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MSK > fractures > Flashcards

fractures Flashcards

1
Q

bones with vulnerable blood supplies where a fracture can lead to AVN, non-union..

A

scaphoid
femoral head
humeral head

certain foot bones - talus, navicular, 5th metatarsal in foot

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2
Q

main cancers that metastasise to the bone

A

(PoRTaBLe)

Prostate
Renal
Thyroid
Breast
Lung
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3
Q

treatment to reduce fragility fractures

A

calcium + vit D
biphosphonates (alendronic acid)

  • denosumab where bisphosphonates contraindicated/not tolerated
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4
Q

bisphosphonates side effects

A
  • reflux, oesophageal erosion - need to be taken on an empty stomach + sit upright for 30mins
  • osteonecrosis of jaw
  • osteonecrosis of external auditory canal
  • atypical fractures
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5
Q

bisphosphonates MoA

A

reduce osteoclast activity - preventing reabsorption of bone

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6
Q

methods of stabilising fractures

A

(stability to allow to heal)

external cast - plaster cast
K wires
intramedullary

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7
Q

early fracture complications

A 
>damage to local tendons, muscles, nerves etc
>haemorrhage leading to shock + death
>compartment syndrome
>fat embolism
>venous thromboembolism
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8
Q

fat embolism post fracture

A

can cause systemic inflammatory response - fat embolism syndrome

presents ysyally 24-72hrs post fracture

pres = stress, petechial rash, cerebral involvement

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9
Q

longer-term fracture complications

A 
>delayed union
> malunion - pain,stiffness, loss of function, deformity
>non-union
>AVN
> infection (osteomyelitis)
>joint instability/stiffness
>contractures (tightening of soft tissue)
>arthritis
>complex regional pain syndrome
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10
Q

reasons why non-union may occur post fracture

A 
poor bloody supply to fracture
gap too big
systemic disease
**smoking**
steroids
NSAIDs
bisphosphonates
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11
Q

neurapraxia

A

occurs when the nerve has a temporary conduction defect from compression or stretch + resolve over time with full recovery

(can take up to 28days)

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12
Q

axonotmesis

A

nerve injury sustained due to compression or stretch from a higher degree of force with death of the long nerve cell axons distal to the point of injury

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13
Q

neurotmesis

A

complete transection of a nerve requiring surgical repair for any chance of recovery of function

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14
Q

prognosis in Salter-Harris fractures

A

fracture prognosis is poorer as the classification progresses

(children’s fractures around the physis aka growth plate)

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15
Q

chronic regional pain syndrome presentation

A 
constant burning or throbbing
sensitivity to stimuli not normally painful
swelling, stiffness
painful/restricted movement
skin colour changes
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16
Q

metatarsal stress fractures

A

commonest - 2nd or 3rd metatarsal

runners, soldiers on prolonged marches, dancers, long walks in people not used to them

xrays may not demonstrate until 3 weeks

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17
Q

when is surgery offered for hallux valgus?

A

for pain + restriction of function

  • cosmetic reasons won’t be happy
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18
Q

This 50 year old lady complains of left 1st MTPJ pain on walking, particularly when wearing thin, non-supportive shoes. She cannot wear high heels because of the pain and stiffness in the joint. On examination, active and passive range of movement of the joint is reduced (and quite tender at the end range of movement) and grind test is positive.

A

hallux rigidus

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19
Q

classification used in ankle fractures

A

Weber classification

Type A - below ankle joint, syndesmosis intact
Type B - at level of joint, syndesmosis intact or partially torn
Type C - above joint, syndesmosis disrupted

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20
Q

management of ankle fractures

A

assessmnet of stability determines posible management - if fracture disrupts syndesmosis, surgery is more likely

conservative = cast or moon boot
surgical = open reduction internal fixation (ORIF)
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21
Q

what are people with tibial shaft fractures more at risk of?

A

compartment syndrome - particularly anterior compartment

–> open fractures common, v slow healing

22
Q

management of tibial shaft fractures

A

conservative (up to 50% displacement + 5degrees angulation)
= above knee cast

surgical = IM nail, ORIF

23
Q

associated risk in tibial plateau fractures

A

neurovascular injury - popliteal structures, common peroneal nerve
compartment syndrome

often associated soft tissue injuries eg ACL

24
Q

management of tibial plateau fractures

A

conservative = above knee cast

surgical (more common, high energy injury)

  • ORIF
  • external fixator
  • delayed total knee replacement
25
Q

causes of femoral shaft fractures

A

high energy injury - major trauma, pobs with other injuries

metastatic disease, Paget’s, long term bisphophonate use for osteoporsis

substantial blood loss can occur in displaced fractures - up to 1.5L

26
Q

management of femoral shaft fractures

A

initially = Thomas splint - temp stabilisation, minimises blood loss + fat embolism

definitive = IM nail, plate fixation or ORIF

27
Q

most common pelvic fragility fracture in elderly?

A

pubic ramus

Low energy pubic rami fractures in elderly tend to be minimally displaced lateral compression injuries + settle with conservative management over time

28
Q

risk in pelvic fractures

A

often leads to significant intra-abdominal bleeding

  • emboli
  • shock + death
29
Q

3 main patterns of pelvic fractures

A
  1. Lateral compression - side impact (RTA)
  2. Anteroposterior compression - torn pubic symphysis, open book pelvic fracture
  3. Vertical shear force - fall from height + rapid deceleration, sacral + lumbosacral roots at high risk of injury
30
Q

mandatory investigation in pelvic fractures

A

PR exam
assess sacral nerve root function + look for blood

blood = open fracture

31
Q

pelvic fracture management

A

initial = pelvic binder

conservative = rest, physio, analgesia, occu

surgical = open reduction internal fixation (ORIF)

32
Q

cause + presentation of scaphoid fractures

A

caused by FOOSH

tenderness in anatomical snuffbox
pain on compressing thumb metacarpal

33
Q

treatment + complication of scaphoid fractures

A

plaster cast 6-12weeks

avascular necrosis*
non-union

34
Q

types of distal radius fractures

A

Colles fracture - FOOSH, dinner fork deformity

Smith fracture - fall onto back of flexed wrist, ORIF

Barton fracture - intra-articular involvinf dorsal or volar rim, ORIF

35
Q

Colles fractures

A

FOOSH, dinner fork deformity

distal radius - causes distal portion to displace posteriorly (upwards)

36
Q

complications of Colles fractures

A

ulnar styloid fracture
median nerve compression from stretch of nerve
bleed into carpal tunnel

long term = rupture of extensor pollicis longus tendon - requires tendon transfer

37
Q

management of Colles fracture

A

(distal radius)

cast, splint

ORIF, manipulation under anesthesia (MUA), K wires

external fixation if in lots of bits (comminuted)

38
Q

why is the forearm prone to multiple injuries?

A

radius + ulnar connected with proximal + distal radioulnar joints = forms ring

fracture of one bone - usually injury in another

39
Q

cause + treatment of isolated ulnar fractures (nightstick)

A

result from direct blow - classic defensive fracture (nightstick)

conservative or ORIF
*make sure no dislocation of radial head at elbow (Monteggia)

40
Q

what is a Monteggia injury?

A

fracture of ulnar shaft + dislocation of radial head at elbow

management = ORIF

41
Q

what is a Galeazzi injury?

A

fracture of distal part of radius + dislocation of distal radioulnar joint
(ulnar intact)

management = ORIF

42
Q

cause + presentation of olecranon fracture

A

fall onto elbow

insertion of triceps tendon - extension of elbow

43
Q

management of olecranon fracture

A

conservative = cast

surgical = tension band wiring, ORIF, plate fixation

44
Q

causes of humeral shaft fracture

A

fall resulting in transverse or comminuted

direct trauma resulting in oblique or spiral

45
Q

biggest risk in humeral shaft fractures

A

neurovascular injury - esp RADIAL nerve (sits in humeral groove)

presentation = wrist drop + loss of sensation in first dorsal web space

46
Q

management of humeral shaft fractures

A

high union rate (90%) - most conservative

conserv = humeral brace / U-slab cast

surgical = IM nail, ORIF plate fixation

47
Q

what nerves are at risk of damage in shaft vs proximal humeral fractures?

A

shaft = radial (humeral groove) - wrist drop

proximal = axillary - regimental patch test

48
Q

cause + management of proximal humeral head fractures

A

common
low energy or osteoporotic bone

conservative = collar + cuff
surgical = ORIF, replacement

**damage to axillary nerve - regimental patch test

49
Q

malunion of a fracture of the distal radius may result in impaired grip strength, is this impairment associated with loss of extension or flexion at the wrist joint post injury?

A

wrist extension is associated with poor grip strength ost distal radial fracture

50
Q

which types of salter-harris fractures are intra-articular?

A

III + IV - fracture splits the physis

51
Q

which nerve is most at risk in a Colles fracture?

A

median nerve

52
Q

Fractures have the potential to remodel over time. That is that they change shape with ‘bone laid down along areas of stress’.

What is the eponymous name given the the physics principle being described and applied here?

A

Wolff’s law

MSK (14 decks)

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