Cortex - Adult trauma 3 Flashcards
Who is hip fractures most common in ?
The majority of patients are >80 female and have osteoporosis
Also have co-morbidities e.g. cerebrovascular insufficiency, cardiac arrhythmias, postural hypotension etc. which contribute to falling over and the fracture occurring
How can hip fractures be classified ?
As intra or extracapsular
Why is it important to know if a hip fracture is intra or extracapsular ?
Because intracapsualr fractures are associated with AVN and non-union
What is the treatment of hip fractures (hint intra and extracapsular fracture treatment differs)?
- Extracapsular fractures - Fixation using compression or dynamic hip screw (this is because no real risk fo AVN or non-union)
- Intracapsular fractures - arthroplasty (hemi-arthroplasty preferred for those with restricted mobility or if cognitivley impaired or THR which is reserved for the higher functioning hip fracture patient)
What are the different ways in which femoral shaft fractures occur ?
- Usually trauma - high energy injuries
- Can occur due to osteoporotic bone, metatstatic disease, Paget’s disease and long term bisphosphonate use for osteoporosis
What complications are you worried about following a femoral shaft fracture ?
- Major blood loss
- Fat embolism formation - can result in ARDS
What is the management of femoral shaft fractures ?
Initial:
- Analgesia with femoral nerve block
- Put on thomas splint to stabalise it
Definite:
- Usually closed reduction and stabilization with an intramedullary nail
What is a proximal tibial (plateau) fracture ?
It is an intra-articualr fracture with either a split in the bone, a depression of the articular surface or a combination of both
How do most fractures occur ?
High energy injury or due to osteoporitic bone in low energy injuries
What sort of injuries can proximal tibial (plateu) fractures occur with ?
Valgus stress to the knee can cause the fracture with failure of MCL and possibly ACL
What is the treatment of Proximal tibia (plateau) fractures?
- ORIF
- Often end up requiring a TKR (total knee replacement)
What are the different mechanisms for tibial shaft fractures ?
- Indirect force and either bending (transverse fracture) or rotational energy (spiral fracture)
- Compressive force from deceleration (oblique fracture)
- A combination of these forces or from high energy injuries (comminuted fracture).
What is the fractures are the commonest cause of compartment syndrome followinf trauma ?
Tibial shaft fractures
What is the treatment options of tibial shaft fractures ?
- Minimally displaced - above knee cast
- Displaced or communted - ORIF
What is the common mechanism of ankle injury ?
Inversion injury and/or rotational force on a planted foot (going over your ankle)
In general what are the 2 main types of injury to the ankle ?
Sprains and fractures
What are the common ligaments to sprain in your ankle ?
The lateral ankle ligaments (anterior & posterior talofibular ligaments and calcaneofibular ligament)
What are the signs suggestive of an ankle sprain affecting the lateral ankle ligaments ?
Pain, bruising and mild to moderate tenderness over the involved ligaments
When may an inversion injury and/or rotational force on a planted foot commonly causing ankle sprains result in a fracture ?
With higher force / energy or in osteoporotic bone
In A&E what criteria is used to identify a suspected ankle fracture and give guidance as to which ankle injuries require an Xray?
Ottawa criteria - Any severe localized tenderness (known as bony tenderness) of the distal tibia or fibula or inability to weight bear for four steps merits an xray.
What is the key to determining the treatment of an ankle fracture ?
Deciding if its stable or unstable
Which ankle fractures are deemed stable and what is the subsequent treatment of them?
Isolated distal fibular fractures with no medial fracture or rupture of the deltoid ligament tx = walking cast or splint
What suggests rupture of the deltoid ligament ?
- Bruising and tenderness medially on the ankle
- Or any talar shift or talar tilt without medial malleolar fracture (this is by definition a deltoid rupture)
What are the unstable ankle fractures and what is the subsequent treatment of them ?
- These are Distal fibular fractures with rupture of the deltoid ligament (e.g. talar shift or tilt evident) - ORIF
- Bimalleolar (both medial and lateral malleoli) fractures - ORIF
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Why must ankle fractures with talar shift be stabalised with ORIF ?
Because even 1mm of talar shift greatly increases ankle contact pressure & ==> subsequent risk of post-traumatic OA
Why may ORIF for treating an ankle fracture be delayed by 1-2 weeks ?
Ankle fractures can be associated with substantial soft tissue swelling and fracture blisters. ==> to allow the soft tissues time to settle and reduce the risk of wound healing problems or infection
