Fractures Flashcards
Open fracture
Open wound
Due to a spike of fractured bone puncturing the skin
Closed fracture
Skin is in tact
Displacement
Direction of translation of the DISTAL fragment
- can be described as medially/laterally/anteriorly/posteriorly displaced
Displacement terms in the hand and forearm
Direction of translation of the DISTAL fragment
- can be described as ulnar/radial/volar/dorsal displacement
Angulation
Direction which the distal fragment points towards and the degree of this deformity
- can be described as medially/laterally/anteriorly/posterior angulation
Angulation terms in the hand and forearm
can be described as ulnar/radial/volar/dorsal displacement
Angulation terms in the lower limb
Varus/valgus/anteriorly/posteriorly
Intra-articular fracture
Fracture extends into the joint
Extra-articular fracture
Fracture does not extend into the joint
Name the 5 fracture patterns
Transverse Oblique Spiral Comminuted Segmental
Transverse fracture
clean fracture straight across horizontally
Oblique fracture
diagonal fracture (at an angle)
Spiral fracture
From twisting injuries
In an S shape
Comminuted fracture
Fracture with 3 or more fragments
Segmental fracture
Bone has fractured in 2 separate places
Very unstable
X ray
Usually need an AP and lateral view
CT
Can determine the degree of articular damage
MRI
Detects occult fractures (clinical suspicion of fracture but normal X-ray)
Primary bone healing
Minimal fracture gap and the bone simply fills the gap with new bone from osteoblasts
Secondary bone healing
Gap at the fracture site which needs to be filled temporarily (by cartilage) in order for new bone to be laid down
Initial fracture management
Analgesia (IV morphine)
Immediate management if there is obvious displacement / dislocation
IV morphine
Immediate reduction
Management of stable fractures
Non operative
- splint
- immobilisation (cast)
- bracing
- rehabilitation
Management of unstable fractures
Reduction under anaesthetic
Surgical stabilisation
- internal fixation
- external fixation
Unstable intra-articular fracture management
ORIF
- using plate and screws
Who gets traction?
Children
Examples of internal fixators
IM nail
Plate
Screws
Examples of external fixators
Pins which go through the skin and into the bone
Open fracture initial management
Antiseptic dressing IV broad spectrum antibiotics Surgical debridement ASAP Removal of infected bone Internal or external fixation
Intra-articular fracture commonly causes which complication?
Post-traumatic osteoarthritis
C-spine clearing in a conscious and co-operative patient
X-ray and if this is clear then remove the C-spine collar
C-spine clearing in a trauma patient
X-ray
CT scan
What are the 3 different X-ray views required for C-spine fractures
AP view
Lateral view
Peg open mouth view
Examination required for pelvic fractures?
PR examination
- need to assess sacral nerve root function and look for the presence of PR blood
Pelvic fracture : Antero-posterior compression injury
Open book fracture
Pelvic fracture : Antero-posterior compression injury management
Prompt reduction
Pelvic binder
NOF fracture - features
Can’t weight bear
Shortening of affected limb
External rotation of affected limb
NOF fracture - complications
AVN
Intracapsular hip fracture
Fracture is within the capsule
Arterial supply to the femoral head could be disrupted if fracture is displaced leading to AVN
Intracapsular hip fracture - management in elderly
Hemi-arthroplasty
OR
Total hip replacement
Intracapsular hip fracture - management in young and active individual
Fixation
Extracapsular hip fracture
Fracture is outwith the capsule so the blood supply is still in tact. All will heal eventually
Extracapsular hip fracture - types (2)
Inter-trochanteric
Sub-trochanteric
Extracapsular hip fracture - management
Internal fixation
- hip screw (or IM nail)
Extracapsular hip fracture - management of a subtrochanteric fracture
Thomas’ splint
Analgesia
Intramedullary nail
Femoral shaft fracture - management
Analgesia
Thomas’ splint
Closed reduction
Internal fixation - IM nail
Distal femoral fracture - cause
Fall onto the flexed knee
Distal femoral fracture - management
Internal fixation
- plate and screws
What is a plataeu fracture?
Proximal tibial fracture
Proximal tibial fracture is an EXTRA/INTRA articular fracture?
INTRA-articular
Proximal tibial fracture - clinical features
Valgus stress