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MSK and Soft Tissue > Fractures > Flashcards

Fractures Flashcards

1
Q

How are fractures described?

A
  1. Integrity of skin/tissue (closed/open)
  2. Location (epiphyseal/ metaphyseal/ diaphyseal/physis)
  3. Orientation/fracture pattern
  4. Displacement
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2
Q

What is an open v closed fracture?

A

Closed: skin overlying intact
Open: skin overlying lacerated, fracture exposed to external environment

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3
Q

Characteristics of a transverse fracture?

A

Fracture line perpendicular to long axis of bone, direct force, high energy.

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4
Q

Characteristics of an oblique fracture?

A

Angular fracture line, angular or rotational force.

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5
Q

What is a spiral fracture?

A

Complex multi-planar fracture line. Rotational force with high energy.

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6
Q

What is a comminuted fracture?

A

More than 2 fracture segments.

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7
Q

What are the indications for open reduction of a fracture?

A 
NO CAST:
N: Non-union
O: Open fracture
C: neurovascular Compromise
A: intra-Articular fracture
S: Salter-Harris 3/4/5
T: polyTrauma
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8
Q

How should fractures be managed?

A
  • ABC, 1” and 2” survey
  • AMPLE Hx
  • Analgesia
  • Imaging
  • Splint
  • Reduction and maintenance
  • Rehabilitation
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9
Q

What is an AMPLE Hx?

A
  • Allergies
  • Medications
  • PMHx
  • Last meal
  • Events surrounding injury.
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10
Q

How is a closed reduction conducted?

A
  • Apply traction in long axis of the limb
  • Reverse mechanism that produced trauma
  • Reduce with IV sedation and muscle relaxation
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11
Q

What are the potential complications of open fracture reduction?

A
  • Infection
  • Mal-union
  • Non-union
  • Implant failure
  • New fracture
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12
Q

Describe normal fracture healing.

A

W 0-3: Haematoma, M0 surround fracture
W 3-6: osteoclasts remodel sharp edges, callus forms within haematoma
W 6-12: bone forms within callus, bridges fragments
M 6-12: Cortical gap bridged by bone
Y1-2: normal architecture through remodelling

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13
Q

What are the early local complications of fracture?

A
  • Compartment syndrome
  • Neurovascular injury
  • Infection
  • Implant failure
  • Fracture blisters
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14
Q

What are the systemic complications of fracture?

A
  • Sepsis
  • DVT/PE
  • ARDS (2” to fat embolism)
  • Haemorrhagic shock
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15
Q

What are the late local complications of fracture?

A
  • Mal/non-union;
  • AVN,
  • osteomyelitis,
  • Heterotopic ossification
  • OA, stiffness.
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16
Q

What is the emergency management of open fractures?

A
  • Remove obvious foreign material
  • Irrigate with normal saline if contaminated
  • Cover with sterile dressing
  • IV ABx
  • Tetanus toxoid/Ig
  • Reduce and splint
  • NPO and OR prep
17
Q

What are the Xray rules in fracture investigation?

A

Xray Rule of 2s:

  • 2 sides = bilateral
  • 2 views = AP + lateral
  • 2 joints = above and below
  • 2 times = before and after reduction
18
Q

What does displacement refer to?

A

Distal fragment relative to the proximal fragment

19
Q

What is heterotopic ossification?

A

Formation of bone in abnormal locations (e.g. in muscle), secondary to pathology.

20
Q

What are the orthopaedic emergencies?

A 
VON CHOP:
V- Vascular compromise
O - Open fracture
N - Neurological compromise
C - Compartment Syndrome
H - Hip Dislocation
O - Osteomyelitis / septic arthritis
P - unstable Pelvic Fracture
21
Q

What is an open fracture?

A

Fractured bone in communication with the external environment. Increased risk of osteomyelitis.

22
Q

Emergency management of open fracture?

A

STAND (splint, tetanus prophylaxis, ABx, Neurovascular status, dressings to cover).

  • Clean/irrigate/cover
  • Immediate IV ABx
  • Consider tetanus toxoid / Ig
  • Reduce and splint fracture
  • NPO and OT prep
23
Q

How are open fractures classified?

A

Gustilo Classification (I-III) based on length of open wound (10cm).

24
Q

Prophylactic ABx in open fractures?

A

GUSTILO I: Cefazolin for 3d

GUSTILO II: Cefazolin 3/7 + gentamicin (G-ve cover) 3/7

25
Q

Mechanism of clavicle fracture?

A
  • Fall on shoulder (87%)
  • Direct trauma to clavicle (7%)
  • FOOSH (6%)
26
Q

Clinical features of clavicle#?

A
  • Pain and skin tenting

- Arm clasped to chest

27
Q

Mx clavicle fractures?

A
  • Proximal and Middle 1/3: figure of 8 sling 1-2/52
  • Distal 1/3:
  • ->undisplaced = sling 1-2/52.
  • ->displaced (CC ligament injury): ORIF
28
Q

Complications of clavicle fracture?

A

(In addition to general # complications)

  • cosmetic bump
  • shoulder stiffness/weakness
  • pneumothorax / neurovascular injury (very rare)
29
Q

Framework for fracture description?

A 
SOLARTAT
Site
Open v closed
Length
Articular
Rotation
Translation
Alignment / Angulation
Type (e.g. Salter Harris etc)
30
Q

What is the Gustilo Anderson classification?

A

Classification of open fractures.

i: wound 10cm, coverage available
iiib: 10cm, requiring soft tissue coverage procedure
iiic: with vascular injury requiring repair

31
Q

Emergency Mx and assessment of vascular injuries?

A
  • Realign limb / apply longitudinal traction and reassess pulses
  • surgical consult
  • direct pressure if external bleeding
32
Q

Which structures are at risk in anterior shoulder dislocation?

A
  • Axillary nerve (lateral aspect of shoulder)

- Musculocutaneous nerve (extensor aspect of forearm)

33
Q

What is the mechanism of Colles fracture?

A

Generally FOOSH

34
Q

Features of Colles fracture?

A

Dinner fork deformity

i) Dorsal tilt
ii) Dorsal displacement
iii) Ulnar styloid fracture
iv) Radial displacement
v) Radial tilt
vi) Shortening

35
Q

Fractures resulting from FOOSH by age?

A

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MSK and Soft Tissue (33 decks)

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