fractures Flashcards
compound fracture
skin is broken and broken bone exposed to air
stable fracture
sections of bone remain in alignment at fracture
pathological fracture
bone breaks due to abnormality within bone
comminuted fractures
breaks into multiple fragments
salter-harris fracture
growth plate fracture
types of fracture more common in kids
greenstick
buckle
colles fracture
transverse fracture of distal radius
causing distal portion to displace posteriorly (upwards)
colle’s fracture deformity
dinner fork deformity
colle’s fracture usual mechanism
FOOSH
scaphoid fracture usual mechanism
FOOSH
key sign of scaphoid fracture
tenderness in anatomical snuffbox
scaphoid bone blood supply
retrograde - blood vessels supply blood from only one direction
fracture can result in loss of blood supply –> avascular necrosis and non-union
which key bones have vulnerable blood supply
scaphoid femoral head humeral head talus 5th metatarsal
what can happen if bones with vulnerable blood supply are fractures
avascular necrosis, impaired healing and non-union
what do ankle fractures involve
lateral malleolus (distal fibula) or medial malleolus (distal tibia)
ankle fractures: weber classification
describe fractures of lateral malleolus
described in relation to distal syndemosis (fibrous joint) between tibia and fibula
The Weber classification defines fractures of the lateral malleolus as: Type A
below ankle joint
will leave syndemosis intact
The Weber classification defines fractures of the lateral malleolus as: Type B
at level of ankle joint
syndemosis will be intact or patially torn
The Weber classification defines fractures of the lateral malleolus as: type C
above ankle joint
syndemosis will be disrupted
when is surgery more likely to be required for ankle fracture
if syndemosis is distrupted by fracture
need to regain good joint stability and function
pelvic ring fractures
when one part of pelvic ring fractures another part will also fracture (think of breaking a polo mint)
pelvic fractures often lead to…..
significant intra-abdo bleeding
can lead to shock and death to need emergency resus and trauma management
why do pelvic # cause intra-abdo bleeding
either due to vascular injury or from cancellous bone of pelvis
causes of pathological fractures
tumour
osteoporosis
Paget’s disease
common sites of pathological #
femur
vertebral bodies
main cancers that metastasise to bone
Prostate renal thyroid breast lung
fragility fractures
occur due to weakness in bone, usually osteoporsos
often occur w/o approp trauma needed to break bone
how can patient’s risk of fragility fracture be predicted
FRAX tool
bone mineral density can be measured using a
DEXA scan
1st line medical treatment for reducing risk of fragility fractures
calcium + vitamin D
bisphosphonattes
how to bisphosphonates work
interfere with osteoclasts - reduce their activity and prevent reabsorption of bone
bisphosphonate side effects
reflux + oesophageal erosions
atypical fractures
osteonecrosis jaw
osteonecrosis external auditory canal
what’s an alternative to bisphosphonates
denosumab - monoclonal antibody which blocks osteoclast activity
imaging
X-ray (2 views always required)
CT
principles of # management
- mechanical aligment
2. relative stability
principles of # management: mechanical aligment
closed reduction - via manipulation of limb
open reduction - via surgery
principles of # management: relative stability
provide stability to give time for healing to occue
fix bone in correct position whilst it heals
various ways bones can be fixed
external cast
IM wires, nails
screws, plates
possible early complications
damage to local structures haemorrhage compartment syndrome far embolism VTE
possible long-term complications
delayed union malunion non-union avascular necrosis infection (osteomyeltitis) joint instability joint stiffness contractures arthritis chronic pain complex regional plain syndrome
fat embolism
can occur following fracture of long bone
fat globules are released into circulation following #and can become lodges in blood vessels
fat embolism syndrome
fat embolisaion can cause systemic inflammatory response
when does fat embolism typically present
~24-72hrs after fracture
Fat embolism: Gurd’s major criteria
resp distress
petechial rash
cerebral involvement
Fat embolism: Gurd’s minor criteria
jaundice
thrombocytopenia
fever
tachycardia
