fractures Flashcards by Imogen Watson

what are the main patterns of fracture?

transverse
oblique
spiral 
communited 
segmental

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when should antibiotic prophylaxis be started with a fracture?

within 3 hours of an open fracture

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what is the empirical treatment for antibiotic prophylaxis?

IV co-amoxiclav and metronidazole

co-trimoxazole if allergic

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what are early complications with fractures?

haemorrhage
infection/sepsis
compartment syndrome
nerve injury

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what are late complications with fractures?

avascular necrosis
stiffness and decreased function
non-union/malunion
DVT and PE

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what is compartment syndrome?

build up of pressure within the fascial compartments

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in which fractures does compartment syndrome most commonly occur?

tibial shaft

supracondylar

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what is the presentation of compartment syndrome?

swelling
out of proportion pain
pain on passive stretching
decreased temp and loss of pulses

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what is a diagnostic presentation of compartment syndrome?

intra compartment pressure >40

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how is compartment syndrome managed?

fasciotomy

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what is a complication of compartment syndrome?

Volkmanns ischemic contracture –> hand bent up

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what fractures are at risk of AVN?

scaphoid
proximal talus 
head of humerus 
capitulum of humerus 
femoral condyles 
intra capsular femoral fracture

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what are complications of a surgical neck of humerus fracture?

AVN

axillary nerve damage

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what is seen with axillary nerve damage?

loss of sensation over the badge area (C5)

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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

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what causes a humeral shaft injury?

RTA, FOOSH or hit with a bat

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what is an olecranon fracture?

fall onto point of elbow with triceps contracted

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what can result due to an olecranon fracture?

olecranon process avulsion

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what occurs due to a radial head fracture?

loss of supination and pronation

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what sign is seen on x-ray with a radial head fracture?

fat pad sign

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what is a Monteggia fracture?

proximal fracture of ulnar with dislocation of radial head

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what is a Galeazzi fracture?

radial fracture with distal dislocation of radioulnar joint

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what is a Colles fracture?

FOOSH with wrist extension:
extra-articular fracture of the distal radius
transverse fracture
usually 1 inch from radiocarpal joint

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what sign is seen with a Colles fracture?

dinner fork deformity

dorsal displacement of wrist

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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?

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