Fractures Flashcards
Define fracture.
Break in continuity of a bone
How do you describe fractures?
- Transverse - force direct at site
- Spiral or oblique - twisting
- Greenstick- concave site usually intact
- Crush
- Burst - from pressure on short bone like vertebrae
- Avulsion - from traction by tendon or ligament
- Intra-articular - Salter-Harris
Other:
- Open or closed
- Dislocation or subluxation - malalignment of joint surfaces
What is a tendon vs ligament?
Ligament = bone-bone connection for stability
Tendon = muscle-bone for movement
What is displacement vs dislocation vs subluxation?
Displacement - shortening, rotation, sideways shift or tilt
Dislocation - complete loss of congruity of the joint surfaces
Subluxation - partial loss of contact of the joint surfaces
Summarise the Salter-Harris classification.
- Along epiphysis only
- Commonest - Along epiphysis then obliquely into metaphysis
- Along epiphysis and fragment displaced
- Though epiphysis and metaphysis
- Severe crush of epiphysis from longitudinal compression
What are the clinical features of fracture?
Symptoms:
- Pain
- Loss of function
- Loss of sensation or motor power - suggests nerve or vascular complications and is the most important symptom
Signs:
- Tenderness
- Deformity
- Swelling
- Local temperature increase from inflammation
- Abnormal mobility or crepitus
- Loss of function
What are the uses of XR in fracture?
- Localising fracture
- Indicating degree and direction of displacement
- Identifies pre-existing disease
- Shows foreign body
- Shows unsuspected fracture (incl. joint above and below)
- Air in tissues suggesting penetrating injury
What are the planes of the body and direction terms?
How long does fracture healing normally take?
3-4 months
What are the principles of fracture management?
Reduce
Hold
Rehabilitate
What is the general management of open fractures?
- Orthopaedic emergency - need to reduce risk of infection
- Surgical debridgement - cleaning and removal of devitalised bone fragments and tissue
- Wound left open covered by sterile dressing
- Antibiotics
- Secondary closure within 72hrs once infection prevented or overcome - usually skin graft or split0skin grafting
What are the indications for fracture reduction?
Fracture involves joint or loss of function
To enable early mobility
To promote union
To prevent neurovascular compromise
For cosmesis
What are the techniques for reduction?
- Manipulation under anaesthesia
- Traction - slowly done e.g. if anaesthesia is contraindicated
- Open reduction - accurate but risk of infection
- Closed reduction and fixation - IM or external fixation causing reduction to be achieved indirectly
What are the methods for maintaining fracture reduction? (hold)
Inrinsic stability i.e. it requires nothing
External splintage e.g. casting (plaster of Paris, polythene, plastazote), cast bracing (hinged or jointed cast), traction (skin traction, skeletal traction, sliding or balanced traction,
Internal fixation e.g. screws, plates, compression plates, IM nails
What is shown?
Thomas’ splint with knee attachment and skeletal traction
What is shown?
Gallows traction
What are the principles of rehabilitation of fractures?
- Moving the limb immediately after the primary treatment, as much as the method of fixation allows
- Prevents stiffness and stimulates union
- When splintage is discontinued then exercise and physiotherapy usually follows before full joint function is restored
What are the complications of fractures?
Shock from haemorrhage
Injury to important internal organs - brain, lung liver
Injury to nerves or vessels
Skin loss or damage
What are the intermediate complications of fracture?
General:
- DVT and PE
- Chest infection
- Renal calculi, acute retention and other urinary tract problems
- Fat embolism syndrome - 3-10days after fracture of long bones
- Crush syndrome - extensive soft tissue damage or ischaemia or large volme or tissues
Local:
- Compartment syndrome
- Gangrene
- Pressure sures and nerve palsies - from treatment
- Infection and wound breakdown
- Loss of aligment
- Tetanus and gas gangrene
What are the late complications of fracture?
- Delayed and non-union
- Post-traumatic psychological disturbances
- Late wound sepsis
- Failure of internal fixation
- Joint stiffness and contracture
- Regional pain syndrome
- Osteoarthritis
