Fractures Flashcards
What is a compound fracture
the skin is broken and the broken bone is exposed to the air. The broken bone can puncture through the skin.
What is a stable fracture
refers to when the sections of bone remain in alignment at the fracture
What does a comminuted fracture refer to
Breaking into multiple fragments
What is a colle’s fracture
transverse fracture of the distal radius near the wrist, causing the distal portion to displace posteriorly (upwards), causing a “dinner fork deformity”. This is usually the result of a fall onto an outstretched hand (FOOSH)
What type of fracture can a FOOSH result in
Scaphoid fracture
Key signs of scaphoid fracture
tenderness in the anatomical snuffbox (the groove between the tendons when extending the thumb).
Complications of scaphoid fracture
scaphoid has a retrograde blood supply, with blood vessels supplying the bone from only one direction.
This means a fracture can cut off the blood supply, resulting in avascular necrosis and non-union.
What do ankle fractures tend to involve
lateral malleolus (distal fibula) or the medial malleolus (distal tibia)
Classification used for ankle fractures
Weber classification
What is important for stability and function of ankle joint
tibiofibular syndesmosis
Main cancers that metastasise to the bones
Po – Prostate R – Renal Ta – Thyroid B – Breast Le – Lung
Guidelines used to guide medical treatments for fragility fractures
NOGG guidelines
How can fractures be mechanically re-aligned
Closed reduction via manipulation of the limb
Open reduction via surgery
What is a fat embolism
Fat embolism can occur following the fracture of long bones (e.g., femur). Fat globules are released into the circulation following a fracture (possibly from the bone marrow).
These globules may become lodged in blood vessels (e.g., pulmonary arteries) and cause blood flow obstruction.
Presentation of a fat embolism
Gurd’s major criteria:
Respiratory distress
Petechial rash
Cerebral involvement
Risk factors for hip fractures
Age
Osteoporosis
Classification system used for intra-capsular NOF
Garden classification is used for intra-capsular neck of femur fractures:
Grade I – incomplete fracture and non-displaced
Grade II – complete fracture and non-displaced
Grade III – partial displacement (trabeculae are at an angle)
Grade IV – full displacement (trabeculae are parallel)
Features of non-displaced intra-capsular fractures
have an intact blood supply to the femoral head, meaning it may be possible to preserve the femoral health without avascular necrosis occurring.
Mx of non-displaced intra-capsular hip fractures
internal fixation (e.g., with screws) to hold the femoral head in place while the fracture heals.
Mx of displaced intra-capsular fractures
Displaced intra-capsular fractures (grade III and IV) disrupt the blood supply to the head of the femur. Therefore, the head of the femur needs to be removed and replaced.
What does hemiarthroplasty involve
Hemiarthroplasty involves replacing the head of the femur but leaving the acetabulum (socket) in place. Cement is used to hold the stem of the prosthesis in the shaft of the femur. This is generally offered to patients who have limited mobility or significant co-morbidities.
What does total hip replacement involve
Total hip replacement involves replacing both the head of the femur and the socket. This is generally offered to patients who can walk independently and are fit for surgery.
Types of extra-capsular hip fractures
Intertrochanteric fractures
Subtrochanteric fractures
Mx of intertrochanteric fractures
Dynamic hip screw(sliding hip screw)
Mx of subtrochanteric fractures
The fracture occurs to the proximal shaft of the femur. These may be treated with an intramedullary nail (a metal pole inserted through the greater trochanter into the central cavity of the shaft of the femur).
Hip fracture presentation
Pain in the groin or hip, which may radiate to the knee
Not able to weight bear
Shortened, abducted and externally rotated leg
IX for hip fractures
Two views are essential, as a single view can miss the fracture. Anterior-to-posterior (AP) and lateral views are standard.
What is a Shenton’s line
Shenton’s line can be seen on an AP x-ray of the hip. It is one continuous curving line formed by the medial border of the femoral neck and continues to the inferior border of the superior pubic ramus. Disruption of Shenton’s line is a key sign of a fractured neck of femur (NOF).
IX in hip fracture if x-ray is negative
MRI/CT
Mx of hip fractures on admission
Appropriate analgesia
Investigations to establish the diagnosis (e.g., x-rays)
Venous thromboembolism risk assessment and prophylaxis (e.g., low molecular weight heparin)
Pre-operative assessment (including bloods and an ECG) to ensure they are fit and optimised for surgery
Orthogeriatrics input
When would an x-ray be required for a suspected ankle fracture
Ottawa rules
if there is any pain in the malleolar zone and any one of the following findings:
bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)
bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)
inability to walk four weight bearing steps immediately after the injury and in the emergency department
Features of colles’ fracture
Transverse fracture of the radius
1 inch proximal to the radio-carpal joint
Dorsal displacement and angulation
Colles’ - Dorsally Displaced Distal radius → Dinner fork Deformity
Initial mx of open fractures
Open fractures constitute an emergency and should be debrided and lavaged within 6 hours of injury
