Disease Profiles: Fracture Management and Complications Flashcards
Which investigations would you perform in suspected fracture non-union?
X-ray, CT - bridging callus

What is chronic regional pain syndrome?
An exaggerated pain response after injury, can be caused by a peripheral nerve injury (type 2) but often is not (type 1)
Which patient group is most at risk of developing compartment syndrome following a tibial fracture?
Male 10-35 years
Name a fracture of the metatarsals which is prone to non union due to poor blood supply
Jone’s fracture of the fifth metatarsal
Why are older patients more likely to be treated non-operatively?
Increased risk of complications of surgery, failure of fixation and failure to rehabilitate satisfactorily
How does alcoholism, steroid abuse and hyperlipidaemia cause AVN?
Increased fat in circulation sludges up the capillary system which promotes coagulation within prone areas of bone
Increased fat in the marrow can compress venous outflow
2-15% of patients with a fracture of which bone will develop compartment syndrome?
Tibial shaft fracture
What is delayed union?
A fracture that is not healed within the expected time, can be caused by infection
What is fracture disease?
Term used to describe stiffness and weakness due to the fracture and subsequent splintage in cast
How are undisplaced, minimally displaced and minimally angulated fractures which are considered stable generally managed?
Usually treated non‐operatively with a period of splintage or immobilization and then rehabilitation
Name a fracture of the pectoral girdle which is prone to non union due to poor blood supply
Fracture of the distal clavicle
Describe the clinical presentation of fracture non-union
Ongoing pain, ongoing oedema, movement at the fracture site
Which type of blood disorder is a risk factor for idiopathic AVN?
Blood clotting disorders (hypercoaguable states)
Which investigations would you perform in suspected AVN?
MRI (early changes), x-ray (later changes)
Describe the definitive management of open fractures
Debridement, stabilisation with fixation, wound closure
Describe the prognosis of neuropraxia
Resolves over time with full recovery (can take up to 28 days)
What is de-gloving?
Avulsion of the skin from its underlying blood supply as a result of a shearing force on the skin
How can you predict the outcome of axonotmesis?
Nerve conduction studies from around a month from the time of injury
How would you manage ongoing haemorrhage from arterial injury in the pelvis?
Angiographic embolization
Describe the clinical presentation of a fracture causing excessive pressure on the skin
Tenting of the skin and ‘blanching’
Describe the management of irreversible AVN
Generally joint replacement is usually required in the hip, knee or shoulder to control symptoms
Rotational osteotomy can be considered if less than 15% of femoral head damaged (rare)
Fusion can be considered in the wrist or foot/ankle
Describe the management of vascular injury with distal ischaemia
Urgent vascular surgery review and emergency surgical management
Describe the non-pharmacological management of chronic regional pain syndrome
TENS machines, physiotherapy, lidocaine patches and sympathetic nerve blocking injections
Describe the general initial management of a fracture
Clinical assessment (especially neurovascular), analgesia, splintage +/- traction, imaging


