fractures Flashcards
What are some risk factors for fractures
smoking, alcohol, malnutrition, impaired vision, osteoporosis
What is the blood supply to the femoral head
intramedullary artery of femur shaft, medial and lateral circumflex branches of profounda femoris, artery of ligament teres
Where is an intracapsular fracture
in the neck
where is an extra capsular fracture
in the trochanteric line roughly
In extra capsular fracture what type of fractures can you get
basicervical, intertrochanteric and subtrochanteric
What do you use to treat hip fractures
early mobilisation and surgery
How do you treat undisplayed intracapsular fractures
screws
How do you treat displaced intracapsular fractures
THR or arthroplasty
What happens in primary bone healing?
there is a minimal fracture gap, where bone is able to refill it- this would be a hairline fracture, fixation with plates and screws
What is secondary bone healing
fracture fills with granulation tissue > soft callus > hard callus = colles fracture
What is the general management?>
ABCDE, analgesia, assess- closed/open, neuromuscular status, soft tissue, compartment syndrome, splint age, reduction, non op/ op
What kind of patterns of fractures can you get?
angulation, displaced, comminution, stable/ unstable, extra/intraarticular
Which part of the bone displays?
The bottom half of the bone
What non op strategies are there?
plaster cast, bracing, traction
if minimally displaced what treatment option is besT>
splintage
if position is unacceptable, what should you do?
reduction
if its an unstable fracture, how do you fix it?
operative stabilisation
When should you not perform ORIF?
When there is significant swelling
When should internal fixation be used?
when displaced intra articular fracture
What does a compartment syndrome require?
fasciotomy
is a femoral shaft fracture usually high energy or low energy?
high
what are the risks of femoral shaft fracture?
ARDS, fat embolism
what is the treatment of femoral shaft fracture
resus, analgesia, splint (thomas) unstable- nailing
If you have a distal femur fracture what do you use to treat it?
plating
What type of stress is a proximal tibial fracture likely to cause?
valgus stress
If it is a high energy proximal tibial fracture with soft tissue damage what procedure should be used?
external fixation
What is a big risk in a tibial shaft fracture?
compartment syndrome
How do you treat tibial shaft fracture?
plaster, IM nailing, ex-fix
What is an intra articular distal tibial fracture called?
Pilon fracture
Is a distal tibial fracture an emergency?
YES 110%
Once soft tissue swelling settles, what do you do in a distal tibial fracture?
internal fixation
What constitutes a stable ankle fracture?
isolated distal fibular fracture or medial malleolus
talar shift happens from what
bimalleolar fractures, distal fibular fracture
What age group tend to fracture their proximal humerus?
elderly
What arteries/ veins are at damage in injury of the proximal humerus?
axillary artery, brachial plexus
what are you at risk of in proximal humerus fracture
AVN/ NON UNION
What nerve is at risk in the humeral shaft fractures?
radial
When is internal fixation used in humeral shaft fractures
non union
What is the usual treatment of distal humerus fractures?
ORIF
If the radius is fractured in isolation and a DRUJ dislocation- wha tis this?
Galeazzi
If the ulna is fractured in isolation suspect a dislocation of the radial head
Monteggia
How should yu treat both fractured bones of the forearm?
ORIF
Where does a colles fracture occur?
Distal radius
What are complications of colles fracture?
median neve compression, EPL rupture, CRPS, loss of grip strength
What is a smiths fracture?
Fall onto back of hand, EXTRA ARTICULAR, unstable ORIF
What is a bartons fracture
intra articular, \orif
What are the three unstable fractures you should treat in polytrauma
pelvic, femoral and tibial
What are early complications of fractures
compartment syndrome, vascular injury, nerve injury and skin necrosis
What is 1st degree nerve injury called?
Neurapraxia
what is second degree nerve block called?
axonotmesis- nerve cell dies distally from point of injury
What is neurotmesis
3rd degree injury, nerve is transcected
What tests should you do in nerve injury?
nerve conduction studies?
What can be early systemic complications?
ARDS, SIRS, fat embolism, hypovolaemia
What are late local complications
DVT, AVN, malunion, nonunion, CRPS
What type of medicine can lead to non union
steroids, NSAIDS, bisphosphonates
Name the biggest late systemic complications
PE
What things should you assess in a fracture?
Open/ closed/ neuromuscular involvement, compartment syndrome, soft tissues.
