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Year 4 Fractures > Fractures > Flashcards

Fractures Flashcards

1
Q

important history points: wrist fractures

A
  • mechanism of injury
  • hand dominance
  • smoking status
  • PMHx - diabetest/thryoid prolongs healing time
  • DHx - NSAIDs and steroids prolong healing time
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2
Q

colle v smith

A

colle = outsward - palm to ground (calle a taxi)
dorsal angulation
distal radius #
dinner fork deformirty
extra-articular
smith = inward - dorsum to ground
volar angulation
distal radius #
very unstable and usually requires ORIF

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3
Q

rule of 22, 11, 11: wrist #

A

displaced v undisplaced
radal inclination on AP view <22degrees
radial heigh <11mm
radial (volar) tile >11 degrees

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4
Q

rx: wrist #

A

undisplaced = short arm casr
displaced = closed reduction undr sedation (shotr arm cast) or anaesthetic (K wires)
open reduction under anaesthetic with IF (ORIF)
short arm MUS to K wires MUA to ORIF

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5
Q

follow up: short arm cast

A

XR 1,2,3 and 6
physio and remove cast - encourage mobilisation week 6

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6
Q

follow up: K wires

A

pin site and XR week 1
wires removed week 3
remove cat and mobilise wk6

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7
Q

follow up: ORIF

A

wound check wk 1-2
change to removable splint wk 2-4 and wean

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8
Q

complications: wirst #

A

pain
N/V damage
Volkmann’s contaracture
arthritis
carpal tunnel

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9
Q

Barton’s: wirst #

A

partial fracture/subluxation
part of articular surface still attached to shaft
volar displacement
ORIF

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10
Q

rx: ankle #

A

undisplaced - short leg cast or removable support boot
displaced (unstable) - CR MUS - moulded short leg cast
then - CRGA - rare (only if unfit for open)
then GA ORIF

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11
Q

displacement: ankle #

A

normal if:
* medial clear space = 4cm (widening = talar shift and subluxation)
* ssyndesmosis tibia/fibula present

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12
Q

ankle #: XR

A

AP (mortician view (15 degree internal rotation)
lateral

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13
Q

rx: ankle dislocation

A

(talar shift - medial clear space >4mm)
reduce and shoer leg cast to stablise

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14
Q

rx: stable fibular #

A
  • short leg cast
  • XR wk 1, 2, 3 and 6
  • non WB until wk6 and wean to fully WB

boot for definite stable injury and WB earlier with boot

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15
Q

def: maisonneuvre #

A
  • high fibular #
  • causes tearing of syndesmosis
  • unstable
  • ORIF
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16
Q

Weber classification: fibular #

A

Weber A: below syndesmosis and stable - non-op
Weber B: at syndesmosis and both stable and unstable if displaced on WB - op = ORIF and non-op
Weber C: above syndesmosis and unstable - ORIF + syndesmosis screw

17
Q

complications: fibular #

A
  • stiffness
  • arthritis
  • N/V damage
  • compartment syndrome
  • metal work failure
  • tendon injury
  • infection
  • anaesthetic risk
18
Q

initial assessment: femoral/tibial #

A
  • n/v assessment inc pulses
  • shock
  • fat embolism
  • splint ASAP (thomas splint = femoral #, back slab = tibial #)
  • open/closed injury ?washout
19
Q

ind: CT in #

A

communituresd or intraarticular

20
Q

rx: tibial #

A

undisplaced = stable = long leg cast
displaced = unstable = sedation CR and long leg cast
then GACR = IM nail or external fixation if extensive tissue damage or highly cominuted)
them GA ORIF = if near joint

21
Q

rx: conservative tibial #

A

6wk long leg cast NWB
6 week partial WB
out of cast and WB as tolerated thereafter

22
Q

Gustilo-Anderson grade

A

I - open <1cm and clean
II - opwn 1-10cm without extensive soft tissue damage/flaps/avulsions
IIIA - adequate soft tissue coverage of # despite extensive soft tissue laceration/flaps or high energy trauma irrespective of wound size
IIIB - extensive soft tissue injury loss with periosteal stripping and bone exposure
IIIC - open assoc with vascular injury of any size

23
Q

rx: open fractures

A
  • give IV co-amox early
  • dress wound and splint
  • tetanus prophylaxis
  • within 24 hours take to theatre, wash, debride, stabilise

IM nail = I - IIIA
external fxation IIIB/C
IIIC usually amputated (MESS score)

24
Q

rx: femoral#

A

GA CR IM nail mst common
GA ORIF rare but in intra-articular distal femoral #

25
Q

signs: fat embolism

A

asymptomatic 12-28hrs
respiratory failure
tachycardia, tachypnoea, hypoxaemia, hypocapnia (type II RF) thrombocytopenia and confusion
petechiall rash = late sign
tx: supportive

26
Q

blood supply: femoral head

A

retinacular vessels - cut off in intracapsular
intramedually vessels

27
Q

types: femoral neck #

A

intracapsular - Garden classification and ?AVN due to blood supply disruption
extracapsular - blood supply maintained

28
Q

rx: extracapsular NOF #

A

DHS for most
cephalomedullary nail if subtrchanteric of reverse oblique

29
Q

rx: intracapsular NOF #

A

Garden classification
Garden 1 - incomplete # and undisplaced - IF DHS
Garden 2 - complete #, not angulated, fairly good blood supply to fem head via fem neck - IF DHS or hemiarth AVN/risk of non-union
Garden 3 - complete #, partially displaced and agulated, severe blood supply damage - young patients closed red and IF mainly hemiarthroplasty or THR if good health and fnx adn >65
Garden 4 - complete fracture, full displacement trabeculla parallel due to degree of displacement - THR or hemi

30
Q

paeds: growth plate #

A

SALTER
I - S = straight across
II - A = above
III - L = lower or below
IV - T = two or through
V - ER = erase growth plate or crush

31
Q

def: greenstick #

A

incomplete
cortex and periosteum interrupted on one side only

32
Q

def: Buckle #

A

incomplete fracture with cortical buckling (usually FOOSH)

33
Q

def: perthes

A
  • idiopathic osteonecrosis of captial femoral epiphysis
  • M>F
  • average age = 7
  • hx - active child, worse with exercise, short stature, hip/groin [ain
  • treatment - <6h observe, >6y surgery
34
Q

def: SUFE

A
  • disorder proximal femoral physiss ledas to slippage of epiphysis
  • hx - obesity, 15-15y, M>F, reduced internal rotation
  • XR - AP, lateral and frog leg
  • tx - in situ pinning and prophylactic pinning other hip
35
Q

def: septic arthritis

A

Kocher criteria (>3/4)
* non WB
* temperature >38.5
* WCC >12
* ESR >40

s. aureus most common
joint aspiration before abx - gram stain, culture, crystals, cells
tx - emergency washout of hip
iv abx up to 6 weeks (flucloxicillin)

Year 4 Fractures (1 decks)

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