Fractures Flashcards

1
Q

Define fractures.

A

Disruption in the integrity and continuity of bone associated with soft tissue injury.

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2
Q

Explain the aetiology of fractures.

A

Trauma: Force applied to bone exceeds its strength. Direct force (penetrative, crushing) or indirect (tension, compression or rotation injuries).

Greenstick: Incomplete fracture with angulation on the opposite side due to stronger fibrous periosteum in children.

Pathological: Minor force causes fracture secondary to underlying bone weakness (malignancy, congenital).

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3
Q

What are the risk factors for fractures?

A

Contact sports

Trampoline use

RTA

Osteogenesis imperfecta

Non-accidental injury

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4
Q

What is the Salter-Harris classification for fractures?

A

Epiphyseal injuries: involve growth plate, types I–V depending on involvement of the physis, metaphysis and epiphysis.

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5
Q

What is Salter-Harris Type 1?

A

Through the growth plate

(Straight through)

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6
Q

What is Salter-Harris Type 2?

A

Through growth plate and metaphysis,

(Above)

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7
Q

What is Salter-Harris Type 3?

A

Through growth plate and epiphysis.

(Lower)

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8
Q

What is Salter-Harris Type 4?

A

Through all three elements (metaphysis, growth plate, epiphysis)

(Through Everything)

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9
Q

What is Salter-Harris Type 5?

A

Crush injury of growth plate.

(cRush)

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10
Q

Summarise the epidemiology of fractures.

A

Very common. Males more than females.

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11
Q

What are the symptoms for fractures?

A

Usually a history of trauma.

Need to assess if there is a history of non-accidental injury:
Time elapsed, force, possibility of glass contamination, associated head injury, medications and previous fractures.

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12
Q

What are the signs for closed fractures?

A

Pallor and swelling over fracture site, obvious deformity.

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13
Q

What are the signs for open fractures?

A

Bleeding and bruising over fracture, associated soft tissue injury.

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14
Q

What are some tests for fractures?

A

Neurovascular status: Assess for distal numbness, tingling, paralysis or loss of pulse.

Musculoskeletal examination: Examine joint above and below for crepitus, effusion and pain.

Tuning fork test: Exacerbates pain over small stress fractures.

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15
Q

What are some approriate investigations for fractures?

A

X-ray (usually in two views frontal and lateral)

Repeat x-ray.

MRI and Bone scan

Genetics for bleeding disorders and osteogenesis imperfecta.

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16
Q

What is the management for fractures?

A

Initial: Resuscitation, analgesia, stabilisation with splints.

Closed reduction: Manipulation under anaesthetic (MUA).

Open reduction and internal fixation: Adequate exposure before fracture is reduced using wires, plates, screws or nails.

External fixation: Avoids soft tissues that are adjacent to the fracture.

Immobilisation: With plaster casts, braces or splints attached from joint above to joint below to allow healing. Traction by application of tension aligns ends of fracture.

Physiotherapy: Prevents contractures and loss of function.

17
Q

What are some complications associated with fractures?

A

Neurovascular damage

Malunion, non-union or delayed union of fracture.

Avascular necrosis

Psychological impact of disabling condition.

Compartment.

Fractures that involve the growth plate – interrupts growth.

18
Q

What is the prognosis for fractures?

A

Typically, upper limb fractures require 3–4 weeks and lower limb 6–8 weeks to heal.