Fracture extra Flashcards
How long do the features of lower limb take to heal?
A. in adults
B. in children
A. Adults → 12 weeks
B. Children → 6 weeks
How long do fractures of upper limb take to heal?
A. In adults
B. In children
A. Adults → 6 weeks
B. Children → 3 weeks
What’s MRI is used for in terms of fracture?
MRI → to assess spinal injury; soft tissues; muscles
What’s CT used to assess in terms of fracture?
- visceral injury in pelvic fracture
- visceral injury in lower rib fracture
What air in the tissue on the imaging may indicate?
- open wound
- fracture
- visceral injury
- infection
How would you fix articular and comminuted long-bone fracture under ORIF e.g. ankle fracture?
Plate and screws
The method used to fix long bone (femur, tibia, humerus) fractures?
Intramedullary nail
* it allows early mobilisation
The method used to fix foot, wrist and hand fractures?
Kirschner (K) wires
* wires are inserted percutaneously and can be placed under tension
Phases of fracture healing (3) just name
- Inflammatory phase
- Reparative phase
- Remodelling phase
What happens in the inflammatory phase of fracture healing?
- Inflammatory 2. Reparative 3. Remodelling
Inflammatory phase:
- first 24-72 hrs
- fracture → bleeding → swelling
- cytokines are released
- this all stimulate repair mechanism
What happens in the reparative phase of fracture healing? (2)
- Inflammatory 2. Reparative 3. Remodelling
Reparative phase → depends on stability of the fracture:
- healing by callus in unstable fractures: occurs between 4-8 weeks; necrotic bone is reabsorbed and weak woven bone is laid down (it’s a precursor for highly organised and strong bone)
- healing by primary bone healing in stable fractures: contact healing can occur when two ends are in direct contact
What happens in the remodelling phase of fracture healing?
- Inflammatory 2. Reparative 3. Remodelling
Remodelling phase:
- starts 8-12 weeks after the fracture
- ends of the repair phase
- continues for years
- strong lamellar bone replaces woven bone
Management of clavicular fracture (2)
Conservative → for uncomplicated fracture:
- broad arm sling for 3 weeks
- analgesia
*bump forms in the healed bone
Reduction with ORIF → needed if the fracture is open or if there s neurovascular compromise
Fracture of which part of the neck of the humerus is more dangerous?
The anatomical neck of humerus → risk of avascular necrosis
What’s the difference between dislocation and subluxation?
- Dislocation → complete loss of contact between the articular surfaces of a joint
- Subluxation → partial loss of contact
What’s the main complication of an anterior shoulder dislocation?
Axillary nerve injury (Regimental badge area)
It supplies: Teres minor, teres major and deltoid
Name (3) methods to reduce dislocated shoulder
A. Kocker’s method
B. Hippocratic method
C. traction/countertraction
Treatment of acromioclavicular joint subluxation/dislocation
- often occur in rugby players
Treatment:
- sling with strapping over joint
- ORIF - occasionally to repair the ligament
Classification of a fracture around the elbow and management (4)
- radial head → undisplaced fractures (support bandage) + immobilisation; displaced (ORIF)
- supracondylar → Mx depends on a fracture pattern
- olecranon → ORIF and K-wires
- Condylar:
- medial epicondylar → ORIF + K-wires
- lateral epicondylar → ORIF (if significant discplacement)
Possible complications of condylar fractures (4)
- growth arrest (in children)
- mal-union
- stiffness
- ulnar nerve palsy
Types of humeral mid-shaft fractures (2)
Both are fracture-dislocation
- Galeazzi
- Monteggia
Management of Galeazzi and Monteggia fractures-dislocations
ORIF with plates and/or intramedullary nail
(4) Types of distal radius fractures (just name)
- Colle’s fracture
- Smith’s fracture
- Chauffeur’s fracture
- Barton’s fracture
Colle’s
- what is this
- management
- complications
Colle’s
- fracture that occurs 2.5 cm from a distal end of the radius + dorsal angulation
- classic dinner fork deformity
Management: reduction of fracture under regional anaesthesia + plaster backslab for 6 weeks + X ray
Complications: Carpal tunnel syndrome, mal-union, stiffness, rupture of extensor pollicis longus
Smith’s
- what is this
- management
Smith’s
*reverse of Colle’s
- anterior angulation of radius + tilt
Management: manipulation under anaesthesia and plaster casts for 6 weeks
Barton’s fracture
- what is this
- management
Barton’s fracture
- intra-articular fracture of a wrist → hand and distal radius displace proximally
Management: Usually ORIF
What’s Chauffeur’s fracture?
Fracture of the radial styloid
What’s needed to assess a suspected scaphoid fracture (imaging wise)
- management
4 radiographic views → but the fracture may still not be visible
*therefore fracture is assumed if there is a tenderness in the anatomical snuffbox area
Management:
- scaphoid plaster (from elbow to knuckles)
- repeat X ray in 2 weeks (bone scan may be needed if still cannot identify fracture)
- if it shows the fracture → plaster on for 8 further weeks
- if fracture not united at 12 weeks → internal fixation needed
What’s Bennet’s fracture?
- cause
- management
Bennet’s
Fracture of first metacarpal extending into carpometacarpal joint
Cause: blow ti the point of the thumb
Management: unstable → should be reduced
if it fails → percutaneous pin inserted
Management of metacarpal and pharyngeal injuries (2)
examples: punching, fighting
* most managed by closed reduction (if necessary) + immobilisation with splinting to the neighbouring finger
* unstable fractures or multiple metacarpal involvement → percutaneous K - wire
