fractures Flashcards
compartment syndrome cause
develops due to build up of pressure within the fascial compartments
compartment syndrome presentation
- swelling
- out of proportion pain
- pain on passive stretch
- decreased temperature
- loss of pulses
- intra-compartment pressure > 30 mmHg
compartment syndrome management
fasciotomy
complication of compartment syndrome
Volkmann’s ischaemic contracture
Volkmann’s ischaemic contracture cause
due to failure to treat compartment syndrome resulting in muscle necrosis and fibrosis
fractures especially at risk of avascular necrosis
- scaphoid
- proximal talus
- head of humerus
- femoral condyles
- intra-capsular femoral head
what is a surgical neck of humerus fracture
fracture of ulna and dislocation of radial head at elbow joint
surgical neck of humerus fractures are most common in
elderly patients with osteoporosis
surgical neck of humerus fracture associations
- avascular necrosis
- axillary nerve damage (presents with loss of sensation over badge patch area i.e. C5)
surgical neck of humerus fracture management
- most commonly managed conservatively
- open reduction and internal fixation of ulna
mechanism of humeral shaft fracture
fall on outstretched hand
humeral shaft fracture association
radial nerve damage (presents with wrist drop and loss of sensation in dorsal first web sapce)
humeral shaft fracture management
conservative (traction brace)
mechanism of olecranon fracture
fall onto point of elbow, with triceps contracted
olecranon fractures result in
avulsion of olecranon process
radial head fractures result in
loss of pronation and supination
radial head fracture associations
- elbow dislocation
- fat pad sign on x-ray
radial head fracture management
conservative
what is a Galeazzi fracture
radial head fracture with ulnar dislocation
what is a Monteggia fracture
ulnar fracture with radial dislocation (more common)
mechanism of a Colles fracture
fall on outstretched hand with wrist extension
what is a Colles fracture
extra-articular fracture of the distal radius with dorsal displacement (broken end of bone points back)
Colles fracture presentation
dorsal displacement and angulation of the wrist (dinner fork deformity)
Colles fracture associations
- median nerve compression
- extensor pollicus longus rupture
- Sudecks dystrophy
mechanism of Smith’s fracture
fall on outstretched hand with wrist flexion
what is a Smith’s fracture
extra-articular fracture of the proximal radius with volar displacement (broken end of bone points forwards)
Smith’s fracture presentation
volar displacement and angulation of the wrist
Smith’s fracture management
open reduction and internal fixation (unstable fracture)
what is a Barton’s fracture
intra-articular fracture of the wrist
Barton’s fracture associations
subluxation of the carpal bones
scaphoid fracture presentation
tenderness over anatomical snuffbox
scaphoid fracture associations
- delayed presence of fracture on x-ray
- non-union
- avascular necrosis
mechanism of Boxer’s fracture
punching injury
what is a Boxer’s fracture
5th metacarpal fracture
Boxer’s fracture management
strap pinkie to adjacent finger
hip fracture presentation
- immobilisation and unable to weight bear
- severe pain in hip, groin and knee
- pain on palpation of greater trochanter and rotation of hip
- shortened, adducted and externally rotated leg
hip fracture diagnosis
x-ray (break in Shenton’s line visible)
what is an intracapsular hip fracture
fracture that occurs at the neck of the femur within boundaries of joint capsule
classification used for hip fractures
Garden classification
what is a garden stage 1 hip fracture
undisplaced and incomplete
what is a garden stage 2 hip fracture
undisplaced and complete
what is a garden stage 3 hip fracture
complete fracture, but incompletely displaced
what is a garden stage 4 hip fracture
complete fracture, completely displaced
intracapsular hip fracture associations
- non-union
- avascular necrosis
intracapsular hip fracture management
- arthroplasty (standard management)
- total hip replacement (better results, but higher risk of dislocation)
- hemi-arthroplasty for less mobile patients
- consider fixation in patients < 60
what is a extracapsular hip fracture
fracture that occurs outside of the joint capsule and that can be classified as trochanteric or subtrochanteric
extracapsular hip fracture associations
- malunion
- non-union
extracapsular hip fracture management
fixation with dynamic hip screw of intramedullary nail
mechanism of femoral shaft fracture
high energy fall
femoral shaft fracture associations
- substantial blood loss
- acute respiratory distress syndrome due to fat embolism
femoral shaft fracture management
- immediate stabilisation with Thomas splint
- closed reduction and IM nail for stabilisation
what is a tibial plateau fracture
proximal tibial fracture that involves the articular surface of the knee joint
tibial plateau fracture associations
- lots of swelling
- compartment syndrome
- common peroneal injury (foot drop)
tibial plateau fracture: management
may need external fixation prior to internal fixation
mechanism of tibial shaft fracture
rotation forces of compression from sudden deceleration
tibial shaft fracture associations
compartment syndrome if open fracture
tibial shaft fracture management
- conservative
- slowest healing fracture
mechanism of distal tibial fracture
rotation forces of compression from sudden deceleration
distal tibial fracture management
conservative
mechanism of pilon fracture
high impact trauma due to fall from height
what is a pilon fracture
distal tibial fracture that involved the articular surface of the ankle
pilon fracture management
- surgical emergency
- external fixation asap
mechanism of ankle fracture
inversion or rotational forces
ankle fracture presentation
inability to weight bear
what is a stable ankle fracture
isolated distal fibular fracture minimally displaced medial malleolus
what is an unstable ankle fracture
distal fibular fracture with deltoid rupture and bimalleolar fracture
stable ankle fracture management
conservative
unstable ankle fracture management
open reduction and internal fixation
classification used for ankle fractures
Weber classification
what is a Weber A ankle fracture
below the syndesmosis (usually stable)
what is a Weber B ankle fracture
at the level of the syndesmosis (can be stable or unstable)
what is a Weber C ankle fracture
above the syndesmosis
mechanism of a 5th metatarsal fracture
inversion injury and avulsion of the insertion of peroneus brevis
5th metatarsal fracture management
moon boot
