Fractures Flashcards
1
Q
What are the features of a fracture?
A
pain loss of function tenderness deformity swelling crepitus abnormal movement or positioning soft tissue
2
Q
What is the metaphysis?
A
the ossified portion of bone in a transitional one between the epiphysis and the diaphysis- should always have a smoothly curved cortex
3
Q
What is an apophysis?
A
bony outgrowth independent of a centre of ossification
4
Q
What is fracture disease?
A
muscle atrophy; stiff joints and osteoporosis
5
Q
What are the indications for ORIF?
A
failed conservative Rx; 2 #s in 1 limb; bilateral indentical #s; intra-articular #s; open #s
6
Q
When might external fixation be used?
A
burns; loss of skin and bone or open #
7
Q
What are the 7 A’s of open #s?
A
ATLS
assessment- neurovascular and soft tissues
antisepsis- swab wound and irrigate
alignment
anti-tetanus
antibiotics- ceftriaxone +/- metronidazole
analgesia
8
Q
What is the mnemonic for Salter-Harris #s?
A
SALTR- S- slipped A-above L-lower T-through R-rammed
9
Q
What are the immediate complications of fractures?
A
internal bleeding external bleeding organ injury nerve/skin injury vessel injury (limb ischaemia)
10
Q
What ar teh later local complications of fractures?
A
skin necrosis/gangrene
pressure sore
infection
non or delayed union
11
Q
What are the lateral geeneral complications of #s?
A
venous or fat embolism; PE; pneumonia; renal stones
12
Q
What are the signs of a fat embolism?
A
confusion; dyspneoa; increased pulse’ decrased PaO2; fits; coma; increased Temp; petechial rash
13
Q
What prevents fat embolism?
A
early fixation of #s
14
Q
What is the viscious cycle of compartment syndrome?
A
pressure–vascular occlusion– hypoxia– necrosis– increased pressure
15
Q
What are the signs of compartment syndrome?
A
erythema; mottling; blisters; swelling; pain on passive stretching
16
Q
What are hte late complications of #s?
A
wound sepsis failure of fixation joint stiffness, contracture or malalignment CRPS non-union delayed union
17
Q
What is non-union defined as?
A
no evidence of progression towards healing
18
Q
What causes non-unions?
A
abnormal biology eg infection; blood supply or mechanics
19
Q
What is delayed union?
A
when a # has not healed within the time expected for THAT #
20
Q
What are hte causes of delayed union?
A
in a bone that has finished growing
poor blood supply or avascular fragment
comminuted/ infected #s
generalised sieases eg malignancy or infection
distraction of bone ends by muscel- ORIF prevents
21
Q
What are the two types of CRPS?
A
type 1- no nerve injury
type 2- if nerve lesions are present
22
Q
What are the signs of CRPS?
A
only local sign (no systenic)- pain (burning); allodynia; vasomotor instability; abnormal sweating
patchy oseopenia
23
Q
Where a # clavicle most common?
A
middle third
24
Q
What is the management of a fractured clavicle?
A
broad arm sling with x-rays at 6 weeks
25
What are the potential neurovascular injuries with a clavicle# ?
brachial plexus; sublcavlisn vessels
26
What other complication can you get with clavicle #?
pnuemothorax
27
How do AC dislocations commonly happen?
fall onto the point of hte hsoulder
28
What are the signs of AC dislocation?
tender prominence over ACJ; adduction of arm across body is very painful
29
What is the mx of AC dislocation?
sling support and early mobilisation
30
Who tends to get #s of proximal humerus?
osteoporotic #s in the elderly after FOOSH
31
How is a minimally siplaced proximal humeral # treated?
conservative with a sling
32
How is a persistently displaced proximal humeral # treated?
interal fixation
33
How is a head splitting or 3/4 part # trated?
arthoplasty
34
What is the most common pattern of a proximal hermal #?
of surgical neck with medial displacement of humeral shaft due to pectoralis major pull
35
What neurovascular injury can occur with prox. humeral #?
brachial plexus/ axillary nerve/ artery
36
How is axillary nerve injury assessed?
loss of sensation in regimental patch area
37
How a humeral shaft # mostly treated?
splinting with a humeral brace and collar and cuff sling
38
How should a humeral shaft# in polytrauma be treated?
internal fixation with IM nail, plate or screw
39
How is non-union with a humeral shaft# treated?
plating and bone graft
40
what can be injured in a humeral shaft #?
radial nerve
41
What are the signs of radial nerve injury?
wrist drop and loss of sensation in the 1st dorsal web space
42
What are the signs of an anterior shoulder dislocation?
loss of shoulder contour; anterior bulge from head of humerus- may be palpated in axilla
43
What is the mechanism for anterior shoulder dislocations?
excessive external rotation or fall onto back of shoulder
44
What is the recurrence rate for ant. shoulder dislocations in pts <20?
80%
45
What is Hamilton's ruler sign?
used for anterior shoulder dislcations- ruler touches both acromion and lateral epicondyle
46
What is a Bankart lesion?
detachment of anterior glenoid labrum
47
What is a Hill-Sach's lesion?
impact # of posterior head of humerus from hitting against anterior glenoid
48
What is the treatment for an anterior shoulder dislocation?
simple reduction
49
What is the mechanism in a posterior shoulder dislocation?
posterior force on adducted and internally rotated arm
50
What are the signs of a posterior shoulder dislocation?
limitation of external rotation
51
What type of xray should be done to assess if there is a posterior shoulder dislocation?
lateral
52
What is seen on a lateral xray with a post. shoudler dislocation?
light bulb sogn
53
How typically gets supracondylar humeral #s?
children (5-7yo)
54
What can be injured in a supracondylar #?
brachial artery, median radial or ulnar nerve
55
How can further injury to the brachial artery be prevented in a supracondylar #?
keep elbow in extension
56
What is the xray sign in an elbow intra-articular #?
posterior fat pad sign
57
What is the treatment for an intra-articular elbow#?
ORIF with anatomic reduction and rigid fixation
58
What is the mechanims for an elbow dislocation?
FOOSH
59
What is the typically dislocation for the elbow?
posterior
60
What is the management of an uncomplicated elbow dislocation?
closed reduction under sedation
61
What is the mechanism of olecranon #?
a fall onto the point of the elbow
62
What is a simple transverse avulsion # of olecranon treated with?
tension band wiring
63
What muscle is responsible for avulsion in olecranon #?
triceps brachii
64
How is a communicated olecranon # treated?
ORIF with a plate and screws
65
What is the sign of a radial head #?
elbow is swollen adn tender over the radial head- flexion/extension may be possible but supination/pronantion will not
66
What is the sign on xray of a radial head #?
posterior fat pad sign
67
How are undisplaced radial head #s treated?
collar and cuff
68
How are displaced/fragmented radial head #s treated?
internal fixation or excision of radial head and replacement
69
What can be injured in radial head #s?
radial nerve
70
What is the terrible triad?
radial head#; elbow dislocation; coronoid process #
71
How are elbow epicondyle #s treated?
fixed with screw
72
How are coronoid #s treated?
ORIF with screw
73
What is the mnemonic for Galleazzi and Monteggia #s?
GRUesome MURder
74
What is a Galleazzi #?
radius # wtih distal ulnar dislocation
75
What is a Monteggia #?
ulnar # with radial dislocation
76
What is the name for an ulnar shaft #?
nightstick #
77
How are ulnar shaft #s treated?
conservatively
78
Who gets Colles #s?
osteoporotic post-menopausal women who FOOSH
79
Describe a Colles #?
dorsal angulation and displacement producing a dinner fork wrist deformity
80
What are hte complications of a Colles #?
median nerve compression; EPL rupture; CRPS; loss of grip strength
81
How is a stable, minimally displaced Colles# treated?
plaster
82
How is a displaced, simple colles# treated?
MUA
83
How is a displaced, comminuted Colles# treated?
MUA and k-wiring, ORIF
84
How is a # of both bones of the forearm treated?
ORIF with plates and screws
85
How is a # of radius and ulna in a child with minimal angulation treated?
plaster
86
Describe a Smith's #?
volarly displaced and angulated # of distal radiu
87
How does a Smiths # occur?
falling onto back of a flexed wrist
88
How is a Smiths # treated?
ORIF using plates and screws
89
Why is management for a Smiths different than a Colles?
Smith's tend to be very unstable
90
What is a Barton's #?
intra-articular # invovling either the dorsal/volar aspect of distal radius; carpal bones sublux with displaced rim fragment
91
What is another name for a Volar Barton's?
intra-articular Smith's
92
What is another name for a dorsal Barton's ?
intra-articular Colle's
93
How are Barton's #s treated>
ORIF
94
How are comminuted intra-articular distal radius # treated?
external fixation +/- k wires
95
What is the mechanism for Scaphoid #s?
FOOSH
96
What are the signs of a scaphoid #s?
tenderness in anatomical snuff box; pain on compressing the thumb metacarpal
97
What are the xrays that hsould be done when a scaphoid # is suspected?
AP, lateral and 2 oblique views
98
What is a clinical scaphoid #?
when # does not show up on xray but suspected clinically
99
How are clinical scaphoid #s treated?
wrist spinted and xrayed again in 2 weeks
100
How is an undisplaced scaphoid # treated?
plaster cast for 6-12 weeks
101
How is a displaced scaphoid # treateed?
special compression screw
102
How is scaphoid # with non-union treated?
screw fixation and bone graft
103
What forms the anatomical snuffbox?
EPL medially and EPB and abductor pollicis longus laterally
104
What can cause non-union in a scaphoid #?
synovial fluid inhibiting # healing or AVN or proximal pole
105
What is a mallet finger?
avulsion of the extensor tenon from its insertion onto the terminal phalanx
106
What is a mallet finger caused by?
forced flecion of extended DIPJ
107
What is the sign of a mallet finger?
inability to extend DIPJ
108
What is the treatment for a mallet finger?
spint holidng DIPJ extended
109
What is a Bennet's #?
carpometacarpal #/dislocation of the thumb
110
What is the treatment for a Bennet's #?
percutaneous wire fixation
111
How are #s of the 3,4 and 5 MC treated?
conservatively
112
What is the name for a 5th MC neck #?
boxers #
113
How much angulation can be tolerated wtih a 5th MC neck '?
45 degrees
114
What ist he treatment for a boxers #?
manipulation with neighbour strapping or k-wire stabilisation
115
How are stable phalangeal #s treated?
neighbour strapping or splintage
116
How are significantly displaced or angulated phalangeal #s treated?
MUA
117
How are unstable phalangeal #s treated?
k-wiring or fixation with small screws
118
How are intra-articular phalangeal #s treated?
k wires or small screws
119
What is the other name for an intracapsular fracture?
subcapital
120
What are hte two types of extracapsular fractures?
intertrochanteric and subtrochanteric
121
What is the treatment for a subcapital #?
THR or arthroplasty
122
What are the adv/disadv for a THR?
high risk of dislocation but better function
123
What are the features of a subcapital #?
external rotation, adduction and shortening
124
What is th feature seen on xray of a subcapital #?
interrupted Shenton's line
125
What is Shenton's line?
the smooth curve from the lower border of the superrior pubic ramus to less trochanter
126
How are extracapsular #s treated?
internal fixation with compression or dynamic hip screw
127
What can be done pre-op to stabilise a subtrochanteric #?
Thomas Splint
128
How do subtrochanteric #s typically happen?
fall onto the side in the elderly
129
What should be looked for in a femoral shaft#?
other injuries as # is high energy
130
What nerve may be damaged in a femoral shaft#?
sciatic nerve
131
What are the complications of a femoral shaft#?
substantial blood loss; fat embolism and ARDS
132
What are the steps in treatment of a femoral shaft #?
analgesia- femoral nerve block; Thomas Splint; closed reduction and IM nail
133
How do distal femoral #s happen?
osteoporotic bone with fall onto a flexed knee
134
What position does the leg take in a distal femoral #?
flexed position- due to gastrocneumius pull
135
What is the sign of a hip dislocation?
interall rotated
136
How are distal femoral #s treated?
plate and screws
137
What is there a high risk of with knee dislocations?
vascular and nerve injury and compartment sydrome
138
What is the treatment for a knee dilocation?
external fixation
139
What may be required after a knee dislocation?
mulit-ligament reconstruction
140
How does a patellar # typically occur?
fall onto flexed knee of dashboard injury
141
What type of dislocation typically happens with patellar dislocations?
lateral
142
How do patellar dilocations typically occur?
direct blow or a contracion of quadricpes with a rotation force
143
What are the predispoations for a patellar discloation?
generalised ligamentous laxity; valgus alignment of the knee; rotation malalignment (femoral neck anteversion); shallow trochlear groove
144
What are the signs of a patellar dislocation?
tenderness over medial retinaculum; haemarthrosis
145
What is a complication of a patellar discloation?
osteochondral # with detached fragments
146
What is the treatment of a patellar dislocation?
temporary splintage wtih PT to strengthen vastus medialis
147
How many patients have a further patellar dislocation after their first one?
10%
148
What type of fracture is a proximal tibial #
high energy
149
What imagin is done with intra-articular tibial #s?
CT to plan surgery
150
What is the tx for intra-articular tibial #s?
reduction of articular surface and plates and screws
151
What often needs to happen for intra-artiular tibial #s?
TKR
152
If there is significant soft tissue damage with an intra-articular tibial #?
temp ex-fix
153
What is the usual mechanism of injury with proximal tibial #s?
valgus stress
154
What is the suual pattern of injury with proximal tibial #s?
laterla plateau # with MCL failure
155
What injury can happen with proximal tibial #s?
common fibular nerve
156
What is the sign of injury to the common fibular nerve?
foot drop
157
What # is the commonest cause of compartment syndrome after trauma?
tibial shaft '
158
What type of # is more common with tibial shaft #?
open #
159
If there is less than 50% diplacement and <5 degrees angulation what is the treatment for tibial shaft #?
above the knee cast
160
How are comminuted and opne# tibial shaft # treated?
IM nailing or ex-fix
161
How long do tibial shaft #s take to heal?
up to 16 weeks to union and a year to heal
162
What is a Pilon #?
intra-articular #s of distal tibia
163
What is the treatment for Pilon #?
ORIF
164
What is the mechanism for Pilon#?
fall from height or rapid decelration
165
What is the imaging for Pilon# and why?
cT to check for other injuries
166
What is the treatment for undisplaced extra-articular distal tibial #s?
conservative
167
What is the treatment for unstable extra-articular distal tibial # that isnt too distal?
IM nail
168
what is the treatment for unstable extra-articular distal tibial # that is too distal?
plating
169
How do most ankle injuries occur?
inversion injury or rotation force on a planted foot
170
WHat is the most common soft tissue ankle sprain?
lateral ankle ligaments
171
What are the lateral ankle ligamnet>
anterior and posterior talo-fibular and calcaneofibular
172
What are the signs of lateral ankle ligamnet sprain?
prain; brusing and tenderness over lateral ligaments
173
When should an ankle xray be done?
any severe localised tenderness (bony tenderenss) of stial tibia or fibula OR inability to weight bear for 4 steps
174
What determines if an ankle # is stable?
if there is inbolvement of medial side- ligaments or bone
175
What is the treatement for a stbale snkle #?
cast/splint for 6 weeks
176
When should you suspect rupture of the deltoid ligament?
bruising and tenderness medially
177
What is seen on xray with a ruptured deltoid ligament?
talar shift and tilt
178
What is the treatment for an unstable ankle #?
ORIF
179
What is the treatment for bimalleolar ankle #?
ORIF
180
What should be looked for in a calcaneal #?
spinal injuries
181
What is the typical mechanism for calcaneal #?
fall from height onto heel
182
What determines the prognossi of a calcaeneal #?
extent of subtalar joint involvement and communition
183
What is the treatment for calcaneal #?
ORIF is debated
184
WHat is the mechanism of injury with talar #s?
forced dorsiflexion from rapid deceleration
185
What are the two types of talar #?
undisplaced or displcaed with subluxation of subtalar joint
186
What is the treatment for a displaced talar #?
closed/open reduction and screw fixation
187
Why is there a high risk of aVN with talar #s?
talus gets distal blood supply
188
What is a Lisfranc #/dislocation?
of base of 2nd MT and dislcoation of base of 2nd MT with or without dislocation of other MTs
189
What are the signs of a Lisfranc?
grossly swollen, bruised foot, unable to weight bear
190
What should be done is xray is noral but suspicion of Lisfranc?
CT
191
What is the treatemtn for Lisfranc #s?
closed or open reduction with screw fixation
192
What is the commonest metatarsal #?
base of 5th MT
193
what type of # is a # of the base of 5th MT?
avulsion # due to fibularis brevis tendon
194
What is the treatment for a # of base of 5th MT?
conservativ efor 4-6 weeks
195
What is a Jones #?
of proximal diaphysis of 5th MT
196
What is the problem with Jones #?
proximal diaphysis of 5th MT gets a poor blood supply
197
What is the treatemnt for a jones #?
screw fixation
198
What is the treatemtn for non-union with a Jones #?
beon graft and fixation
199
What is the treatment for a # of 1st MT?
fixaetion
200
What is the treatment for 2nd MT #?
cast until pain subsides
201
What is the tretment for #s of other metatarsals that are minimally displcaed?
cast
202
what is the treatment for other MT #s that are displaced?
k-wires
203
What is the treatment for # toes?
protection in a stout boot
204
What is the treatmetn ofr an intra-articular # of base of proximal phalanx of hallux?
reduction nd fixation
205
What is the treatment for toe discloation?
closed reduction and neighbour strapping or k wiring
206
What type of # do the elderly typically get in the thoracic spine?
wedge insufficiency #s
207
What is spinal shock?
complete loss of sensation and mottor functio nand refleces below the level of injury for 24 hours
208
What is the bulbocavernous reflex?
contraction of anal sphincter with a squeeze of glans penis, taping mons pubis or pulling on urethral catheter
209
what does the return of the bulbocavernous reflex indicate?
end of spinal shock
210
What causes neurogenic shock?
temporary shutdown of sympathetic outflow from cord from T1-L2
211
What happen in neurogenic shock?
hypotension and bradycardia for 24-48 horus
212
What is the treatment for neurogenic shock?
IV fluids
213
What is complete spinal cord injury?
no sensory or voluntary motor function below level of injury
214
What is incomplete spinal cord injury?
some neurologic function present distal to injury
215
What indictes incomplete spinal injury?
sacral sparing
216
What is sacral sparing?
perianal sensation; voluntary anal sphincter contractio nand hallux flexion
217
What is central cord syndrome?
a type of incomplete spinal injury that happen after a hyperextension injury in c-spine with OA- no # or dislocation
218
What are the 3 types of pelvic #?
lateral compression; vertical shear; anteroposterior compression
219
What causes a lateral compression #?
side impact
220
describe a pelivc lateral compression injury?
through pubic rami or ischium with sacral compression# or SI joint disruption with one half of pelvic displaced medially
221
What is the mechanism for vertical shear pelvic #s?
axial force on one hemipelvis
222
What is the sign of a vertical shear peliv #?
one leg shortened due to that side being displcaed superiorly
223
What is the otehr name for an anteroposterio compression injury?
open book#
224
What happens in open book #?
of pubic symphysis
225
What is the initial treatment for an open book#?
pelvic binding
226
What should be done if there is ongoing haemodynamic instability with a pelivc #?
angiogram adn emboliation or open packing pelivs
227
What is mandatory in a # pelvis?
PR exam
228
What type of a # is an acetabualr #?
high energy
229
What type of pelvic # due osteoporotic elderly tend to get?
lateral compression #
230
What imaging should be done with acetabular #?
CT
231
What causes acetabular #s?
hip dislocation- typically posteior wall
232
What is the significance of the periosteum in childrens #s?
is much thicker and tends to remain intact- more stable and provides lots of osteoblasts for repair
233
What age should childrens #s be treated as adult #s?
12-14
234
What are the common #s of the distal radius in children?
buckle #s; greenstick #s and salter harris II #s
235
What branch of the median nerve is often damaged ina supracondylar # of the elbow?
anterior interosseous branch
236
What indicates that t/here is injury to the anterior interosseous branch
child is unable to make OK sign- loss of FPL and FDP
237
What is the tx for femoral shaft #s in 2-6 yos?
Thomas Splint
238
What is the tx for children older than 6 for femoral shaft #s?
IM nailing
239
What is a Toddler's #?
undisplaced spiral # of tibial shaft
240
What is the definitive managemtn for femoral shaft #s?
closed reduction and IM nails
241
What is the sign of a posterior shoulder dislocation?
excessive internal rotation
242
What aspect of the vertebral body is affected in a wedge #?
anterior
243
What type of alignment is not well tolerated in a boxers #?
rotational
244
Why is rotational malalignment badly tolerated in a boxers #?
can lead to grip problems
245
What are the signs of a posterior hip dislocation?
internal rotation ; adduction and flexion
246
What are the signs of an anterior hip dislcoation?
extended and externally rotated
