Fractures Flashcards
What is a greenstick fracture?
- incomplete fracture
- Cortex on the tension side of the fracture fails but the cortex on the compression side of the fracture remains intact
What is a torus fracture?
crease of the bone and periosteum
What is plastic deformation?
bad bend which stays bent, but isn’t obviously fractured
What is the growth plate?
- a lucency between the epiphysis and metaphysis - can appear similar to a fracture
- The physis is the weakest part of a developing bone, so is prone to injury
What are Salter-Harris fractures?
- In normal bones, the epiphysis is always centered on the metaphysis
- In Salter-Harris fractures, the epiphysis is not centered on the metaphysis due to a fracture involving the growth plate
What is a typical history and features of non-accidental injury?
- History that does not match the nature or the severity of the injury
- Vague parental accounts or accounts that change during the interview - inconsistency
- Accusations that the child injured him/herself intentionally
- Delay in seeking help
- Child dressed inappropriately for the situation
- Obvious/suspected fractures in a child under 2yrs
- Injuries in various stages of healing, especially burns and bruises
- More injuries than usually seen in children of the same age
- Injuries scattered on many areas of the body
- Increased intracranial pressure in an infant
- Suspected intra-cranial trauma in a young child
- Any injury that does not fit the description of the cause given
What is the general management of children’s fractures?
- Reduce, retain, rehabilitate
- Children are more amenable to conservative treatment - plaster, traction, less invasive fixation - due to increased modelling potential
- Exceptions to the rule of conservative management in children - displaced intra-articular fractures, displaced growth plate injuries, some open fractures
What is the plaster of paris?
- Diaphyseal fracture - joint immobilised above and below to prevent rotation
- Metaphyseal fracture - adjacent joint immobilised
What are the techniques of fixation?
- Diaphyseal - flexible nails
- Metaphyseal - K wires
- Epiphyseal - K wires and screws
- External fixation - try and avoid in children where possible
- Used in contaminated wounds, acute vascular injury, burns and multiple injuries
What are the symptoms of a fracture?
- Localised bony (marked) tenderness - not diffuse mild tenderness
- Swelling
- Deformity
- Crepitus - from bone ends grating with an unstable fracture
What is found on examination of a fracture?
- Open or closed injury
- Assessment of distal neurovascular status (pulses, capillary refill, temperature, colour, sensation, motor power)
- Assess for compartment syndrome
- Assess the status of the skin and soft tissue envelope
What is the general initial management of a fracture?
- Clinical assessment
- Analgesia (usually IV morphine)
- Splintage +/- traction
- May involve the application of a temporary plaster slab (known as a backslab), a sling, an orthosis or a Thomas splint (for femoral shaft fractures)
- Imaging - x-ray, CT, MRI
- Guidelines e.g. Ottawa guidelines for ankle injury assist with selecting patients for x-ray
- A useful rule is that if a patient cannot weight bear on an injured lower limb, X‐ray of the painful area should be requested
- If a fracture is obviously grossly displaced, if there is an obvious fracture dislocation (e.g. of the ankle) or if there is risk of skin damage from excessive pressure, reduction of the fracture should be performed before waiting for x-rays
- X‐rays post reduction should still demonstrate any fractures adequately
How are undisplaced, minimally displaced and minimally angulated fractures managed?
considered to be stable are usually treated non‐operatively with a period of splintage or immobilization and then rehabilitation
How are displaced or angulated fractures managed?
may require open/closed reduction
How are unstable fractures managed?
treated with surgical stabilisation which may involve the use of small percutaneous pins (K‐wires) for small fragments, cerclage wires, screws, plates & screws, intramedullary nails or external fixation
How are unstable extra-articular fractures treated?
- Unstable extra-articular diaphyseal fractures can be fixed with ORIF using plates and screws with the aim of anatomic reduction and rigid fixation leading to primary bone healing
- In fractures with very swollen soft tissues, where blood supply to fracture site is tenuous (high energy), where ORIF may cause extensive blood loss (e.g. femoral shaft), or plate fixation may be prominent (e.g. tibia), ORIF tends to be avoided and closed reduction with IM nail fixation used instead to encourage secondary bone healing
- Another option where ORIF is not suitable is external fixation which encourages secondary bone healing, however this carries the risk of pin site infection and loosening
How are displaced intra-articular fractures managed?
- Require anatomic reduction and rigid fixation by way of ORIF using wires, screws and plates
- Fractures involving a joint with predictable poor outcome may be treated with joint replacement or arthrodesis
How are fracture-dislocations managed?
Fractures can occur with dislocations (known as fracture‐dislocation) and these may reduce with closed reduction however ORIF may be required if reduction cannot be achieved, if a bony fragment prevents congruent reduction or if the joint is very unstable
What is the pathophysiology of open fractures?
Open fractures can either occur due to a spike of fractured bone puncturing the skin (‘inside-out’ injury) or due to laceration of the skin from tearing or penetrating injury (‘outside-in’ injury)
- The higher the energy of the injury, the amount of contamination, any delay in appropriate treatment and problems with wound closure increases the risk of infection
- The presence of a concomitant vascular injury raises the risk of amputation
What is Gustilo classification?
describes the degree of contamination, the size of the wound, whether the would would be able to be closed or require plastic surgery cover, and the presence of an associated vascular injury
