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Ortho and Rheum > Fractures > Flashcards

Fractures Flashcards

1
Q

What is an oblique fracture?

A

One which occurs diagonally across the bone - in one plane

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2
Q

What is a spiral fracture?

A

Similar to oblique but occurs in more than one plane- not as simple as cutting a stick down the middle

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3
Q

What is angulation displacement fracture?

A

One in which the two parts of the bones point at different angles

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4
Q

What is a translation displacement fracture?

A

Bone parts are pointing in the same direction (same angulation) but one is moved off the exact line of the other - displaced to the side

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5
Q

What is rotation displacement fracture?

A

One bone segment is rotated away from the other one - same angle and line but two parts don’t line up

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6
Q

What is impaction fracture?

A

Shortening of the bone without loss of alignment

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7
Q

What is foreshortening fracture?

A

Shortening of the bone with loss of alignment

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8
Q

When giving a displacement description - which part of the bone is it referring to?

A

Is it referring to the distal fragment

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9
Q

What is the ‘rule-of-3’s’ for fracture healing?

A

Closed, paediatric, metaphyseal, upper limb fracture is simplest and will heal in 3 weeks
Any complicating factor doubles the healing time. Aka an adult femur diaphyseal fracture will take 24weeks. Adult (6weeks), diaphyseal (12weeks), lower limb(24 weeks).

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10
Q

What is difference between metaphyseal and diaphyseal?

A

Shaft of the long bone is the diaphysis
Ossified portion of bone in transitional zone between epiphysis (end of bone beyond the growth plate - physis) and diaphysis is the metaphysis

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11
Q

What is fracture disease?

A

Muscle atrophy, stiff joints and osteoporosis that follows immobilisation for treatment of a fracture

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12
Q

What is open reduction internal fixation?

A

Open surgery to realign the bone and then fix with screws etc on the inside and reconstruct joint surfaces - allows joint mobility

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13
Q

When is open reduction internal fixation indicated? x5

A 
Intra-articular #s
Failed conservative treatment 
2 #'s in 1 limb
Bilateral identical #s
Open #s
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14
Q

What is external fixation and when is it useful?

A

Using wires into the bone, a bar and clamps to attach it all. Intervention is away from field of injury therefore good if burns, loss of skin or open fracture

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15
Q

How does lag screw fixation work and when is it useful?

A

Proximal hole is bigger than distal hole in bones and therefore when screw is tightened it pulls the distal segment into the proximal one - good for oblique fractures

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16
Q

What is the Gustilo classification of open fractures?

A

Type 1: low-energy, wounds 1cm causing moderate soft tissue damage
Type 2: greater than 1cm
Type 3: all high-energy fractures irrespective of wound size

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17
Q

Different subtypes of Type 3 Gustilo classification

A

IIIa - adequate local soft tissue coverage
IIIb - inadequate local soft tissue coverage
And periosteal stripping
IIIc - arterial injury needing repair

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18
Q

7a’s of emergency management of open fractures

A

ATLS (ABCDE)
Assessment - NV status, soft tissue injury and photographs of wound
Antisepsis - Take a swab from wound, copious irrigation - cover with large antiseptic dressing
Alignment: align and splint
Anti-tetanus
Antibiotics: 3rd gen cephalosporin eg. ceftrixone + metronidazole
Analgesia

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19
Q

Why is fracture reduction needed?

A

Return of function
Aids revascularisation
Frees any structures trapped between bone ends
Prevents later degeneration if joints involved

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20
Q

When is traction still used to fix fractures?

A

In children

In adults it has largely been replaced by fixation (internal and external)

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21
Q

What is traction?

A

Use of pulleys, weights and and ropes to apply force to a bone to aid mending in the early stages

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22
Q

What is skin traction?

A

Adhesive strapping to attach load to the limb - weight at end of bed

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23
Q

What is fixed traction?

A

Eg. using a Thomas splint

Does not require gravity, force is in the splint

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24
Q

What is skeletal traction?

A

Pin through bone allows bigger forces to be applied

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25
Q

What is balanced traction

A

Weight of limb is balanced against a load - can enable patient to lift leg out of bed

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26
Q

What is Gallows traction?

A

Suitable for children up to 2 years - buttocks rise just above bed

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27
Q

What is Salter and Harris classification of epiphyseal injury?

A

SALTR
I - Slipped - fracture through growth plate not affecting bone - seen in babies and pathological conditions
II - commonest injury with fracture line through growth plate and then up Above the growth plate into metaphysis
III - Lower - displaced fragment with fracture line through growth plate and down into epiphysis
IV - Through/Transverse - through metaphysis down through growth plate and into epiphysis
V - Ruined/Rammed - compression of growth plate

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28
Q

Prognosis with various epiphyseal injuries

A

Worst prognosis with type V
Good prognosis with 1 and 2
Poor prognosis with 3 and 4 - as proliferative and reserve zones are affected

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29
Q

When will fat embolism occur after a fracture?

A

Typically arises on day 3-10

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30
Q

How does fat embolism present?

A

Confusion, dyspnoea, tachycardia, decreased PaO2, fits, coma, petechial rash

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31
Q

What will you see on CXR/CT in fat embolism

A

Small subpleural nodular opacities - snow storm appearance

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32
Q

Mortality with fat embolism

A

10-20%

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33
Q

What is crush injury/compartment syndrome?

A

Dead weight of limb when immobile or in coma may cause crush/compartment - pressure leads to vascular occlusion, leads to hypoxia, necrosis and then increased pressure etc etc

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34
Q

Signs of crush injury/compartment syndrome x5

A

Redness, mottling, blisters, swelling and pain on passive muscle stretching

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35
Q

Management of crush injury/compartment syndrome

A

Prompt fasciotomy is limb/life saving

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36
Q

When is non-union said to have occurred?

A

If no evidence of progression towards healing, clinically or radiologically

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37
Q

What is delayed union?

A

When fracture does not heal within the time reasonably expected for that fracture

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38
Q

Causes of delayed union?

A

Fracture in bone that has finished growing
Poor blood supply (lower tibia) or avascular fragment (scaphoid)
Communited/infected fractures
Generalised disease - eg. malignancy, infection
Distraction of bone ends by muscle

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39
Q

What is Complex Regional Pain Syndrome type 1?

A

Occurs in limb trauma without nerve injury. Its a “complex disorder or pain, sensory abnormalities, abnormal blood flow, sweating and trophic changes in superficial or deep tissues”

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40
Q

Another name for CRPS type 1?

A

Reflex sympathetic dystrophy/ Sudecks atrophy

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41
Q

What is CRPS type 2?

A

When nerve lesions are present - causalgia

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42
Q

Presentation of CRPS?

A 
Initial trauma (may be trivial or severe) - followed weeks or months later by pain, allodynia/hyperalgesia, vasomotor instability, abnormal sweating 
Often burning pain and can affect whole limb
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43
Q

What makes symptoms worse in CRPS?

A

Exercise

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44
Q

Treatment of CRPS

A

Encourage optimism
Avoid bad habits leading to immobility
Amitriptyline +/- NSAIDs

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45
Q

What causes clavicle fracture? Most commonly and also historically

A

Historically - fall onto outstretched hand

Most after a direct blow to the shoulder

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46
Q

Which part of the clavicle is most commonly fractured?

A

Middle 1/3

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47
Q

Management of clavicle fractures normally?

A

Broad arm sling with follow up x-rays at 6 weeks to ensure union

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48
Q

What is broad arm sling?

A

Sling over whole arm and then going around the neck

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49
Q

When might clavicle fractures need more than conservative management

A

Lateral end fractures if non-union occurs - may need internal fixation

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50
Q

Complications of clavicle fracture x3

A

Brachial plexus injury
Subclavian vessel injury
Pneumothorax

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51
Q

When do scapula or acromion fractures occur?

A

They are high energy transfer injuries - therefore usually present with other fractures

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52
Q

Signs of acromioclavicular joint dislocation

A

Tender prominence over the AC joint

Adduction of arm across the body will increase pain

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53
Q

Management of AC joint dislocation

A

Sling support and early mobilisation

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54
Q

When do proximal humerus fractures occur?

A

Typically stable osteoporotic fractures in the elderly

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55
Q

What can proximal humerus fractures result in

A

May result in 2-4 fragments eg. tuberosities coming off

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56
Q

What typically causes fractures of the humeral shaft?

A

Fall onto outstretched arm

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57
Q

Management of humeral shaft fracture

A

90% conservative management - splinting with a humeral brace and gravity traction with ‘collar and cuff’
Immobilise for 8-12 weeks

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58
Q

What is a complication of humeral shaft fracture or surgery to treat it

A

Radial nerve injury causing wrist drop

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59
Q

What can cause anterior shoulder dislocation

A

Fall on arm or shoulder

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60
Q

Signs of anterior shoulder dislocation

A

Loss of shoulder contour (flattening of deltoid) and an anterior bulge from head of humerus

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61
Q

What can be damaged in anterior shoulder dislocation

A 
Axillary nerve (check deltoid patch sensation) and check pulses 
Can also be damaged during reduction
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62
Q

Treatment of anterior shoulder dislocation x2

A

1) Simple reduction - longitudinal traction to arm in abduction - gentle pressure to replace head
2) Kocher’s method - Flex elbow to 90 - abduct shoulder, externally rotate shoulder/humerus and adduct arm back across front of body before internally rotating shoulder

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63
Q

Post treatment of shoulder dislocation

A

Support arm in internal rotation with broad arm sling

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64
Q

How does posterior shoulder dislocation present

A

Rare and presents with limitation of external rotation

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65
Q

Details of inferior shoulder dislocation x3

A

Rare
From hyperabduction
High incidence of complication: NV injury, tuberosity avulsion, rotator cuff tear

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66
Q

What is a supracondylar fracture and in whom is it common?

A

Fracture in shaft of humerus just above the condyles - most common fracture of childhood

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67
Q

Complications of supracondylar fractures? x4

A

May compromise brachial artery, median, radial or ulnar nerve function

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68
Q

What should you do after supracondylar fracture to prevent further injury

A

Keep elbow in extension - prevent exacerbating brachial artery damage

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69
Q

What is Gartland classification of supracondylar fractures?

A

Type I - non-displaced
Type II - angulated with intact posterior cortex - posterior hinge is intact but there is a gap anteriorly
Type III - posterior displacement - unstable fracture

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70
Q

Details of Gartland type III classification

A

IIIa - posteromedial displacement threatens the radial nerve
IIIb - posterolateral displacement threatens the median nerve

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71
Q

Management of supracondylar fractures

A

Type I - above elbow backslab and sling
Type II - reduction usually required
Type III - ORIF

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72
Q

Complication if fracture of medial condyle

A

Ulnar nerve compression

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73
Q

Complication if fracture of lateral condyle

A

Cubitus valgus and ulnar nerve palsy

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74
Q

What is an intercondylar humerus fracture

A

T shaped supracondylar fracture with a line going down for a break between the condyles

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75
Q

Most common cause of elbow joint effusion in children

A

Supracondylar fracture

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76
Q

Most common cause of elbow joint effusion in adults

A

Radial head or neck fracture

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77
Q

Signs of elbow joint effusion on lateral xray

A 
Sail sign (displacement of anterior fat pad by joint effusion - pushing it out so it is no longer aligned with the humerus)
Posterior fat pad sign (displacement of posterior fat pad making it visible - normally not visible)
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78
Q

Signs of radial head fracture

A

Elbow is swollen and tender over the radial head
Flexion and extension may be possible
Pronation and supination hurt
May see joint effusion on xray but fractures often missed

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79
Q

Treatment of radial head fracture

A

Undisplaced = collar and cuff

Displaced limiting supination/pronation - may need internal fixation

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80
Q

Complications of radial head fracture x2

A

1) 3-14% are associated with terrible triad of radial head fracture, elbow dislocation and coronoid process fracture - leading to joint instability and complications
2) Radial nerve injury may occur with severe ant.displacement - but is rare

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81
Q

Typical patient for pulled elbow - what happens

A

Child 1-4 year old who has been lifted by the arms - radial head slips out of annular ligament

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82
Q

Presentation of pulled elbow

A

Arm held slightly flexed and twisted inwards

83
Q

Management of pulled elbow

A

Reduction by cradling elbow, thumb and forefingers over radial head - either Hyperpronate or supinate and flex the elbow

84
Q

Caution with pulled elbow

A

25% recur therefore warn parents not to pull arm of child

85
Q

What causes elbow dislocation?

A

Fall on not yet fully outstretched hand with elbow flexed - causes posterior ulna displacement on humerus

86
Q

Signs of elbow dislocation

A

Swelling and arm held in flexion

87
Q

Reduction of elbow dislocation

A

Stand behind patient

With fingers on epicondyles - push forwards on olecranon and down on forearm

88
Q

What is needed after elbow dislocation reduction

A

X-ray to exclude any fractures

Immobilise in backslab for 10 days

89
Q

Complications of elbow dislocation

A

Stiffness
Instability
Ectopic ossification
Radio-ulnar joint disruption

90
Q

What to do if olecranon fracture?

A

ORIF

91
Q

When is elbow arthroplasty indicated?

A

Comminuted distal humerus fractures where ORIF may be difficult

92
Q

What forearm fracture do falling children often get?

A

Buckle forearm fracture - dorsal Cortex crumples on pressure but volar cortex remains intact therefore distal fragment is angled dorsally

93
Q

Signs of buckle forearm fracture

A

Local tenderness and swelling

Also called torus fracture which means mound

94
Q

Management of buckle forearm fracture

A

They are stable fractures therefore a splint or short-arm cast for 3 weeks may be sufficient

95
Q

What are greenstick fractures?

A 
One cortex (volar or dorsal) is compressed and the other bends/rotates 
Deformation can continue to angulate with growth
96
Q

What is Colles fracture?

A

Fracture of distal radius causing dorsal angulation and displacement producing ‘dinner-fork’ wrist deformity

97
Q

What is usual history for Colles fracture?

A

Fall into outstretched hand. - common in osteoporotic post menopausal women

98
Q

What is the wrist deformity in Colles fracture?

A

Dinner-fork wrist deformity - due to dorsal angulation of distal radius

99
Q

Reduction of Colles fracture

A

Biers block - tourniquet around arm, empty arm of blood, inflate tourniquet, inject local anaesthetic, manipulate fracture, 30mins after anaesthetic release tourniquet

100
Q

What is Smiths fracture?

A

Reverse Colles - distal radius fractures with fragment angled palmarly (volar displacement) - usually extra-articular
Fixation commonly needed

101
Q

What is Bennetts fracture?

A

Carpometacarpal fracture/dislocation of the thumb

Need percutaneous wire fixation

102
Q

Signs of scaphoid fracture

A

Tender in anatomical snuff box
Pain on axial compression of the thumb
Pain on ulnar deviation of pronated wrist or supination against resistance

103
Q

Imaging of suspected scaphoid fracture

A

Need scaphoid series X-ray

104
Q

What is paronychia?

A

Infection under the eponychial fold - antibiotics may help in early stages but if collection forms then drainage is required

105
Q

What is a felon?

A

Infection of the pulp of a distal finger

106
Q

Which is the most common metacarpal to be fractured?

A

5th metacarpal - punching injuries

107
Q

Management of stable closed metacarpal fractures?

A

Splint/cast for two weeks - wrist in partial extension, MCPs in flexion and fingers in extension

108
Q

Management of unstable wrist fractures

A

May require k wires or ORIF

109
Q

What is risk with punching Metacarpal fractures

A

May be wounds eg, from victims teeth - can get infected and can be communicating with joint

110
Q

What is gamekeepers thumb

A

Partial or complete tears of ulnar collateral ligament at MCP joint - due to forced thumb abduction - also called Skiiers thumb

111
Q

Treatment of gamekeepers thumb

A

Partial - can be managed with thumb casting

Complete - needs surgical management

112
Q

What is the main concern with pelvic fractures?

A

Concern for the contents rather than the bones itself - like a suit of armour

113
Q

When do pelvic fractures usually become worrying

A

When 2 or more fractures with one above the level of the hip because then it is unstable - 25% have internal injuries

114
Q

Sign of pelvic fracture

A

Leg length discrepancy

115
Q

Signs of serious complications of pelvic fracture

A 
Haemorrhage - abdominal distension
Bladder rupture
Urethral rupture - drop of blood at end of urethra - unable to pass urine - prostate high riding on PR
Sciatic nerve trapping - persistent pain
Perineal or scrotal haematoma
116
Q

What is Malgaignes fracture?

A

Pelvic fracture / Usually a fracture anterior and posterior to the acetabulum which causes displacement of a fragment involving the hip joint
Leg shortening is sign
- 60% of all unstable fractures and 20% of all fractures

117
Q

Management of acetabulum fractures

A

Open reduction and reconstruction of the articular surface to delay onset on OA

118
Q

How do you examine a patient with suspected pelvic fracture?

A

Gentle palpation of iliac crests, pubic symphysis, sacrum/coccyx, and posterior SI joints
Can gently compress pelvis but no rocking as will cause pain and can exacerbate bleeding

119
Q

What are the signs of an intracapsular hip fracture?

A

External rotation, adduction and shortening

120
Q

Where does an intracapsular hip fracture occur? 3 types

A

Just below the head of femur

Can be subcapital, transcervical or basicervical (just before trochanters)

121
Q

Risk with intracapsular hip fractures

A

Medial femoral circumflex artery supplies the head via the neck therefore ischaemic necrosis of the head may occur

122
Q

Treatment of intracapsular hip fracture

A

If non-displaced then screw fixation is okay as risk of avascular necrosis is much less
If displaced then hemiarthoplasty (hip replacement)

123
Q

Details of intertrochanteric-extracapsular fractures x3

A

Occurs in older age group
Blood supply adequate therefore non-union not usually a problem
Screw fixation

124
Q

What causes femoral shaft fracture?

A

Usually considerable force therefore look for fractures/damage elsewhere

125
Q

Problem with femoral shaft fracture? x2

A

Lots of blood can be lost even in a simple fracture

Sciatic nerve injury can also occur

126
Q

What happens to two fragments in femoral shaft fracture?

A

Lower fragment pulled up by hamstrings and adducted by adducters
Proximal fragment is flexed by iliopsoas, abducted by gluteus medius and laterally rotated by gluteus maximus

127
Q

Treatment of femoral shaft fracture?

A

Stabilise in ED

Locked intramedullary nail introduced over a guide wire

128
Q

Consequences of condylar fractures and tibial plateau fractures

A

Intra-articular therefore demand accurate joint reconstruction to minimise later OA

129
Q

What causes posterior hip dislocation

A

Eg. car crash with front seat passengers when knee strikes dashboard

130
Q

Where do you feel for femoral head in posterior hip dislocation

A

In the buttock

131
Q

What happens to the leg in posterior hip dislocation

A

Leg is flexed, internally rotated, adducted and shortened

132
Q

What can happen in posterior hip dislocation

A

Sciatic nerve may be lacerated, stretched or compressed

133
Q

Treatment of posterior hip dislocation

A

Reduce under GA and traction for 3 weeks to promote capsule healing

134
Q

How does the patella typically dislocate?

A

Laterally as a result of a twisting motion of the lower leg, combined with the contraction of the quadriceps

135
Q

How does the knee appear after patella dislocation?

A

Flexed with a lateral deformity

136
Q

Management of patella dislocation

A

Reduction with gentle medial pressure combined with extension of the knee - followed by period of immobilisation in cast/posterior splint or brace - rehab with quadriceps strengthening exercises

137
Q

What usually causes patella fracture? x2

A

Fall onto a flexed knee or due to dashboard injury in motor vehicle accident

138
Q

Management of patella fracture

A

Non-displaced with intact extensor mechanism - just manage conservatively
Displaced may need surgical fixation

139
Q

Management of isolated collateral ligament injuries

A

Medial rarely needs surgery

Lateral surgery is required if there is instability - look for associated common peroneal nerve injury

140
Q

Cause of medial meniscus tear

A

Twists to a flexed knee eg. football

141
Q

Cause of lateral meniscus tear

A

Adduction and internal rotation

142
Q

Signs of meniscus tear

A

Extension is limited (knee locking) - as displaced segment lodges between femoral and tibial condyles
Can only walk on tiptoes
Tender joint line
Knee can suddenly give way if tear becomes free at one end

143
Q

Management of meniscus tear

A

Conservative when possible - arthroscopy is usually needed for locked knees, cysts or persisting symptoms

144
Q

What tibia fracture is commonly associated with anterior cruciate injury

A

Avulsion fractures of the intercondylar region

145
Q

What sort of tibial fractures are common?

A

Open shaft fractures because little anterior covering tissue

146
Q

Management of pretibial lacerations

A

Better to use adhesive strips (steristrips) than to suture because these can be loosened if skin swells and if flap stretched too tightly then skin will necrose

147
Q

What is a Toddler’s fracture?

A

Spiral fracture of the distal tibial shaft seen in toddlers - supportive treatment - should only occur in a toddler who is walking

148
Q

What is a common ankle ligament strain and how does it occur?

A

Strain to anterior talofibular part of the lateral ligament - caused by twisted inversion

149
Q

Signs of ant. talofibular ligament strain

A

Stiffness and tenderness over the lateral ligament - pain on inversion

150
Q

Sign of more serious problem than lateral ankle ligament strain

A

Tenderness over medial malleolus

151
Q

Treatment of lateral ligament strain

A

RICE

Rest, Ice, Compression, Elevation

152
Q

What causes medial deltoid ligament strain

A

Rare - due to eversion

153
Q

What can occur with ankle ligament strains

A

Malleolar and metatarsal fractures

154
Q

What is Maisonneuve’s fracture?

A

Proximal fibular fracture + syndesmosis rupture - and medial malleolus fracture or deltoid ligament rupture
Therefore always examine proximal fibula with ‘ankle sprains’

155
Q

What is Lisfranc fracture-dislocation

A

At 1st tarsometatarsal joint - can cause compartment syndrome of the medial foot

156
Q

What are Os Calcis fractures

A

Fractures of the calcaeneus - often bilateral after a serious fall
Will have swelling, bruising and inability to weight bear

157
Q

What is AO Weber classification of malleolar fractures?

A

a1 - transverse fibula fracture at or below joint line with no medial injury
a2/3 - with medial injury
b1-3 - fibula fracture at joint line + medial injury (b2) and posterior injury (b3)
c1/2 - oblique fibular fracture above ruptured tibiofibular ligament with medial injury (c2)
c3 - maisonneuves fracture - proximal fibula injury

158
Q

What are the most common injuries with facial trauma?x2

A

Facial laceration and mandible fracture

159
Q

What should always be considered with facial trauma?

A

C-spine injury

160
Q

Management of rugby players “cauliflower” ear

A

Drain haematoma repeat every few days and strap pressure dressing against head

161
Q

Signs of mandible injury

A

Local tenderness and swelling
Jaw malocclusion
A mobile fragment and may have bone protruding into mouth
If communited fracture then tongue can make it very difficult to manage airway

162
Q

Diagnosis of mandible injury

A

Orthopantogram radiograph

163
Q

Treatment of mandible fracture

A

ORIF with miniplates is better than wiring the teeth together

164
Q

Signs of zygomatic arch fractures

A

Before swelling there will be a depression in front of the ear
Lateral jaw excursions of jaw opening may be painful

165
Q

Investigation of zygomatic arch fractures

A

Submentovertex view

166
Q

Good treatment for swollen eye

A

Rubber glove filled with ice

167
Q

What is likely to be the result of trauma to face/eye?

A

Inferior orbital plate fracture because it is very fragile and pressure is transmitted here from resilient eye ball

168
Q

What do you see on X-ray with orbital fracture? X3

A

Eyebrows sign - air leaking into orbit
Tear drop sign- herniation of fat and fluid through orbital floor
Fluid level in maxillary Antrum/sinus (underneath)

169
Q

What sort of xray should be done to investigate orbital fracture?

A

Occipital mental view at 45degrees because otherwise with front on the thick Petrous bone obscures view of upper facial bones

170
Q

What physical signs may occur with orbital floor fracture?

A

Damage to inferior rectus muscle therefore eye cannot look up
Intraorbital Nerve damage - loss of sensation on cheek, nose and upper lip
Feel a step when run finger along maxillary margin

171
Q

What is elephants trunk on xray

A

Zygomatic arch - the head is the zygomatic bone body

172
Q

What is the tripod fracture?

A

Occurs with front on facial trauma
Zygomatic arch and infraorbital plate fracture and zygomatico-frontal suture separation
Patient face - cheekbone will look depressed

173
Q

What is an OM 30degree facial xray good for viewing

A

Lateral wall of maxillary antrum(sinus) - can sometimes rupture with orbital fracture
And zygomatic arch

174
Q

How does mastoid appear on xray?

A

Aero-type appearance because of patchy black from air

175
Q

How does mandible usually dislocate?

A

Anteriorly

Can be from laughing, yawning or trauma

176
Q

Signs of mandible dislocation

A

Patient can’t move jaw

177
Q

Management of mandible dislocation

A

Reduce it - wrap gauze around thumb and push mandible from inside the mouth down and posteriorly

178
Q

What is key blood-wise in fracture?

A

The haematoma that forms as a result - it is the only blood supply to the fracture

179
Q

What occurs in repair of fracture

A

Inflammatory response with cytokines - promote angiogenesis - therefore new vessels form and then new bone gets put down (woven bone)

180
Q

What is the mature type of bone

A

Lamellar bone

181
Q

What is new bone

A

Woven bone

182
Q

How do fractures heal?

A

Bones being close together so that osteoblasts and osteoclasts can work for remodelling - if bones move then won’t heal - hence casts

183
Q

What is wolfs law?

A

Bone remodels according to the load that is put on it - remodelling occurs in the direction of loading and resumes normal shape

184
Q

What drug shouldn’t be given to people with fractures

A

NSAIDs and steroids - slow down healing

185
Q

Greenstick fracture?

A

Elastic and dense bone - therefore deforms instead of fractures - defect in one bit but cortex still in continuation

186
Q

What is avulsion fracture

A

Bit of bone pulled off by the muscle

187
Q

What do you get in a fracture under tension

A

Transverse fracture

188
Q

What do you get in compression fracture? (Eg. Dashboard crush in accident)

A

Oblique fracture at 30 degrees

189
Q

What do you get with torsion injury

A

Spiral

190
Q

What do you get with direct high energy injury

A

Communited

191
Q

Initial management of any open fracture

A

IV augmentin 1.2grams with gentamicin (unless penicillin allergy - clindamycin)
Give tetanus

192
Q

What is important thing you need to know for hip fracture?

A

Intracapsular or extracapsular - because intracapuslar - blood supply to the head of femur will be interrupted and head will be dead and need replacing

193
Q

Blood supply to femoral head

A

Medial circumflex artery

194
Q

What is garden classification of hip fracture?

A

1 and 2 are not displaced
Therefore in theory blood supply is not affected
Garden 1 - incomplete fracture
Garden 2 - complete fracture
Garden grade 3 - partially displaced - trabecular are still aligned
Grade 4 - fully displaced and trabecular not aligned

195
Q

Management of garden grade 1 and 2 hip fracture

A

Grade 1 and 2 - screw

Also screw for young patients displaced #

196
Q

What is dynamic hip screw?

A

Sliding screw that allows fracture to slide and compress - therefore walk on it straight away after surgery

197
Q

When do you use dynamic hip screw

A

Displaced extracapsular NOF #

198
Q

How do you treat intracapuslar displaced feature (garden 3 and 4)

A

Hemi or total arthroplasty

199
Q

Management of distal forearm fractures in children?

A

They have very thick periosteum that you can manipulate with a wire OR leave to heal (will heal completely without doing anything)

200
Q

Intracapuslar hip fracture - when do you do total hip replacement and when do you do hemiarthroplasty

A

Hemiarthroplasty if old and frail etc - if young and can manage it then do THR

201
Q

What do you need to do in hip dislocation

A

Urgent reduction to avoid AVN - occurs within 24-48hrs

202
Q

What is Galeazzi fracture

A

Distal 1/3 fracture of radius with dislocation of the radioulnar joint

203
Q

What is Bartons fracture

A

Intraarticular distal fracture (unlike Colles or Smiths)

204
Q

Position of leg in hip fracture

A

Shortened, adducted and externally rotated

Ortho and Rheum (13 decks)

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