrist flexed in ulnar deviation (as if holding a footy about to kick)

31
Q

What is a Smiths fracture

A

Fracture of distal radius with VOLAR angulation and displacement

32
Q

Normal lines in pelvic or hip x-rays

A

Shenton’s line: curve from inferior line of femoral neck to acetebulum
Iliopectineal line
Ilioischial line
Sacral arcuate lines

33
Q

Pelvic ring fracture radiology

A

disruption of any of the pelvic rings (pelvic inlet or rami)

34
Q

Signs of instability of pelvic ring fracture

A

Over 5mm displacement of posterior Sacroiliac complex
posterior sacral fracture gap
Avulsion fractures

35
Q

management of pelvic ring fracture

A

Immediate:
- Resuscitation, massive transfusion guidelines
- Pelvic binder/sheet - placed over greater trochanters (not iliac crest/abdo)
- External fixation
Definitive:
- +/- ORIF

36
Q

Acetabular fracture mechanism of injury

A

Impaction of femoral head, lateral compression or axial loading

37
Q

Letournel’s lines

A

Iliopectineal line - disruption = anterior column fracture
Ilioischial line - disruption = posterior column fracture
Acetabular roof, anterior rim and tear drop
Teardrop displacement = sacral fracture
Angulated sacral arcuate lines = sacral fracture

38
Q

Classifications of femoral neck fracture

A

Anatomical:
- intracapsular (Subcapital, transcervical, basicervical)
- extracapsular (intertrochanteric and subtrochanteric)
GARDEN CLASSIFICATION - predicts development of AVN
I: undisplaced, incomplete
II: undisplaced, complete
III: Complete fracture, imcompletely displaced
IV: complete fracture, completely displaced

39
Q

Management of fractured NOF

A 
Undisplaced: internal fixation
Displaced:
- Under 60y - urgent ORIF
- 60-80y - usually hemiarthroplasty
- 80y+ arthroplasty
40
Q

Ankle fracture classification

A

Weber Classification
A: below the level of the ankle joint (tibiofibular syndesmosis intact) Stable = manage conservativel
B: at level of ankle joint extending superiorly and laterally up fibula - no widening of distal tiobiofibular articulation
C: above level of ankle joint, tibiofibular syndesmosis disrupted (widening of distal tibiofibular articulation) +/- medial malleolus fracture UNSTABLE - REQUIRES ORIF

41
Q

Ottawa ankle rules for x-rays

A

Ankle x-ray indicated if:
- Bone tenderness at posterior edge of lateral malleolus OR medial mallolus
OR
- inability to bear weight either immediately after injury or in ED

Foot x-ray series indicated if:
- Bone tenderness at base of 5th MT
OR
- bone tenderness at navicular
OR
- inability to bear weight either immediately after injury or in ED

Orthopaedics (5 decks)

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