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T&O Surgery > Fractures > Flashcards

Fractures Flashcards

1
Q

What is a compound fracture?

A

Skin is broken and bone exposed to air

Broken bone can puncture through the skin

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2
Q

What is a stable fracture?

A

Bone remains in alignment at the fracture

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3
Q

What is a pathological fracture?

A

Break due to abnormality within the bone

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4
Q

What is a greenstick fracture?

A

Fracture in which the bone bends and breaks

Occurs most often during infancy and childhood when bones are soft

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5
Q

What is a buckle (torus) fracture?

A

Incomplete fracture where one side of the bone bends on itself, does not affect the other side

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6
Q

What is a Salter-Harris fracture?

A

Fracture of the growth plate only in children

See classification system below

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7
Q

What is a Colle’s fracture?

A

Transverse fracture of distal radius

Dorsal angulation of distal fragment

Dinner fork deformity

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8
Q

What is a Smith’s fracture?

A

Transverse fracture of distal radius

Palmar angulation of distal bone, bone is pointing to palmar side

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9
Q

Why is a Smith’s fracture more dangerous than a Colle’s fracture?

A

Due to palmar angulation of distal bone fragment neurovascular bundles are more at risk as they are in this direction

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10
Q

How do you remember which is which with Colle’s and Smith’s?

A

Colle’s

Hand is outward

Dinner-fork deformity = Dorsally displaced

Smith’s

Hand is inward

Caused by FOOSH

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11
Q

What is a key sign of a scaphoid fracture?

A

Tenderness in the anatomical snuffbox

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12
Q

Why are scaphoid fractures so dangerous?

A

Retrogade blood supply
Blood vessels supply bone from only one direction

Fracture can cut off blood supply causing avascular necrosis and non-union

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13
Q

What bones have vulnerable blood supply which can lead to avascular necrosis?

A

Scaphoid
Femoral head
Humeral head
Talus
Navicular
Fifth metatarsal in the foot

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14
Q

What does an ankle fracture involve?

A

Lateral or medial malleolus

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15
Q

What classification is used to describe lateral malleolus fractures?

A

Weber classification

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16
Q

When is surgery more likely to be required with ankle fractures?

A

When the fracture disrupts the tibiofibular syndesmosis (fibrous joint between the tibia and fibula)

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17
Q

What are the different classifications of the weber classification?

A

Type A
Below ankle joint, syndesmosis intact

Type B
At ankle joint, syndesmosis intact or partially torn

Type C
Above joint, syndesmosis disrupted

18
Q

What happens when one part of the pelvic ring fractures?

A

Another part of the pelvic ring will also fracture, like breaking a polo

19
Q

Why do pelvic ring fractures require emergency trauma management?

A

Often causes significant intra-abdominal bleeding due to vascular injury from cancellous bone of pelvis

Can lead to shock and death

20
Q

What causes pathological fractures?

A

Underlying disease of the bone such as tumours, osteoporosis or Paget’s disease of the bone

21
Q

What cancers metastasise to the bones?

A

PoRTaBLe (ignore vowels, consonants-cancer)
Prostate
Renal
Thyroid
Breast
Lungs

22
Q

What causes fragility fractures?

A

Bone weakness usually due to osteoporosis

Low energy fractures that is a typical for a usual break

23
Q

How can a patient’s risk of fragility fracture be predicted?

A

FRAX tool

24
Q

How is bone mineral density measured?

A

DEXA scan

25
Q

What is used first line for reducing fragility fracture risk?

A

Calcium and Vitamin D
Bisphosphonates (alendronic acid)

26
Q

How do bisphosphonates work?

A

Interfering with osteoclasts and reducing their activity

Prevents reabsorption of bone

27
Q

What are the side effects of bisphosphonates?

A

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

28
Q

What is denosumab?

A

Monoclonal antibody

Alternative to bisphosphonates where they cannot be used

29
Q

What is the mechanism of action of denosumab?

A

RANKL inhibition
Prevents osteoclast maturation

30
Q

What are the principles of fracture management?

A

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

31
Q

What are the early complications of fractures?

A

Local structure damage

Haemorrhage- leading to shock and death

Compartment syndrome

Fat embolism

Venous thromboembolism

32
Q

What are the long-term complications of fractures?

A

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

33
Q

When can a fat embolism occur after a fracture?

A

If there is a fracture of a long bone e.g. femur

34
Q

What happens in a fat embolism?

A

Fat globules released into circulation

Globules become lodged in vessels causing obstruction

35
Q

What can systemic inflammatory response to fat embolisation cause?

A

Fat embolism syndrome

Presents 24-72 hours after fracture

36
Q

What is Gurd’s major criteria for fat embolism syndrome diagnosis?

A

Respiratory distress
Petechial rash
Cerebral involvement

37
Q

What are some features of Gurd’s minor criteria for fat embolism syndrome diagnosis?

A

Jaundice
Thrombocytopenia
Fever
Tachycardia

38
Q

What reduces risk of fat embolism syndrome?

A

Operating early to fix the fracture

39
Q

What is the mortality rate of fat embolism syndrome?

A

10%

40
Q

What is a Monteggia fracture?

A

Fracture of the proximal ulna + dislocation of the radial head at the capitellum

41
Q

What is a Galeazzi fracture?

A

Fracture of the radial shaft + dislocation of the distal radio-ulnar joint

42
Q

What is a Barton fracture?

A

Intra-articular fracture of distal radius + dislocation of radio-carpal joint

T&O Surgery (34 decks)

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