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Toni's Presentations > Fracture > Flashcards

Fracture Flashcards

1
Q

Traumatic fractures

A

Direct: e.g. Assault/RTA
Indirect: fall on outstretched hand -> clavicle #
Avulsion

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2
Q

Stress fracture

A

Bone fatigue due to repetitive strain

E.g. In marathon runners

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3
Q

Pathological fractures

A

Normal forces in diseased bone -> #
Local: tumour
General: osteoporosis, Cushing’s, paget’s

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4
Q

Fracture patterns

A 
Transverse
Oblique
Spiral 
Multifragmentary aka comminuted
Crush
Greenstick
Avulsion
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5
Q

Fracture deformity

A

Translation
Angulation or tilt
Rotation
Impaction

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6
Q

Soft tissue issues to consider in fracture

A

Open or closed?
Compartment syndrome
Neuro vascular status

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7
Q

Primary survey

A

C-spine
Chest
Pelvis

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8
Q

Fracture assessment in secondary survey

A

Assess neurovascular status
Check for dislocations
? Reduction and splinting prior to imaging:
reduces bleeding, pain, risk of neurovasc injury
X-ray once stable

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9
Q

6 As of open fracture

A 
Analgesia: M+M
Assess: soft tissues, nv status
Antisepsis: irrigate, swab, cover
Alignment: reduce # + splint
Anti-tetanus: check last tetanus jab
Antibiotics: fluclox 500mg IV/IM + benpen 600mg IV/IM
Or augmentin 1.2g IV
Debride and fixate in theatre
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10
Q

Most dangerous complication of open #

A

Clostridium Perfringens
Wound infection + gas gangrene
+- shock + renal failure
Rx debride, benpen, clindamycin

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11
Q

Gustillo classification of open #s

A
  1. Wound <1cm
  2. Wound >1cm, minimal soft tissue damage
  3. Extensive soft tissue damage
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12
Q

reduction

A

If displaced -> reduce unless no effect on outcome e.g. Ribs
Aim = anatomical reduction
Alignment > opposition

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13
Q

Methods of reduction

A

Closed reduction: under local/regional/general anaesthetic
traction to disimpact, manipulation to align
Traction: only used to overcome contraction of large muscles e.g.femur mostly seen in paeds
Open reduction + internal fixation

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14
Q

Indications for internal fixation

A

Intra articular #
Open #
2 # in one limb
Failure of conservative management

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15
Q

Principles of restriction

A 
Fixation:
reduces strain -> bone formation
reduces pain
increases stability
increases function
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16
Q

Methods of restriction

A

Non rigid: slings, elastic support
Plaster: first 24 hrs back slab/split cask, risk compartment synd
Functional brace: joint free to move, bone shaft supported in cast
Continuous traction: collar + cuff
External fixation: pins, wires + ext frame
Internal fixation: pins, plates, screws, nails

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17
Q

Rehab

A

Immobility -> reduced bone/muscle mass + joint stiffness
Maximise mobility of uninjured limb
Quick return to function reduces morbidity later
Physio
OT
Social services

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18
Q

General # complications

A

Tissue damage: haemorrhage, infection, rhabdomyolysis
Anaesthesia: anaphylaxis, teeth, aspiration
Prolonged bed rest: UTI/chest infection, pressure ulcer, muscle wasting, DVT/PE, reduced BMD

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19
Q

Specific # complications

A

Immed: NV damage, visceral damage
Early: compartment synd, infection, fat embolisation -> ARDS
Late: AVN, union issues, growth disturbance, post traumatic OA, complex regional pain synd, myositis ossificans

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20
Q

complications: neurological

A

Seddon classification
Neuropraxia: temporary interruption of conduction w/o loss of axon continuity
Axonotmesis: axon disruption-> distal Wallerian degeneration
connective tissue preserved, regeneration and recovery possible
Neurotmesis: entire nerve fibre disrupted, req surgery, recovery not complete

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21
Q

Common # associated palsies

A

Axillary N: numb chevron, weak abduction
ant shoulder dislocation/ humeral surgical neck #
Radial N: waiter’s tip, humeral shaft #
Ulnar N: claw hand, elbow dislocation
Sciatic N: foot drop, hip dislocation
Fibular N: foot drop, # neck of fibula, knee dislocation

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22
Q

Compartment syndrome

A 
Fascia divide groups of muscles, nerves and vessels in limbs into discrete compartments
Fascia do not stretch or expand easily
# -> oedema -> incr compartment P -> decr venous drainage -> incr P
Compartment P > capillary P = ischaemia
Muscle infarction: rhabdo + ATN, fibrosis -> Volkman's isch.contracture
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23
Q

Compartment syndrome presentation

A

Pain in passive stretching of muscles
Warm erythematous swollen limb
^ CRT
Weak/ absent peripheral pulses

24
Q

Management of compartment syndrome

A

Elevate limb
Remove bandages, split/remove cast
Fasciotomy

25
Q

Causes of delayed/non Union

A

Ischaemia: poor supply / AVN
Infection
Incr inter-fragmentary strain
Interposition of tissue between fragments
Intercurrent disease: malignancy/malnutrition

26
Q

Non-union

A

Hypertrophy: rounded, dense, sclerotic bone end
Atrophy: osteopenic bone
Management
optimise bio: infection, blood supply, graft, BMP
optimise mechanics: ORIF

27
Q

Avascular necrosis

A

Sites: femoral head, scaphoid, talus
-> soft, deformed bone => pain, stiffness, OA
X-Ray: sclerosis + deformity

28
Q

Myositis ossificans

A

Heterotrophic ossification of muscle at sites of haematoma formation
-> restricted painful movement
Commoner in elbow + quadriceps
Can be surgically excised

29
Q

Pellegrini-stieda disease

A

A form of myositis ossificans

Calcification of the superior attachment of the MCL at the knee following trauma

30
Q

Complex regional pain syndrome type 1

A

Complex disorder of pain, sensory abnormalities, abnormal blood flow, sweating and trophic changes in superficial or deep tissues with no evidence of nerve injury
Assoc with: #s, carpal tunnel release, ops on dupuytron’s contracture, HZV, MI, idiopathic

31
Q

Symptoms of complex regional pain syndrome type 1

A

Wks/maths following injury, area neighbouring traumatised area
Lancing pain, hyperalgesia or allodynia
Weakness hyper-reflexia, dystonia, contractures
Swollen, shiny skin
Usually self limiting, can try gabapentin, amitryptiline
Refer to pain team

32
Q

Growth disturbance due to fracture

A

Salter-Harris classification of growth plate injuries

  1. Straight across 5% e.g. SUFE
  2. Above 75%
  3. Lower 10%
  4. Through 10% union across physis interferes with growth
  5. Crush uncommon physis injury -> growth arrest
33
Q

Osteoporosis RF

A 
Age + shattered
Steroids
Hyper para/thyroidism
Alcohol + cigarettes
Thin BMI<22
Testosterone low
Early menopause
Renal/liver failure
Erosive/inflammatory bone disease: RA / myeloma
Dietary Ca low/ malabsorption
34
Q

NOF presentation

A 
O/E shortened + externally rotated
mechanism
RF
premorbid mobility
premorbid independence
comorbidities
MMSE
35
Q

NOF management

A 
Resus: dehydration, hypothermia
Analgesia: M + M
Assess NV status of limb
Imaging: AP + lateral films
Prep for theatre
36
Q

Prep for theatre

A 
Anaesthetist: inform of pt, book theatre
Bloods: FBC, U=E, clotting, X-match (2U)
CXR
DVT prophylaxis: LMWH + TEDS
ECG
Films: orthogonal X-Rays
Get consent
37
Q

Imaging

A 
AP + lateral films
Check Shenton's lines
Intra or extra capsular?
Displaced or non-displaced?
Osteopaenic?
38
Q

Classification

A

Intracapsular: subcapital, transcervical, basicervical
Extracapsular: intertrochanteric, sub trochanteric

39
Q

Intracapsular #s - Garden classification

A
  1. incomplete, undisplaced #
  2. complete, undisplaced #
  3. complete, partially displaced #
  4. complete, completely displaced #
40
Q

NOF anatomy

A

Capsule attaches: proximally to acetabular margin, distally to intertrochanteric line
Blood supply to femoral head: retinacular vessels in capsule running distal -> prox (damage = risk of AVN), intramedullary vessels, artery of ligamentum teres

41
Q

Surgical management of intracapsular NOF #

A 
Garden 1/2: ORIF with cancellous screws
3/4: <55yrs = ORIF with screws, f/u in OP with arthroplasty if AVN develops (30%)
55-75 yrs = total hip replacement
>75 yrs = hemiarthroplasty
mobile: cemented Thompson's
immobile: uncemented Austin Moore
42
Q

Surgical management of extracapsular NOF #

A

ORIF with DHS - dynamic hip screw

43
Q

Complications specific to NOF #

A

AVN of femoral head in 30% displaced #
non/mal-union 10-30%
infection
OA

44
Q

Prognosis of NOF #

A

mortality at 1 yr = 30%
50% never regain pre-morbid function
>10% unable to return to permorbid residence

45
Q

Colles #

A

FOOSH
female elderly pop with osteoporosis
‘dinner fork’ deformity

46
Q

X-ray features of Colles’ fracture

A

distal radius: extra-articular #
dorsal displacement + angulation (11 degree volar tilt) of distal fragment
decreased radial height + inclination
+- ulna styloid avulsion or impaction

47
Q

Management of Colles’ fracture

A 
NV injury: median nerve + radial artery
reduction -> imaging
manipulation under anaesthesia
# clinic f/u for cast in 48hrs
6wks cast + physio
48
Q

Complications specific to Colles’ #

A 
Medican N injury
Frozen shoulder
Tendon rupture (EPL)
Carpal tunnel syndrome
Mal/non-union
Sudek's atrophy/CRPS
49
Q

Smith’s # (aka reverse Colles’)

A

Fall onto back of flexed wrist
# of distal radius
Volar displacement + angulation of distal fragment
Reduction + cast for 6 wks

50
Q

Barton’s #

A

oblique intra-articular # of dorsal distal radius
dislocation of radio-carpal joint
reverse Barton’s = volar aspect of radius

51
Q

Presentation of scaphoid #

A

FOOSH
Tenderness in anatomical snuffbox
Tender on telescoping of thumb

52
Q

Specific management of scaphoid #

A

Request scaphoid x-ray view
Treat with suggestive clinical hx even if X-ray normal (scaphoid plaster)
+ve X-ray after 10 days (localised decalcification) -> 6 wks plaster
-ve but clinically tender -> 2wks plaster

53
Q

Complications specific to scaphoid #

A

AVN of scaphoid (blood supply distal-> proximal)

= stiffness + pain at wrist

54
Q

Monteggia #

A

proximal 1/3 of ulna shaft
ant dislocation of radial head at capitulum
(palsy of deep branch radial N)

55
Q

Galleazzi #

A 
# of radial shaft between mid and distal 1/3s
dislocation of radio-ulna joint
56
Q

Specific management of radial + ulna shaft #s

A 
unstable: adults = ORIF, kids = MUA + above elbow plaster
plaster in most stable position
proximal # = supination
distal # = pronation
mid-shaft # = neutral

Toni's Presentations (121 decks)

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