Corban Notes Flashcards
What are the factors that modify healing?
- Underlying conditions- disease, systemic conditions
- Location- flat irregular bone take longer
- Age
- Type of injury- complicated fx tale longer
What are the 3 phases to fracture healing?
- Inflammatory
A) cellular- hematoma and clot formation (should not be disturbed)
B) vascular- inflammatory response and granulation tissue. Hyperaemia and increased osteoclastic activity
C) callus -primary callus begins and fracture line becomes hazy and widens - Reparative (weeks)
- more order to callus formation
- osteoid replaced by mature bone
- fx stable by end of this stage - Remodelling (months-years)
- new bone laid down along lines of stress
- unnecessary bone removed
- x-rays normal but bone scans may still be warm
What are the complications of a trauma in the a) immediate stage (hrs)
B) isn’t mediate (days-weeks)
C) delayed (months-years)
1. Immediate: Vascular injury Compartment syndrome Thromboembolism Neurological damage (eg SC injury, or peripheral nerve damage)
- Intermediate
-osteomyelitis (bone infection)
-gangrene
-disuse osteoporosis
-myositis ossificans
-osteo necrosis
-delayed union
Synostosis (joining of adjacent bones eg radius and ulna) - Delayed (months to yrs)
- DJD
- non union
- pseudo articulation
- growth disturbances
What are some radiographic indicators of non-accidental childhood injury
What would be some DDx
-multiple fx at various stages of healing
-atypical fx
-metaphyseal corner fx m.c around knee
-
cluster of fractures with high specificity for abuse:
-metaphyseal fx
-posterior ribs
-scapula
-spine
-sterna,
DDx:
- infantile cortical hyperostosis
- congenital syphilis
- scurvy
- osteogenesis imperfecta
Lunate dislocations
- give me some info
- MOI
- what are some of the variations seen?
M.c carpal to dislocate
- hyper extension injury
- look for pie sign (rotates anteriorly)
- look for loss of normal sclerotic lunate line on PA view
Variations:
Lunate dislocation- carpals remain in place and lunate dislocates
Peri-lunate dislocation -lunate remains in place and remainder of carpals displace posteriorly
Trans-scaphoid, peri-lunate dislocation:
-peri lunate dislocation with scaphoid fracture
Name the metacarpal fractures and what they are
- Boxers/ bar room fx- transverse fx of the neck of the metacarpals (bar room 4,5) boxers (2,3)
- Bennetts- fx at medial aspect of 1st metacarpal
- Rolando fx- comminuted Bennett fracture
Name the phalangeal fx and were they are?
Proximal- Gamekeepers thumb (avulsion at the ulna collateral ligament attached to base of proximal phalanx)
Middle- volar plate fx- anterior surface at the base
Distal
A) tuft fx (comminuted) -potentially open
B) baseballers finger
What are all the fractures that occur at the ankle? And explain their location
- Malleolar fracture
- Bimalleolar fx
- Trimalleolar fx
- Dupuytren -distal fibula fracture above the lateral malleolus, with tibiofibular syndesmosis widening and lateral displacement of the talus
- Maisonneuves fx- fx of proximal fibula secondary to sever ankle injury. Fibula moves laterally due to distal ligamentus disruption.
Explain to me the Danis webber classification?
It’s ankle fracture based on fibula involvement
3 types
Type A: below mortise joint- usually stable so can be treated conservatively
Type B: if it crosses or interacts at all with the mortise joint
-usually spiral
-may be stable or unstable
Type C: above mortise joint
C1: distal, at syndesmosis
C2: distal above syndesmosis
(c1/2 can also be classified as dupuytrens fx if seen with syndesmosis widening
C3: proximal, usually with medial ankle injury
-unstable and requires surgical repair
- Ankle dislocations/ sprains
2. Talar done osteochondral fractures
Medial more common
Posterior more common
Usually have an assosiated Fx
Talar dome osteochondral fractures:
- look got these following inversion injury
- look at corners of talus on oblique view
Foot trauma:
What are all the fractures or problems u can get in the foot?
- Hind foot fxs
- calcaneus- if boehlers angle is less than 28 degrees= compression
- avulsive- beak fx: avulsive by achillies tendon - Talus fx (avulsion or aviators fx)
- Hind foot dislocation- talocalcaneal/ subtalar
- talonavicular
Mid foot:
1. Navicular
2.Mid foot dislocation:
A) lisfranc- tarsal/ metatarsal with ass. Fracture
-due to high or low impact twisting injuries
-may require weight bearing images
Forefoot fractures:
A) metatarsal fx
2. Jones (dancers fx)- proximal shaft or base of 5th metatarsal
3. Bedroom fx- stubbed toe note: tuft fx potentially open
What are the names of the fractures of the distal femur?
- Condylar fx- due to impact
Y or T configuration
-isolated condylar - Osteochondral fx
- articular surface fx
- may be post traumatic or due to AVN
What are the fractures of the patella?
- Transverse
- Comminuted
- Vertical- best seen on sunrise view
DDx: bipartite or tripartite patella
Which way to knee dislocations generally go?
What’s MOI
Most occur laterally
Caused by sudden change in direction with foot planted
Proximal tibia fractures?
- Bumper fracture
- pagets disease
- anorexia - Segonds fx
- avulsion fx at the TFL attachment to lateral tibial condyle
- almost 100% will have ACL tear
- 70% meniscal tear - Proximal fibula fx
Usually associated with other injuries to the knee or ankle
