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Phase 2 - MSK > Fractures > Flashcards

Fractures Flashcards

1
Q

What inflammatory mediators are released following a fracture?

A

Interleukins 1 and 6 (attract inflammatory cells)
BMP and FGF (cell differentiation and proliferation)
IFF-2 and TGF-B (lay down collagen matrix)

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2
Q

Where are the inflammatory mediators released from?

A

PLatelets

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3
Q

Describe the process of fracture healing

A
  1. Periosteal tear causes bleeding and a haematoma formation
  2. Fibroblasts enter and capillaries sprout into the haematoma
  3. Cytokine release causes granulation tissue to form
  4. Granulation tissue develops into a callus (adding type 2 collagen)
  5. Continued microfractures increase the size of the callus
  6. Callus is replaced by lamellar bone by osteoblasts and clasts
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4
Q

What factors help with remodelling of the callus?

A

Osteoclasts

Movement of surrounding tendons and muscles

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5
Q

Give some factors which affect bone healing

A
  • Smoking
  • NSAIDS
  • Age
  • Hormones
  • Functional activity (movement aids osteogenesis)
  • Nerve function
  • Nutrition (Vit D deficiency)
  • Local blood supply (periosteal stripping)
  • Degree of immobilisation (more movement means greater blood supply)
  • Local pathology
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6
Q

Define bone non-union

A

The permanent failure of healing following a broken bone

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7
Q

What are the different types of non-union?

A

Hypertrophic non-union

Atrophic non-union

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8
Q

Describe hypertrophic non-unopn

A

Callus forms but bony ends do not join together

- treat by rigidly immobilising fracture

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9
Q

Describe atrophic non-union

A

Callus does not form

  • improve fixation
  • expose raw ends of bone
  • bone grafts
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10
Q

How can ultrasound be used in bone healing?

A

Causes micro-mechanical stress fractures which helps to induce callus formation

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11
Q

What are BMPs?

A

Bone Morphogenic Proteins

  • Cytokines and metabologens which induce bone and cartilage development
  • Can be produced with recombinant DNA technology to treat spinal fusions and fracture non-union
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12
Q

Define a fracture

A

A discontinuity in the bone cortex

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13
Q

Describe a transverse fracture

A

At riht angle to shaft

Due to side force

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14
Q

Describe an oblique fracture

A

At an oblique angle to shaft

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15
Q

Describe a spiral fracture

A

Curving or twisting along the bone

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16
Q

Describe a butterfly fracture

A

One fragment in the shape of a butterfly wing

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17
Q

Describe a comminuted fracture

A

More than two fragments

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18
Q

Describe an impacted fracture

A

One fragment has been driven into the other

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19
Q

Describe displaced fractures

A

The bone ends shift in relation to each other

Is described in relation to the distal fragment

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20
Q

What are the main symptoms of fractures?

A

Pain
Deformity
Decreased movement

21
Q

When do you use the Salter-Harris classification?

A

Fractures that occur through the growth plate in children

22
Q

Describe the components of the Salter Harris Classification

A

SALTRA
1 = S = Straight across the physis
2 = A = above the physis
3 = L = lower than the physis
4 = T = through the metaphysis, physis and epiphysis
5 = R = rammed physis which ahs been crushed
6 = A = avulsion of physis by ligament

23
Q

Give your initial management for a fracture

A 
ABCDE
Control haemmorhage w/ pressure and splinting
Fluid resuscitation
Pain control
Immobilisation
Cover with sterile dressing
24
Q

What would you assess when sassessing a fracture?

A

Mechanism of injury
Blood supply (colour, tempt, cap refill, pulses)
Nerve supply
- movement, sensation
Soft tissue injury
- open wounds, swelling, tenderness
Bone injury
- deformity, crepitus
Movement
- active movement will be decreased with pain
- passive allows assessment of joint stability

25
Q

What x-rays do you need to get for a fracture?

A

Two views at rigth angles to each other

Joint above and joint below

26
Q

What are the radiographical signs of a fracture?

A

Soft tissue swelling
Lipohaemarthrosis
Loss of continuity of cortex
Angulation of the bone

27
Q

What are the signs which indicate the severity of a fracture?

A 
Damage to soft tissues
Impairment of circulation to distal limb
Compartment syndrome
Comminution
Wide displacement
28
Q

How much blood can be lost from certain fractures?

A 
Pelvis = 5L
Humerus = 1L
Femur = 2L
29
Q

When would you operate on fractures?

A

Open fractures

Displaced intra-articular fractures

30
Q

Give an example of percutaneous fixation

A

K-wires

- are driven into the bone through the skin in order to reduce fractures and hold fragments together

31
Q

Give an example of internal fixation

A

Plates and screw

- allows for early mobilisation

32
Q

What is important to emphasize to patients if htey have a fracture?

A

Mobilisation is important as there is an increase in the flow of synovial fluid, therefore the cartilage receives more nutrients.

33
Q

Give some life threatening complications of fractures

A

Haemmorhage - pelvi fractures especially
Arterial injury
Crush injury - release of breakdown products (Ca2+, K+, myoglobin) Treat with alkaline diuresis

34
Q

Give some lib threatening complications

A 
Open fractures
Dislocation
Vascular injury 
Compartment syndrome
Neurological injury 
Intra-articular fractures - risk of subluxation or dislocation
35
Q

Give some late complication of fractures

A 
Non-union
Mal-union
Avascular necrosis
Traumatic arthropathy 
Growth disturbance
Contractures e.g. Volkmann's ischaemic contractures
36
Q

Describe what happens in greenstick fractures

A

Children with flexible bones

Bone bends but the cortex only breaks on one side, causing an incomplete fracture

37
Q

Describe a Colles fracture

A

Distal radius fracture
Get dorsal angulation
Get dorsal and radial displacement (dinnerfork)
Commonly due to FOOSH
Can get an associated ulnar styloid fracture

38
Q

Describe a Smiths fracture

A

Distal radius fracture
Volar Angulation and displacement
Fall on flexed hand
More unstable than Colles as flexors are stronger

39
Q

Describe a scaphoid fracture

A

FOOSH

Tenderness in anatomical snuff box - put in scaphoid cast and xray at one week

40
Q

Give some complication that can occur with scaphoid fractures

A
  • Avascular necrosis of the proximal part of the scaphoid - palmar carpal artery
  • Non-union or delayed union
  • Reduced grip strength and reduced range of motion
41
Q

What metacarpals tend to be fractured in punch injuries?

A

5th metacarpal

42
Q

Which metacarpals tend to be fractures in boxers?

A

1st and 2nd metacarpals

43
Q

Describe a Bennet’s fracture

A

Fall to teh thumb which causes a fracture subluxation of the metocarpalphalangeal joint

Need manipulation and plaster or internal fixation

44
Q

What must you ensure when assessing a fractured phalanx?

A

Make sure there is no rotational deformity

Splint it to the adjacent finger

45
Q

Management and complications for a surgical neck of humerus fracture

A

Needs fixation
Risk of avascular necrosis and fracture dislocation
Sling
Hemiarthroplasty if necrosis occurs

46
Q

What must you check in humeral fractures?

A

Integrity of the radial nerve as it runs posteriorly in the radial groove

  • Triceps extension
  • Wrist extension

Manage with traction and hanging cast
May need an intramedullary nail

47
Q

How will someone present with a fractured neck of femur?

A

Shortened and externally rotated leg

48
Q

What treatment would you given an elderly patient who had a fractured NOF and why?

A

Hemiarthroplasty

Risk of avascular necrosis

Phase 2 - MSK (3 decks)

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