Fractures Flashcards
How can the types of hip fracture be broadly categorised?
Intracapsular vs. extracapsular
How can you determine if a fracture is intracapsular?
What are the types of intracapsular fracture?
Intracapsular fracture = proximal to intertrochanteric line
Types of intracapsular fracture:
- Displaced
- Non-displaced
What are the types of extracapsular fracture?
- Intertrochanteric
- Subtrochanteric
How do you typically manage a non-displaced intracapsular fracture?
Internal fixation
How do you typically manage a displaced intracapsular fracture?
Either THR or hemiarthroplasty (may opt for hemiarthroplasty in older, more frail patients)
How do you typically manage an intertrochanteric fracture?
Dynamic hip screw (DHS)
How do you typically manage a subtrochanteric fracture?
Intramedullary nail
What are the typical symptoms and signs of a hip fracture?
Symptoms:
- Pain
- Inability to weight bear
Signs:
- Shortened, abducted and externally rotated leg
What is the diagnostic investigation for hip fracture?
XR hip (AP and lateral views)
What is the name for the continuous curving line formed by the medial border of the femoral neck, continuing to the inferior border of the superior pubic ramus?
Shenton’s line - disruption of this line is a key sign of #NOF
NICE guidelines recommend that surgery for a hip fracture is carried out within (…?) hours of the patient being admitted to hospital
48 hours
What is a Colle’s fracture?
Transverse fracture of the distal radius
What is typically the cause of a Colle’s fracture?
FOOSH - fall onto outstretched hand
What might you see on examination in a patient with a Colle’s fracture?
“Dinner fork deformity”
What is typically the cause of a scaphoid fracture?
FOOSH - fall onto outstretched hand
What sign might be present on palpation of the hand/wrist in a patient with a scaphoid fracture?
Tenderness in the anatomical snuffbox
What is they key complication of a scaphoid fracture?
Avascular necrosis
What is meant by the term pathological fracture?
A fracture which occurs as a result of underlying disease of the bone (e.g. osteoporosis, tumour/mets, Paget’s disease of the bone)
What is the mnemonic to remember which cancers commonly metastasise to bone?
PoRTaBLe:
- Prostate
- Renal
- Thyroid
- Breast
- Lung
Which system can be used to classify paediatric growth plate fractures?
Salter-Harris classification
Describe the Salter-Harris classification
Types I-V (remember using mnemonic SALTER)
I/S - Straight across (physis)
II/A = Above (physis and metaphysis)
III/L = Lower (physis and epiphysis)
IV/TE = Through Everything (physis, epiphysis and metaphysis)
V/R = cRush injury involving physis
Ankle fractures involve either the… or the…
- Medial malleolus (distal tibia)
- Lateral malleolus (distal fibula)
Which classification system can be used to describe fractures of the lateral malleolus?
Weber classification
Describe the Weber classification
This system describes the location of the fracture in relation to the distal syndesmosis (join) between the tibia and fibula
A = below the ankle joint (syndesmosis intact) B = at the level of the ankle joint (syndesmosis may/may not be affected) C = above the ankle joint (syndesmosis disrupted)
A T-score between -1 and -2.5 means…
Osteopenia
A T-score less than -2.5 means…
Osteoporosis
A T-score less than -2.5 plus a fracture means…
Severe osteoporosis
Which treatment can be used as an alternative form of bone protection in a patient who cannot tolerate a bisphosphonate
Denosumab (monoclonal antibody - inhibits osteoclast activity)
Which rules are used to determine whether an ankle XR is indicated?
Ottowa ankle rules
What are the Ottowa ankle rules?
- Inability to weight bear for four steps, OR
- Bone tenderness over medial malleolus, OR
- Bone tenderness over lateral malleolus
Describe the management of a…
a) Displaced scaphoid fracture
b) Undisplaced scaphoid fracture
a) Screw fixation
b) Cast for 6-8 weeks
