Fractures Flashcards
What type of fracture is this?
What causes this type of fracture?
What are some major complications of this type of fracture?
How should you treat this fracture?
Fracture of the femoral shaft
High energy injury (e.g. fall from height/RTA) or can be pathological
Blood loss and hypovolaemic shock, fat embolus causing ARDS
Resuscitation, analgesia, splinting, internal fixation
What specific type of analgesia could be used for femoral shaft fractures?
Femoral nerve block
What type of splint can be used for femoral shaft fractures?
Who specifically are they used in? Why?
Thomas Splint
Mostly used in kids as their bones heal faster and so they can tolerate how long they use it for
What type of fracture is this?
This type of fracture can be split into two types, what are they?
Distal femoral fracture
Intra-articular and extra-articular
How do you treat an intra-articular distal femoral fracture?
Anatomical reduction and rigid fixation with plate and screws
How do you treat an extra-articular distal femoral fracture?
Can use Thomas splint
If not too distal can nail
If very distal use plating
What type of fracture is this?
How can this type of fracture be caused?
Which direction of stress is this injury associated with?
What scan is useful to determine the personality of these fractures?
Are these fractures intra or extra-articular? What does this cause?
Proximal tibial fracture
High energy in young, low energy in old
Valgus stress
CT scan
Intra-articular, high chance of post-traumatic arthritis
What are the principles of treatment of proximal tibial fractures?
Anatomical reduction and rigid fixation.
Elevation
What type of fracture is this?
Why should all cases of this type of fracture be monitored overnight?
Are open fractures common here or not?
To what degree of angulation is accepted in this bone?
How good is the affected bone at healing?
Give an example of conservative and operative healing.
Tibial shaft fracture
They have a very high risk of compartment syndrome
Open fractures are very common here
5 degrees
Not good, takes a long time (can be up to a year)
Conservative- plaster casting
Operative- IM nailing, plating or external fixation
What is this fracture known as?
Is it intra or extra-articular?
What usually causes it?
How would you treat it?
Pilon Fracture
Intra-articular
High energy injury, usually a fall from height
External fixation until soft tissue damage settles and then internal fixation
What type of fracture is this?
What other injuries are usually associated?
What other investigation is usually required?
How would you treat it?
Distal tibial fracture
Fractures of spine, pelvis, calcaneus and possibly soft tissue injuries
CT scan
Internal fixation if no soft tissue damage, external fixation if soft tissue damage
What are two examples of ankle fractures which are stable and can be treated conservatively?
Isolated distal fibular fractures
Displaced medial malleolus fractures
What are 3 examples of ankle fractures which cause talar shift?
How should you treat fractures with talar shift? Why?
Bimalleolar fractures
High malleolar fractures
Distal fibular fracture with deltoid ligament rupture
Treat with ORIF- risk of arthritis
What type of fracture is this?
What causes the majority of these fractures?
What risks are associated?
Proximal humeral fracture/Fracture of the surgical neck of humerus
Osteoporosis in the elderly
Brachial plexus, axillay artery/nerve injuries, AVN, non-union
What would be the management of a fracture of the proximal humerus in the following cases…
Elderly patient?
Split into 3 or 4 parts?
Younger patient?
What complications can occur after both conservative or surgical management?
Conservative
Arthroplasty
Internal fixation
Stiffness and rotator cuff dysfunction
What type of fracture is this?
What nerve is most likely to be damaged in these injuries and how will it present?
How likely is non-union?
What type of injury normally causes these fractures?
Humeral shaft fracture
Radial nerve: wrist drop and numbness in the first dorsal web space
10% no matter the management
Rotational injuries
What is the primary treatment for humeral shaft fractures?
When should internal fixation be used instead of this?
What type of internal fixation would usually be used?
Bracing
Non-union, high energy, pathological fractures, polytrauma, unable to tolerate brace
IM nails
What type of fracture is this?
Is it usually intra or extra articular?
How is it treated?
Distal humeral fracture
Intra-articular
ORIF
What type of fracture is this?
What causes it?
How is it treated?
When is an exception to this treatment?
Olecranon fracture
Fall onto elbow and triceps pulls
Internal fixation
Very low demand
What type of fracture is this?
What do these fractures often occur alongside?
What sign should you look for to assess elbow damage?
Fracture of the radial head
Elbow dislocations
Fat pad sign
How would you treat a radial head fracture in each of the following situations?
Minimally displaced marginal fracture?
Displaced fracture with large fragment blocking movement?
Comminuted fractures?
Conservatively
Internal fixation
Excision and possible replacement
What type of fracture is this?
Monteggia Fracture
What type of fracture is this?
Galeazzi Fracture
Radius fractured, ulnar dislocated at the DRUJ is known as what?
Ulna fractured, radial head dislocated is known as what?
Isolated ulnar fracture is known as what?
Galeazzi Fracture
Monteggia Fracture
Nightstick Fracture
What is the treatment for…
Fractures of radius and ulna?
Monteggia/Galeazzi fractures?
Isolated ulnar fracture?
ORIF
ORIF for fracture, reduction of dislocation
Conservative
What type of fracture is this?
What usually causes it?
Is it intra or extra-articular?
Which way does it angulate/displace?
What is the typical deformity associated with these fractures?
Colles’ Fracture
FOOSH
Extra-articular
Dorsally
Dinner fork deformity
How would you treat the following Colles’ fractures…
Stable, minimally displaced/angluated?
Displaced, simple fracture?
Displaced and communated fracture?
Conservatively- POP
Reduction under anaesthesia
Reduction under anaesthesia and ORIF
What are 4 complications associated with a Colles fracture?
Median nerve compression (acute carpal tunnel)
EPL rupture
Complex regional pain syndrome
Loss of grip strength
What causes a Smith’s fracture?
Intra or extra-articular?
Which direction of displacement/angulation?
Stable or unstable?
How do you treat?
Fall onto back of hand
Extra-articular
Volar
Unstable
ORIF
Is a Barton’s fracture intra or extra-articular?
How is it treated?
Intra-articular
ORIF
What defines polytrauma?
What are major fractures?
More than 1 major fracture
Long bone fractures or pelvic fracture
What two fractures pose the biggest risk of blood loss?
What makes up the lethal triad?
Pelvic and femoral shaft
Hypothermia, acidosis, coagulopathy
In a polytrauma case, what orthopaedic injuries need to be treated as an emergency?
Unstable pelvic, femoral or tibial fractures
Open fractures
Fractures with vascular compromise
Compartment syndrome
What are 4 early local complications of fractures?
Compartment syndrome
Vascular injury (distal ischaemia)
Nerve injury
Skin necrosis
What are 3 indications for investigating nerve injury after a fracture?
Open fractures
Penetrating injuries
Neuralgic pain
What are 5 early systemic complications of a fracture?
Fat embolus
Hypovolaemia
SIRS
ARDS
MODS
What are some causes of atrophic non-union?
What is the cause of hypertrophic non-union?
Lack of blood supply, too big a gap, steroids, smoking, poor nutritional status
Too much movement
What causes Volkmann’s Ischaemic contracture?
Missed compartment syndrome
What are the only fractures which require an x-ray to confirm union?
Diaphyseal fractures of long bones
