Fractures Flashcards by SCRUBS Leicester

What is a compound fracture?

Skin is broken and bone exposed to air

Broken bone can puncture through the skin

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What is a stable fracture?

Bone remains in alignment at the fracture

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What is a pathological fracture?

Break due to abnormality within the bone

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What is a greenstick fracture?

Fracture in which the bone bends and breaks

Occurs most often during infancy and childhood when bones are soft

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What is a buckle (torus) fracture?

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

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What is a Salter-Harris fracture?

Fracture of the growth plate only in children

See classification system below

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What is a Colle’s fracture?

Transverse fracture of distal radius

Dorsal angulation of distal fragment

Dinner fork deformity

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What is a Smith’s fracture?

Transverse fracture of distal radius

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

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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

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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

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What is a key sign of a scaphoid fracture?

Tenderness in the anatomical snuffbox

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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

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

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

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What does an ankle fracture involve?

Lateral or medial malleolus

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What classification is used to describe lateral malleolus fractures?

Weber classification

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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)

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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