Fracture management Flashcards
What mechanism of injury commonly causes humeral neck fractures?
Falling onto an outstretched hand with osteoporotic bone.
Most common humeral neck fracture?
Surgical neck fracture with medially displacement of the humeral shaft due to the pec major pull.
Minimally displaced proximal humeral fracture management?
Conservative- with sling and gradual return to mobilisation.
Persistently displaced humeral neck fractures?
Internal fixation (plate, screws, wires or IM nails)
Humeral head splitting fractures?
Replacement- arthroplasty.
What is more common, anterior or posterior shoulder dislocation?
Anterior
Mechanism of injury of traumatic anterior shoulder dislocation?
An excessive internal rotation force.
Bankurt lesion
Anterior shoulder dislocation resulting in detachment of the anterior glenoid labrum and capsule.
Hills-sachs lesion
Posterior humeral head can impact on the anterior glenoid producing an impaction fracture of the posterior head.
Nerve at risk in anterior shoulder dislocation
Axillary nerve
Sign of axillary nerve damage?
Loss of sensation in the badge patch area
What confirms an anterior shoulder dislocation?
Xray- if unsure use two views.
Management of anterior shoulder dislocation?
Closed reduction
Then use of sling for 2-3 weeks.
Anterior shoulder dislocation and greater tuberosity fracture?
Closed reduction then ORIF the fracture.
Mechanism of injury for a posterior shoulder dislocation
Posterior force on the adducted internally rotated arm.
Treatment of posterior shoulder dislocation
Closed reduction and sling.
How do acromioclavicular injuries usually occur?
Falling onto the point of the shoulder.
Treatment of acromioclavicular injuries?
Conservative management
Who gets surgery in acromioclavicular injuries?
Those with chronic pain.
Management of a humeral shaft fracture?
Conservative unless non-union.
Intra-articular distal humeral fractures?
ORIF
Olecranon fractures?
ORIF with plate and screws.
Mechanism of injury for olecranon fractures?
Fall onto the point of the elbow with contraction of the triceps muscle.
Radial head fractures- minimally displaced?
Conservatively.
Radial head fractures-comminuted?
ORIF if the fragment is large.
Fracture of the ulnar shaft is also known as
Nightstick fracture
Fracture of both bones in the forearm
ORIF
Monteggia or Galeazzi fracture?
ORIF
Colles fracture mechanism of injury?
Fall onto outstretched arm
Minimally displaced or angulated Colles fractures?
Splintage
Largely displaced Colles fracture?
ORIF with dorsal plate and screws
Smiths fracture management
ORIF using volar plate and screws.
Bartons fracture management
ORIF
Comminuted intra-articular distal radial fractures
External fixation
Scaphoid fracture mechanism of injury
Fall onto outstretched hand.
Undisplaced scaphoid fractures
Plaster cast for 6-12 weeks
Displaced scaphoid fractures
Screw fixation
3rd, 4th and 5th MCP fracture
Conservative
Boxers injury
Likely to damage 5th MCP
Up to 45 degrees of angulation can be tolerated- however rotational deformities can not.
Treatment of boxers injury
Strap to next finger.
Any suspicion of fight bite in boxers injury
Explore in theatre.
Management of phalangeal fractures
Neighbouring strapping or splint age
Significantly displaced phalangeal fractures
K wiring or small screws.
Intracapsular hip fractures
Hemiarthroplasty or total hip replacement
Extracapsular hip fractures
Dynamic hip screw
Subtrochanteric fracture
IM nail
Pubic rami fractures
Conservative
Greater trochanteric fractures
Conservative
Unstable femoral shaft fractures
IM nailing
Stable femoral shaft fractures
Thomas splint
Distal extra-articular femur fractures
Not too distal- IM nail
Distal- plate and screws
Distal intra-articular femur fractures
Plate and screws
Proximal tibial fractures
If high energy and substantial soft tissue damage may need external fixation
Rigid fixation
Intra-articular proximal tibial fractures
Plate and screws
Low energy tibial shaft fracture
Conservative
High energy tibial shaft fracture
IM nailing.
Distal tibial shaft fracture
May have too much soft tissue swelling- therefore need to externally fixate until safe to go in and put plate and screws.
Intra-articular fibula fracture also known as?
Pilon fracture
Significant soft tissue damage in intra-articular distal fibular fracture
Urgent external fixation
Internally fixate once soft tissues have settled.
Isolated distal fibular fracture?
Conservative
Bimalleolar fractures
ORIF
Fractures with talar shift
ORIF
Stable ankle fracture
Walking cast or splint age for 6 weeks.
Falling from height you are likely to fracture your?
Calcaneous
Talar fracture
ORIF
Lisfranc fracture
ORIF
5th MTP fracture
Walking cast, bandaging and stout boot
1st MTP fracture
ORIF
What might you use to view acetabulum fractures?
CT after Xray
Undisplaced or small acetabulum fractures?
Conservative
Unstable acetabulum fractures
ORIF in young
Older- hip replacement
Low energy pubic rami fracture in the elderly
Conservative
Lateral compression fracture description
Side impact where one half of the pelvis is displaced medially.
Vertical shear fracture description
Axial force on one hemipelvis where the affected side is displaced superiorly.
Anteroposterior compression injury description
Wide distribution of the pubic symphysis and the pelvis opens up. Substantial bleeding occurs.
Open book (anteroposterior compression) pelvic fractures management
Reduce to stop the blood loss. Maybe use an external fixation.
