Fractures Flashcards
What is a compound fracture?
Skin is broken and bone exposed to air
Broken bone can puncture through the skin
What is a stable fracture?
Bone remains in alignment at the fracture
What is a pathological fracture?
Break due to abnormality within the bone
What is a greenstick fracture?
Fracture in which the bone bends and breaks
Occurs most often during infancy and childhood when bones are soft
What is a buckle (torus) fracture?
Incomplete fracture where one side of the bone bends on itself, does not affect the other side
What is a Salter-Harris fracture?
Fracture of the growth plate only in children
See classification system below
What is a Colle’s fracture?
Transverse fracture of distal radius
Dorsal angulation of distal fragment
Dinner fork deformity
What is a Smith’s fracture?
Transverse fracture of distal radius
Palmar angulation of distal bone, bone is pointing to palmar side
Why is a Smith’s fracture more dangerous than a Colle’s fracture?
Due to palmar angulation of distal bone fragment neurovascular bundles are more at risk as they are in this direction
How do you remember which is which with Colle’s and Smith’s?
Colle’s
Hand is outward
Dinner-fork deformity = Dorsally displaced
Smith’s
Hand is inward
Caused by FOOSH
What is a key sign of a scaphoid fracture?
Tenderness in the anatomical snuffbox
Why are scaphoid fractures so dangerous?
Retrogade blood supply
Blood vessels supply bone from only one direction
Fracture can cut off blood supply causing avascular necrosis and non-union
What bones have vulnerable blood supply which can lead to avascular necrosis?
Scaphoid
Femoral head
Humeral head
Talus
Navicular
Fifth metatarsal in the foot
What does an ankle fracture involve?
Lateral or medial malleolus
What classification is used to describe lateral malleolus fractures?
Weber classification
When is surgery more likely to be required with ankle fractures?
When the fracture disrupts the tibiofibular syndesmosis (fibrous joint between the tibia and fibula)
What are the different classifications of the weber classification?
Type A
Below ankle joint, syndesmosis intact
Type B
At ankle joint, syndesmosis intact or partially torn
Type C
Above joint, syndesmosis disrupted
What happens when one part of the pelvic ring fractures?
Another part of the pelvic ring will also fracture, like breaking a polo
Why do pelvic ring fractures require emergency trauma management?
Often causes significant intra-abdominal bleeding due to vascular injury from cancellous bone of pelvis
Can lead to shock and death
What causes pathological fractures?
Underlying disease of the bone such as tumours, osteoporosis or Paget’s disease of the bone
What cancers metastasise to the bones?
PoRTaBLe (ignore vowels, consonants-cancer)
Prostate
Renal
Thyroid
Breast
Lungs
What causes fragility fractures?
Bone weakness usually due to osteoporosis
Low energy fractures that is a typical for a usual break
How can a patient’s risk of fragility fracture be predicted?
FRAX tool
How is bone mineral density measured?
DEXA scan
What is used first line for reducing fragility fracture risk?
Calcium and Vitamin D
Bisphosphonates (alendronic acid)
How do bisphosphonates work?
Interfering with osteoclasts and reducing their activity
Prevents reabsorption of bone
What are the side effects of bisphosphonates?
Reflux and oesophageal erosions
- Take on an empty stomach and sit upright for 30 minutes before moving or eating
Atypical fractures
Osteonecrosis of the jaw
Osteonecrosis of external auditory canal
What is denosumab?
Monoclonal antibody
Alternative to bisphosphonates where they cannot be used
What is the mechanism of action of denosumab?
RANKL inhibition
Prevents osteoclast maturation
What are the principles of fracture management?
Mechanical alignment
Closed reduction- manipulation of limb
Open reduction- surgery
Relative stability
Fixing the bone in place e.g. external casts or nails, screws or plates
What are the early complications of fractures?
Local structure damage
Haemorrhage- leading to shock and death
Compartment syndrome
Fat embolism
Venous thromboembolism
What are the long-term complications of fractures?
Delayed union (slow)
Malunion (misaligned)
Non-union (doesn’t heal)
Avascular necrosis
Infection (osteomyelitis)
Joint instability
Joint stiffness
Contractures (tightening of soft tissue)
Arthritis
Chronic pain
Complex regional pain
When can a fat embolism occur after a fracture?
If there is a fracture of a long bone e.g. femur
What happens in a fat embolism?
Fat globules released into circulation
Globules become lodged in vessels causing obstruction
What can systemic inflammatory response to fat embolisation cause?
Fat embolism syndrome
Presents 24-72 hours after fracture
What is Gurd’s major criteria for fat embolism syndrome diagnosis?
Respiratory distress
Petechial rash
Cerebral involvement
What are some features of Gurd’s minor criteria for fat embolism syndrome diagnosis?
Jaundice
Thrombocytopenia
Fever
Tachycardia
What reduces risk of fat embolism syndrome?
Operating early to fix the fracture
What is the mortality rate of fat embolism syndrome?
10%
What is a Monteggia fracture?
Fracture of the proximal ulna + dislocation of the radial head at the capitellum
What is a Galeazzi fracture?
Fracture of the radial shaft + dislocation of the distal radio-ulnar joint
What is a Barton fracture?
Intra-articular fracture of distal radius + dislocation of radio-carpal joint
