Fractures Flashcards
See picture 2. Name types of fractures.
Memo in album.
How is fracture displacement described?
LARA Length Angulation Rotation Apposition/translation
Name 5 basic steps of how fractures heal.
- Haematoma
- Inflammation
- Callus formation
- Consolidation
- Remodelling
What is an acetabular #
Femoral head driven into pelvis
4 types of acetabular fractures
- Anterior column #
- Posterior column
- Transverse
- Combination
What is an anterior column acetabular fracture (3)
Runs through ant acetabulum- separates a segment between ASIS and obturator foramen.
Uncommon, good prognosis
Doesn’t involve weight bearing of acetabulum.
Where is posterior column acetabular #
Run upwards from obturator foramen to sciatic notch.
What injury is usually associated with or causes a posterior column acetabular #?
Posterior hip dislocation
Possible complication of posterior column acetabular #
Injury sciatic nerve
Rx post column acetabular #
ORIF
What is transverse acetabular #
Uncomminuted # running transversely through acetabulum. Separates ilium above from ischium and pubis below
transverse acetabular # rx
Easy to reduce. ORIF.
What is combined or complex acetabular #
Combination of ant and post column and transverse acetabular #
Usually in value roof of acetabulum
Poor prognosis. V difficult to reduce.
How treat acetabular fractures in general? (4)
Resus ATLS
Reduce dislocation if present
Maintain reduction with traction, (10kg/10% body weight)
Definitive rx delayed until pt fit for sx. DON’T DELAY MORE THAN 7 DAYS!
Contra-indications for surgery to acetabular # (4)
- Severly comminuted complex #
- Lack sx expertise
- Lack of blood transfusion service
- Associated abdominal injuries requiring a laparotomy/bladder repair.
Are acetabular # usually treated surgical or non-surgical?
Non-surgical
ORIF preferred mostly, but due to many contraindications due to associated injuries and high R complications, it’s not done commonly in practice.
5 complications of acetabular #
- Sciatic nerve injury
- Sepsis
- AVN femoral head
- Osteoarthritis
- Shock
Which structure is at risk in posterior column acetabulum fracture?
Superior gluteal NV bundle
Usual treatment supracondylar fracture?
Closed reduction and percutaneous pinning (crpp) except type 1 Gartland(immobilise 3 weeks )
Adults orif
Mechanism of injury supracondylar fracture?
Fall on outstretched hand mostly
<4% flexion injury
Usual demographic of supracondylar fracture?
One of most common fractures in paeds, age 5-7
!!! Which 3 nerves and artery are of concern in supracondylar fracture?
- Anterior interosseous nerve neuropraxia (branch of median n !) - most common (can’t flex IPJ of thumb and DPJ of index - can’t do ok sign)
- radial nerve palsy - close second (inability to extend wrist, MCPJ, thumb IPJ)
- ulnar nerve palsy seen with flexion type injury patterns, but far less common
Radial artery
How is displacement of fracture described?
In terms of distal fragment
Name 10 early local complications of fractures
Skin
• skin necrosis
• fracture blisters
Open wound
Muscle
• compartment syndrome
• tendon injury
Nerve
• neuropraxia
• axonotmesis
• neuronotmesis
Vessels:
• arterial injury
• infection
Name 10 early systemic complications of fractures
- Haemorrhagic shock
- fat embolism syndrome
- ARDS
- sirs
- multiple organ failure syndrome
- DvT
- pe
- pressure sores
- tetanus
- sepsis
Name 10 late complications of fractures
- Delayed Union
- non union
- mal union
- avascular necrosis
- growth disturbance
- osteoarthritis
- joint stiffness
- complex regional pain syndrome
- heterotopic ossification
- osteomyelitis
Name 10 complications of #nonunion
• Conversion to open # • neuro vascular compression • limb length discrepancy . Deformity . Unstable limb • weak, pain, loss of function • bone atrophy • osteoarthritis • bone hypertrophy • malignancy
How long do # of lower and upper limb take to heal in children?
• Upper limb: 3 weeks
. Lower limb: 6 weeks
How long do # of lower and upper limb take to heal in adults?
Upper: 6 weeks
Lower: 12 weeks
What is a Colles # (7)
ColleD • distal radius # • dorsal displacement • dorsal angulation • dinner fork deformity on arm . From fall on outstretcheD hand - dorsal flexion • common in elDerly (osteoporosis) •Rx closeD reDuction and cast
