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fractures Flashcards

1
Q

what is primary bone healing

A

bone simply bridges gap with new bone from osteoblasts

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2
Q

what is secondary bone healing

A
  • fracture occurs
  • haematoma occurs with inflammation from damaged tissues
  • macrophages and osteoclasts remove debris and resorb the bone ends
  • granulation tissue forms from fibroblasts and new blood vessels
  • chondroblasts form cartilage
  • osteoblasts lay down bone matrix
  • calcium mineralisation produces immature woven bone
  • remodelling occurs with organization along lines of stress into lamellar bone
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3
Q

how long does it take for soft callus to form

A

2-3 weeks

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4
Q

how long does it take for hard callus to form

A

6-12 weeks

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5
Q

does smoking affect bone healing

A

yes due to vasospasm

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6
Q

what can cause a hypertrophic non-union

A

too much movement at site of fracture

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7
Q

what are the 5 types of fractures

A
  • transverse
  • oblique
  • spiral
  • comminuted
  • segmental
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8
Q

what is a transverse fracture

A

-pure bending force where the cortex on one side fails in compression and the cortex on the other side in tension

basically line through the middle of the bone width ways

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9
Q

what is an oblique fracture

A

like a diagonal line

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10
Q

what causes oblique fractures

A

shearing force

-fall from a high, deceleration

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11
Q

can oblique fractures shorten and angulate

A

tend to shorten

may angulate

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12
Q

what is a spiral fracture

A

its a squigly line diagonally

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13
Q

what causes spiral fractures

A

torsional forces

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14
Q

what is a comminuted fracture

A

fractures with three or more segments

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15
Q

what is a segmental fracture

A

bone is fractured in two separate places

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16
Q

what do intra-articular fractures have a greater risk of

A

stiffness, pain and post-traumatic osteoarthritis

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17
Q

in what ways can a distal fragment be displaced in a fracture

A

anteriorly or posteriorly

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18
Q

how can a distal fragment be translated

A

medially or laterally

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19
Q

what is angulation

A

direction in which the distal fragment points towards and the degree of this deformity

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20
Q

what is an anterior displacement called in the forearm and hand

A

volar

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21
Q

what is a posterior displacement called in the forearm and hand

A

dorsal

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22
Q

what is a medial translation called in the forearm and hand

A

ulnar

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23
Q

what is a lateral translation called in the forearm and hand

A

radial

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24
Q

what angulations do you get in the upper limb

A

radial/ulnar and dorsal/volar

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25
Q

what kind of angulations do you get in the lower limb

A

varus and valgus

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26
Q

initial management of a femoral shaft fracture

A

thomas splint

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27
Q

how do you treat displaced or angulated fractures where the angle is deemed unacceptable

A

fixed with closed reduction and cast application

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28
Q

what fractures need ORIF (open reduction and internal fixation)

A
  • unstable extra-articular diaphyseal fractures

- displaced intra-articular fractures

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29
Q

which fractures should you not do ORIF

A
  • fractures where the soft tissue is too swollen
  • fractures where blood supply is tenuous or ORIF may cause haemorrhage (e.g. femoral shaft)
  • where plate fixation may be too prominent (e.g. tibia)
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30
Q

when is CRIIF used (closed reduction and indirect internal fixation)

A
  • fractures where soft tissue is swollen
  • where blood supply is tenuous or ORIF may cause haemorrhage
  • where plate fixation may be too prominent
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31
Q

what are some early local complications of fractures

A
  • compartment syndrome
  • vascular injury with ischaemia
  • nerve compression or injury
  • skin necrosis
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32
Q

what are some early systemic complications of fractures

A
  • hypovolaemia
  • fat embolism
  • shock
  • acute respiratory distress syndrome
  • acute renal failure
  • systemic inflammatory response syndrome
  • multi-organ dysfunction syndrome
  • death
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33
Q

what are some late local complications of fractures

A
  • stiffness, loss of function
  • chronic regional pain syndrome
  • infection
  • non-union/mal-union
  • Volkmann’s ischaemic contracture
  • post traumatic osteoarthritis
  • DVT
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34
Q

late systemic complication of fracture

A

pulmonary embolism

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35
Q

what causes compartment syndrome

A

rising pressure from bleeding and exudate within a fracture compresses the venous system
-results in congestion within the muscle and secondary ischaemia

36
Q

presentation of compartment syndrome

A

severe pain in comparison to the grade of injury and pain on passive movement

37
Q

treatment for compartment syndrome

A

emergency fasciotomies

-wounds left open for a period then closed

38
Q

what happens if compartment syndrome is left untreated

A

ischaemic muscle will necrose resulting in fibrotic contracture known as Volkmann’s ischaemia contracture and poor function

39
Q

what is neurapraxia

A

nerve has temporary conduction defect from compression or stretch
-resolves over time

40
Q

what is axonotmesis

A

long nerve cell axon distal to the point of injury die in a process known as wallerian degeneration

41
Q

what is neurotmesis

A

complete transection of nerve

42
Q

what is a colle’s fracture

A

complete fracture of the radius bone of the forearm close to the wrist resulting in an upward displacement of the radius and obvious deformity

43
Q

what nerve injury is associated with colles fracture

A

acute median nerve compression/carpal tunnel syndrome

44
Q

what nerve injury is associated with anterior dislocation of the shoulder

A

axillary nerve palsy

45
Q

nerve injury associated with humeral shaft fracture

A

radial nerve palsy (in spiral groove)

46
Q

nerve injury associated with supracondylar fracture of the elbow

A

median nerve injury (usually anterior interosseous branch)

47
Q

nerve injury associated with posterior dislocation of the hip

A

sciatic nerve injury

48
Q

nerve injury associated with bumper injury to lateral knee

A

common peroneal nerve palsy

49
Q

what artery damage does a knee dislocation risk

A

popliteal artery injury

50
Q

what artery does paediatric supracondylar fracture of the elbow risk

A

brachial artery injury

51
Q

artery damage associated with shoulder trauma

A

axillary artery compromise

52
Q

risk associated with pelvic fractures

A

life threatening haemorrhage from arterial or venous bleeding

53
Q

what are the signs that you should immediate review and intervene by a vascular surgeon

A
  • pain
  • pallor
  • pulseless
  • perishingly cold
  • paraesthesia
  • paralysis
54
Q

what is tenting of skin

A

The skin is very slow to return to normal, or the skin “tents” up during a check. This can indicate severe dehydration that needs quick treatment

55
Q

what is blanching of the skin

A

a sign of restricted blood flow to an area of the skin causing it to become paler than the surrounding area

56
Q

what is de-gloving

A

shearing force on the skin resulting in avulsion of the skin from its underlying blood vessels

57
Q

signs of good fracture healing

A
  • resolution of pain
  • function and movement at fracture site
  • absence of point tenderness
  • no local oedema
58
Q

signs of non-union

A
  • ongoing pain
  • ongoing oedema
  • movement at the fracture site
  • bridging callus may be seen on X-ray
59
Q

hypertrophic non-union

A

-instability and excessive motion at the fracture site

60
Q

what is atrophic non-union

A

rigid fixation with a fracture gap, lack of blood supply to the fracture site, chronic disease or soft tissue interposition

61
Q

what type of fractures have bad blood supply

A
  • scaphoid waist fractures
  • fractures of the distal clavicle
  • subtrochanteric fractures of the femur
  • jones fracture of the fifth metatarsal
62
Q

which is one of the slowest healing bone

63
Q

which fractures are prone to developing AVN

A

fractures of the femoral neck, scaphoid and talus

64
Q

what is systemic inflammatory response syndrome

A

amplification of inflammatory cascades in response to trauma with pyrexia, tachycardia, tachypnoea and leukocytosis

65
Q

what can lead to MODS

A
  • hyovolaemia
  • SIRS
  • ARDS
66
Q

what is an inside out fracture

A

spike of fractured bone from within puncturing the skin

67
Q

what is an outside in fracture

A

laceration of the skin from tearing or penetrating injury

68
Q

what is debridement

A

removal of all contamination and excision of non-viable soft tissue

69
Q

what are the three grades of ligament ruptures

A 
grade 1 (sprain)
grade 2 (partial tear)
grade 3 (complete tear)
70
Q

mainstay treatment for soft tissue injuries

71
Q

which tendon tears require surgical repair for restoration of function

A

quadriceps tendon

patellar tendon

72
Q

which complete tendon tears can be treated conservatively

A
  • achilles tendon
  • rotator cuff
  • long head of biceps brachii
  • distal biceps
73
Q

most common bacteria for septic arthritis

A

staph aureus

74
Q

who gets E.coli septic arthritis

A
  • elderly
  • IV drug users
  • seriously ill
75
Q

how is the periosteum different in children

A

its thicker and tends to remain intact

76
Q

at what age are fractures treated as adult fractures

77
Q

what is Salter-Harris classification I

A

pure physeal separation

78
Q

what is Salter-Harris II

A

similar but small metaphyseal fragment attached to physis and epiphysis

79
Q

what is salter-harris II and IV

A

intra-articular and splitting the physis

80
Q

what is salter-harris V

A

compression injury to the physis with subsequent growth arrest

81
Q

which is the most common physeal fracture

A

salter-harris II

82
Q

what is a monteggia fracture

A

a fracture of the ulnar shaft with concomitant dislocation of the radial head

83
Q

what is a Galeazzi fracture

A

a fracture of the middle to distal third of the radius associated with dislocation or subluxation of the distal radioulnar joint

84
Q

where are supracondylar fractures

A

supracondylar region of distal humerus

85
Q

treatment for a femoral shaft fracture in children 2-6

A

thomas splint or hip spica cast

86
Q

treatment for femoral shaft fracture in children 6-12

A

flexible intramedullary nails, traction and cast

msk (45 decks)

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