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Musculoskeletal > Fractures > Flashcards

Fractures Flashcards

1
Q

Describe primary bone healing

A

Minimal gap, bone able to fill gap. E.g. hairline fracture, fixation with plate & screws

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2
Q

Describe secondary bone healing

A

Fracture gap fills with granulation tissue, then cartilage (soft callus), then bone (endochondral ossification, hard callus), eg. colles fracture & POP, IM nail, ex-fix

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3
Q

What is the fracture healing process?

A

Haematoma-soft callus-hard callus-remodelling

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4
Q

What does communition mean in relation to fractures?

A

Bone breaks down into fragments- high energy impacts (watch soft tissus, compartment syndrome) or poor quality bone

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5
Q

What are some non operative holding management strategies?

A

Cast (POP, lightweight), functional bracing, traction

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6
Q

What are some internal fixations?

A

K-wires, cerclage wires, onlay devices-plates, screws, inlay devices- IM (intramedullary) nails

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7
Q

What are some external fixations?

A

Temporary, definitive. Can be lateral rod only, or ring shaped round limb

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8
Q

What is a possible management strategy for some intra or periarticular fractures?

A

Replacement

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9
Q

What is the general management if simple minimally displaced extra-articular fracture in acceptable alignment and stable?

A

Conservative management, splint

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10
Q

What is the general management if position unacceptable of fracture?

A

Reduction

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11
Q

What is the general management if fracture unstable and patient is fit?

A

Operative stabilisation

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12
Q

What is the general management if fracture caused by high energy, or substantial soft tissue swelling?

A

Avoid ORIF, wait until tissues settle, may opt for indirect techniques- nailing, ex-fix

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13
Q

What is the general management if undisplaced intra-articular fractures?

A

May be stable and treated non-operativey

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14
Q

What is the general management if displaced intra-articular fractures?

A

Reduction and rigid internal fixation to prevent post trauma OA

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15
Q

What is the general management of peri-articular fractures which risk non-union or AVN?

A

Joint replacement

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16
Q

What is the general management of open fractures?

A

ABx, tetanus, early debridement and operative stabilisation

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17
Q

What is the general management compartment syndrome in complicated fracture?

A

Fasciotomy & operative stabilisation

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18
Q

What is the general management if vascular injury has occurred in complicated fracture?

A

Reduction, stabilisation and reassess circulation. May need revascularisation procedure (stent etc)

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19
Q

What is the general management of nerve injury in a complicated fracture?

A

If open > explore, closed > reduce fracture & hold, recheck and observe

20
Q

Describe a femoral shaft fracture

A

Usually high energy (unless pathological). Approx 1l blood loss, associated with other injuries, risk fat embolism, ARDS.

21
Q

How are femoral shaft fractures commonly treated?

A

Resuscitation, analgesia- femoral nerve block, splintage- Thomas splint. If unstable- IM nailing

22
Q

Describe the treatment of extra articular distal femur fractures?

A

Unstable- thomas splint. If not too distal can nail, if distal - plating.

23
Q

Describe the treatment of intra-articular distal femur fractures?

A

Anatomical reduction, rigid fixation, plate & screws

24
Q

Describe proximal tibial fractures

A

High energy young, low in old usually. Usually valgus stress- lateral tibial plateau fracture with disruption at articular surface.

25
Q

What temporary treatment may a high energy proximal tibial fracture with substantial soft tissue damage need?

A

Temporary spanning with ex-fix

26
Q

How is the personality of a proximal tibial fracture determined?

A

CT

27
Q

What is the management of proximal tibial fractures?

A

Reduction, rigid fixation. Elevation-depressed articular fragments & bone grant. High proportion get post trauma arthritis

28
Q

Describe fractures of the tibial shaft

A

Low or high energy. Risk of compartment syndrome. Open fracture common. Internal rotation poorly tolerated. 16 wks time to union, >1yr non-union. Conserative-plaster, operative-IM nailing, plating, ex fix

29
Q

What is an intra articular distal tibial #?

A

Pilon #

30
Q

What are some associated injuries of distal tibial #?

A

Spine, pelvis, calcaneus

31
Q

What are the concerns in distal tibial #?

A

Significant soft tissue injury, surgical emergency > urgent bridging ex-fix.

32
Q

What is the management of a distal tibial #?

A

Internal fixation once soft tissues settle

33
Q

Are isolated distal fibular and minimally displaced medial malleolus # stable or unstable?

A

Stable- may be treated conservatively

34
Q

What shift occurs in unstable bimalleolar fractures?

A

Talar shift

35
Q

What is 1st degree nerve injury?

A

Neurapraxia- temporary conduction block/demyelination. Should resolve within 28d

36
Q

What is 2nd degree nerve injury?

A

Axonotmesis- nerve cell axon dies distally from point of injury=wallerian degeneration. Structure of nerve (endoneurial tubes) intract, regenerates at 1mm per day

37
Q

What is 3rd degree nerve injury?

A

Neurotmesis- nerve transected-rare with # or dislocation. Needs surgery

38
Q

What are the indications for exploration of nerve injury?

A

Open #, penetrating injury, neuralgic pain> ongoing compression

39
Q

What should be done if no function returns after #, indicating nerve injury?

A

NCS, nerve grafting, tendon transfers

40
Q

What are some early systemic complications of #?

A 
Hypovolaemia
 	Fat embolism
 	Acute Respiratory Distress Syndrome
 	Systemic Inflammatory Response Syndrome
 	Multi-Organ Dysfunction Syndrome
41
Q

What are some late local complications of #?

A 
Stiffness, loss of function, “fracture disease”
	Post-traumatic arthritis
 	Non-union
 Atrophic non union
 Hypertrophic non-union
 	Malunion
 	Volkmann’s ischaemic contracture
 	Chronic Regional Pain Syndrome
 	Osteomyelitis
 	Avascular necrosis
 	DVT
42
Q

What is malunion in fracture healing?

A

Fracture has healed in a non -anatomic position sufficient to cause symptoms-pain, stiffness, loss of function, deformity

43
Q

What fractures require XR to confirm union?

A

Only diaphyseal fractures of major long bones

44
Q

What are some signs of fracture healing?

A

Pain improvement, no tenderness, no movement at fracture site, no swelling or oedema

45
Q

What are some causes of atrophic non-union?

A

Poor blood supply to fracture site, fracture gap too big and no movement, systemic disease, smoking, medicines e.g. steroinds, NSAIDs, bisphosphonates. Infetion

Musculoskeletal (16 decks)

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