fractures Flashcards
what are the main patterns of fracture?
transverse oblique spiral communited segmental
when should antibiotic prophylaxis be started with a fracture?
within 3 hours of an open fracture
what is the empirical treatment for antibiotic prophylaxis?
IV co-amoxiclav and metronidazole
co-trimoxazole if allergic
what are early complications with fractures?
haemorrhage
infection/sepsis
compartment syndrome
nerve injury
what are late complications with fractures?
avascular necrosis
stiffness and decreased function
non-union/malunion
DVT and PE
what is compartment syndrome?
build up of pressure within the fascial compartments
in which fractures does compartment syndrome most commonly occur?
tibial shaft
supracondylar
what is the presentation of compartment syndrome?
swelling
out of proportion pain
pain on passive stretching
decreased temp and loss of pulses
what is a diagnostic presentation of compartment syndrome?
intra compartment pressure >40
how is compartment syndrome managed?
fasciotomy
what is a complication of compartment syndrome?
Volkmanns ischemic contracture –> hand bent up
what fractures are at risk of AVN?
scaphoid proximal talus head of humerus capitulum of humerus femoral condyles intra capsular femoral fracture
what are complications of a surgical neck of humerus fracture?
AVN
axillary nerve damage
what is seen with axillary nerve damage?
loss of sensation over the badge area (C5)
what are complications of a humeral shaft injury? what sign is seen?
damage to radial nerve
presents with wrist drop and loss of sensation first dorsal web space
what causes a humeral shaft injury?
RTA, FOOSH or hit with a bat
what is an olecranon fracture?
fall onto point of elbow with triceps contracted
what can result due to an olecranon fracture?
olecranon process avulsion
what occurs due to a radial head fracture?
loss of supination and pronation
what sign is seen on x-ray with a radial head fracture?
fat pad sign
what is a Monteggia fracture?
proximal fracture of ulnar with dislocation of radial head
what is a Galeazzi fracture?
radial fracture with distal dislocation of radioulnar joint
what is a Colles fracture?
FOOSH with wrist extension:
extra-articular fracture of the distal radius
transverse fracture
usually 1 inch from radiocarpal joint
what sign is seen with a Colles fracture?
dinner fork deformity
dorsal displacement of wrist
what complications can occur with a Colles fracture?
median nerve compression
extensor pollicis longus rupture
what is a smith fracture?
FOOSH with wrist flexed
what is the presentation of a Smith’s fracture?
volar displacement of wrist
how are smith’s fractures managed and why?
ORIF
very unstable fractures
what is Barton’s fracture?
intra-articular fracture of wrist
smith/colles with dislocation of radiocarpal joint
what is a scaphoid fracture?
tenderness over anatomical snuffbox
what is associated with a scaphoid fracture?
delayed presence of fracture on x-ray
requires 4 x-rays
non-union
AVN
what is Bennet’s fracture and what causes it?
intra-articular fracture of 1st carpometacarpal joint (base of thumb)
caused by first fights
what would be the leg presentation in a hip fracture?
shortened, adducted and externally rotated leg
where do intracapsular fractures occur?
at the neck of femur within the boundaries of the joint capsule
what is there a risk of in intracapsular hip fractures? and why?
AVN due blood supply being in area
what is the management for intracapsular hip fracture?
older and reduced mobility -hemi/THR
if younger and fitter <70 - reduction and internal fixation
what is an extra-capsular hip fracture?
fracture outside of the joint capsule
classified as either trochanteric or subtrochanteric (lesser trochanter the line)
what is the management for extra-capsular fracture?
fixation with dynamic hip screw
if reverse oblique, transverse or subtrochanteric then IM nail
what is the management for a femoral shaft fracture?
immediate stabilisation with a Thomas splint
closed reduction and IM nail for stabilisation
what is a tibial plateau fracture?
proximal tibial fracture that involves the articular surface of knee joint
what is associated with tibial plateau fracture?
lots of swelling
compartment syndrome
post traumatic OA
what nerve can be injured with a tibial plateau fracture? what does it cause?
common peroneal nerve injury = foot drop
what type of injury causes a tibial shaft fracture?
sudden deceleration
how is tibial shaft fracture managed?
conservatively managed but has slowest healing time
what is a pilon fracture?
distal tibial fracture that involves the articular surface of the ankle
what is the mechanism of a pilon fracture?
high impact trauma due to fall from height
how is a pilon fracture managed?
immediate external fixation
considered medical emergency
what is a stable ankle fracture? how is it managed?
isolated distal fibular fracture with a minimally displaced medial malleolus fracture
conservatively
what is an unstable ankle fracture? how is it managed?
distal fibular fracture with deltoid rupture and bi-malleloar fracture
instability results from asymmetric joint space due to shift of talus
when do you x ray in ankle injury?
if pain in malleolar zone
can’t weight bear steps
tenderness over distal tibia
bone tenderness over distal fibula
what is the mechanism of a 5th metatarsal injury?
inversion
what is the mechanism of action of a Pott’s injury
eversion
what is the most common site of a stress fracture in the foot?
2nd metatarsal shaft
what is a Pott’s fracture?
bimalleolar ankle fracture
what is the most common type of shoulder dislocation?
anterior
what is the mechanism of an anterior shoulder dislocation?
excessive external rotation or fall backwards
what is the presentation of an anterior shoulder dislocation?
arm help in adduction
loss of sensation over badge patch area
what is the management for shoulder dislocations?
closed reduction under sedation with sling to immobilise
what is the mechanism of a posterior shoulder dislocation?
fall onto internally rotated arm
direct blow to anterior shoulder
what is seen on x-ray of posterior shoulder dislocation?
light bulb sign
in which direction is hip dislocation most common?
posterior
what is the presentation of a posterior hip dislocation?
shortened leg, adducted and internally rotated
what is the presentation of an anterior hip dislocation?
unshorted leg, abducted and externally rotated
what can be damaged with hip dislocation?
sciatic nerve
what is the management for hip dislocation?
ABCDE
reduction under GA
