Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CP3 @ UoN - Musculoskeletal & MDD > Fractures > Flashcards

Fractures Flashcards

1
Q

What is the general approach to assessing fractures?

A 
Hx & exam
   -mechanism & site
   -associated injuries
   -joint sx, neurovascular sx
Radiology
   -two plain film orthogonal views
   -image joints above & below injury
CT/MRI
   -if fracture poorly visualised on XR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How can long bone fractures be described radiologically?

A 
Simple OR comminuted (3+ pieces)
   -if simple is it transverse, spiral or oblique?
Which bone?
Location on bone?
   -mid-shaft, base/head
   -intra-articular?
Displaced/non-displaced
   -translation?
   -alignment?
   -rotation?
   -length?
Open/compound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does translation refer to?

A

Bones shifted sideways/back/forward in relation to each other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does alignment refer to?

A

Fragments tilted/angulated in relation to each other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are greenstick fractures?

A

Paediatric fractures occurring in children due to malleable bones

  • bone fractures on one side
  • buckles on the other
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the prognosis of a greenstick fracture?

A

Reduction easy

Healing quick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the risk factors for fracture?

A

Osteoporosis/Osteomalacia/PDB
1o/metastatic neoplasia
Bone cysts
Congenital diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the four phases of fracture repair in unstable conditions?

A

Inflammation
Soft callus
Hard callus
Remodelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the inflammatory phase of fracture repair in unstable conditions

A

1-7 days
Fracture ends bleed
Haematoma formation around fracture site
Fibrin & capillary network forms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the soft callus phase of fracture repair in unstable conditions

A

1-3 weeks
Vascular network expands
Fibrous tissue replaces haematoma
Subperiosteal new bone formation begins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the hard callus phase of fracture repair in unstable conditions

A

1-4 months
Calcification of soft callus
Forms rigid, calcified tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the remodelling phase of fracture repair in unstable conditions

A

Once fracture solidly united remodelling takes place (mo-yr)
New woven bone replaced by lamellar bone
Medullary canal restored

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does fracture repair take place in absolute stability?

A

Bone ends heal w/o callus formation

-cannot be visualised on XR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the two types of fracture repair?

A

Unstable (Plaster of Paris)

Stable (surgical intervention)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the possible acute complications of fractures?

A 
Compartment syndrome
Visceral injury
Nerve injury
Vascular injury
Infection
Rhabdomyolysis
Bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is compartment syndrome?

A

Neurovascular compromise resulting from bleeding, oedema or inflammation causing increased pressure in an osteofascial compartment
-venous collapse further increases pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How long does it take for necrosis to occur in compartment syndrome?

A

6hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which osteofascial compartments are most commonly affected in compartment syndrome?

A

Forearm

Lower leg flexor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does compartment syndrome present?

A

Pain
-bursting, described as ‘worst ever’
-not relieved by strong opioids
Arterial system still intact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What compartmental pressure indicates a need for immediate decompression?

A

> 30mmHg above DBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the management of compartment syndrome?

A 
Remove casts, bandages, dressings etc.
Elevate limb
Immediate fasciotomy
Debridement
Aggressive IV fluids
   -risk of myoglobinuria & AKI
Leave wound open
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the potential late complications of compartment syndrome?

A 
Infection
DVT/PE
Pressure sores
Delayed/non/mal union
Avascular necrosis
Joint instability
OA
Complex regional pain syndrome
Neurovascular compromise
   -limb loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a delayed union fracture?

A

When a fracture takes longer than expected to heal for an injury of its type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the risk factors for a delayed union fracture?

A

Local - poor blood supply, infec, poor apposition of bone ends, presence of foreign bodies
Systemic - poor nutrition, smoking, corticosteroid therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the main clinical feature of a delayed union fracture?

A

Persisting fracture tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the X-ray features of a delayed union fracture?

A

Fracture line remains visible

Little callous formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the management of a delayed union fracture?

A

Eliminate any possible cause

Immobilise bone in plaster BUT promote muscular exercise w/i cast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is a non-union fracture?

A

Fracture that will never unite w/o intervention

-diagnosed when not healed after 2x usual expected time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the clinical features of a non-union fracture?

A

Movement elicited at side

Pain diminishes as site gap becomes pseudoarthrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the X-ray features of a non-union fracture?

A 
Hypertrophic non-union
   -enlarged fracture ends
Atrophic non-union
   -tapered fracture ends
   -no suggestion of new bone formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the management of a non-union fracture?

A

Conservative (splinting/bracing)

Surgical (rigid fixation +/- bone graft)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is a mal-union fracture?

A

Bones unite in unsatisfactory position due to inadequate reduction/immobilisation
-usually an obvious deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the management of a mal-union fracture?

A

Remanipulation
Osteotomy
Internal fixation
Limb lengthening procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is a Colles Fracture?

A

Fracture of distal radius (w/i 4cm radio-carpal joint)

-w/ dorsal displacement of distal fragment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What causes a Colles Fracture?

A

Fall onto outstretched hand (FOOSH) in extension

  • marked visible deformity
  • associated w/ osteoporosis in elderly women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the X-ray signs of a Colles Fracture?

A

Dorsal displacement of radius
Radial impaction & angulation
-shortened radius compared to ulna (dinner fork deformity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How should a Colles Fracture be managed initially?

A

Manipulation w/ traction & application of moulder plaster
-anaesthetised w/ haematoma/Bier’s block
If good position achieved manage conservatively
-X-rays at wk 1 & 2

38
Q

What is the definitive management of a Colles Fracture?

A

Open reduction & internal fixation (w/ locking plate)

-req in unstable/commuted fractures

39
Q

What are the potential complications of a Colles Fracture?

A

Median nerve damage

Post-traumatic Carpal Tunnel Syndrome

40
Q

What is a Smith’s Fracture?

A

Fracture of distal radius (w/i 4cm of radio-carpal joint)

-w/ volar displacement of the distal segment

41
Q

What is the cause of a Smith’s Fracture?

A

Fall on flexed wrist

42
Q

What is the management of a Smith’s Fracture?

A

Less common & more unstable

Always require open reduction & internal fixation

43
Q

What is the most commonly fractured carpal bone?

A

Scaphoid

44
Q

What is the cause of a Scaphoid Fracture?

A

Occur w/ violent hyperextension of wrist

45
Q

How does a Scaphoid Fracture present?

A

Pain maximal in anatomical snuff box
Pinch grip weak
Undisplaced

46
Q

What X-rays does a Scaphoid series consist of?

A

AP
Lat
2 oblique views

47
Q

What is the management of an undisplaced Scaphoid Fracture?

A

Conservative - immobilisation in thumb spica for 6-8wks

-10% risk of non-union, may require surgery

48
Q

What is the main complication of a Scaphoid Fracture?

A

Avascular necrosis

49
Q

What are the common types of Forearm Fracture?

A

Monteggia (most common)

Galeazzi

50
Q

What are the features of a Monteggia Fracture?

A

Proximal ulna fracture

Radial head dislocation

51
Q

What are the features of a Galeazzi Fracture?

A

Fracture of radius
Dislocation of distal radio-ulnar joint
-often associated w/ radial nerve injury or extensor tendon injury
-ant interosseous nerve injury often missed

52
Q

What are the clinical features of an anterior interosseous nerve injury?

A

FPL & FDP paralysis

-lack of pinch mechanism b/w thumb & index finger

53
Q

What are the common causes of a Femoral Neck Fracture?

A

Fragility fracture in elderly

Pathological fracture at site of bony mets

54
Q

What are the signs on examination of a Femoral Neck Fracture?

A

Hip pain on passive movements
If fracture displaced
-pt lies w/ limb shortened & externally rotated

55
Q

What are the three main vessels supply blood to the femoral head?

A 
Intramedullary vessels (run inside medullary canal)
Medial/Lat Circumflex artery anastomoses
   -from profunda femoris
   -run proximally through joint capsule
   -medial circumflex is main source
Artery of ligamentum teres
   -<10% of normal blood supply
56
Q

What are the three types of femoral head fracture?

A

Intracapsular
Intertrochanter
Subtrochanteric

57
Q

What is an intracapsular fracture?

A

Fractured NOF

-occurs proximal to capsular insertion on femoral neck

58
Q

What is the Garden Criteria?

A

Used to grade NOF fractures based on degree of displacement

  • Garden 1 = incomplete, impacted
  • Garden 2 = complete, not displaced
  • Garden 3 = complete, continuity b/w fracture heads
  • Garden 4 = Complete, no continuity
59
Q

What are the management options for intercapsular fractures?

A 
Garden 1/2
   -open reduction &amp; internal fixation
Garden 3/4
   -hemiarthroplasty
   -high risk of AVN
60
Q

How should young pts w/ intercapsular fractures be managed?

A

Should have any fracture screwed

-hemiarthroplasty may require multiple revisions

61
Q

How should fit pts w/ intercapsular fractures be managed?

A

If mobilising well & good w/ ADLs then total hip replacement rather than hemiarthroplasty
-better outcomes

62
Q

What is an intertrochanteric fracture?

A

Fracture lies b/w trochanters

  • extracapsular
  • no threat to blood supply of femoral head
63
Q

What are the management options for intertrochanteric fractures?

A

Dynamic hip screw

  • fracture reduced on traction table
  • guide-wire positioned under fluoroscopy
  • DHS then fixed
64
Q

What is a subtrochanteric fracture?

A

Fracture below trochanters

  • extracapsular
  • no threat to blood supply of femoral head
  • occur in high energy trauma/lytic lesions
65
Q

What are the management options for subtrochanteric fractures?

A

Intramedullary nail & hip screw

66
Q

What is the general approach to assessing hip fracture patients?

A

Take full falls hx
?prev fractures/bone pain before fall
?length of lie (rhabdomyolysis)

67
Q

What investigations are appropriate in hip fracture patients?

A

Bloods (incl coag/group & save)
ECG & CXR
AP pelvis/lat hip X-ray

68
Q

What is the prognosis of a hip fracture?

A

10-20% require a change to more dependent residential status

-mobilise w/i 24hrs for best outcome

69
Q

What is the mechanism of injury resulting in a wedge compression fracture of the thoracolumbar spine?

A

Excessive spinal flexion w/ intact post ligaments

  • anterior fractures
  • occur w/ minimal trauma in osteoporosis
70
Q

How do wedge compression fractures of the thoracolumbar spine present?

A

Marked pain
-worse on movement/wt bearing
-slowly improves over months
Multiple fractures cause kyphotic deformity of lumbar spine

71
Q

What investigations are appropriate in wedge compression fractures of the thoracolumbar spine

A

AP/lat X-rays of spine

72
Q

What are the management options for wedge compression fractures of the thoracolumbar spine?

A

Bed rest for 1-2wks
Conservative
-mobilisation/muscle strengthening
-thoraco-lumbar brace for 3mo (if marked wedging)
Surgical
-kyphoplasty (if ongoing pain at level of fracture)

73
Q

What are the common cervical vertebral fractures?

A

Jefferson’s fracture
Hangman’s fracture
Odontoid fracture

74
Q

What is a Jefferson’s fracture and how is it diagnosed?

A

C1 fracture due to axial compressive force on vertex of skull transmitted to spine
-open mouth XR to dx

75
Q

What is a Hangman’s fracture and how is it diagnosed?

A

C2 fracture due to hyperextension of the neck

-lat XR to dx

76
Q

What is an Odontoid fracture and how is it diagnosed?

A

Fracture of odontoid peg associated w/ spinal cord injuries

-peg view XR to dx

77
Q

Describe tibial fractures

A

Most common fracture in adult

Open fracture common due to s.c. position

78
Q

What are the management options for a tibial fracture?

A

Minimally displaced/undisplaced
-full length cast (mid-thigh to metatarsal neck, knee flexed, ankle 90o)
Displaced
-reduction under GA w/ XR guidance before full length cast application

79
Q

How should a tibial fracture be monitored?

A

Limb elevated/observed for 48hrs (compartment syndrome)
Position checked w/ XR at 2wks
Changes to below knee cast at 4wks

80
Q

In which groups are ankle fractures common?

A

Young athletes

Osteoporotic older women

81
Q

What malleoli can be fractured in the ankle?

A

Medial malleolus
Lateral malleolus
Posterior malleolus (formed by post tibia)

82
Q

What is the most common mechanism of injury causing an ankle fracture?

A

Abduction & lat rotation of joint

-leads to lat malleolus shearing off

83
Q

What are the signs on examination of an ankle fracture?

A

Intense pain

Inability to stand

84
Q

What X-rays should be ordered when investigating an ankle fracture?

A

AP
Lat
Mortise

85
Q

What is the Weber classification?

A

Used to classify lat malleolus fractures based on relationship to syndesmosis (tibulofibular joint)

  • Weber A = fracture below syndesmosis (intact)
  • Weber B = fracture at syndesmosis (partially intact)
  • Weber C = fracture above syndesmosis (non-intact)
86
Q

What is Talar Shift?

A

Important indicator of instability in ankle

-talus no longer exhibits equal joint space around articulation w/ fibula & tibia

87
Q

What are the management options for an ankle fracture?

A

Weber A
-stable, rarely require surg management
-6wks plaster of paris
Weber B
-conservative management tried (repeat X-rays wkly)
-if fails try ORIF
Weber C
-never stable, requires open reduction & internal fixation
Multiple malleoli
-always unstable, operative management

88
Q

What are the Ottowa rules?

A 
X-ray of ankle required only if
   -pt unable to wt bear
   -has pain
   -bony tenderness at lat/med malleolus
X-ray of foot required only if
   -pt unable to wt bear
   -bony tenderness over navicular/base of 5th metatarsal
89
Q

What is the Salter Harris Critera?

A

Classifies physeal (growth plate) fractures (SALTER)

  • Type 1 = Straight across (rare)
  • Type 2 = Above (most common)
  • Type 3 = Lower
  • Type 4 = Through
  • Type 5 = ERasure of growth plate
90
Q

What is the general management of closed long bone fractures?

A

A-E resus
Analgesia
Image length of bone + joint above/below
Manipulation & stabilisation in plaster of Paris
-ensure ankle at 90o
Re-image & check for complications
Conservative/surgical management long term

91
Q

What is the general management of open long bone fractures?

A

A-E resus
Analgesia
Check distal neurovascular status/soft tissue injury
IV a/b +/- tetanus prophylaxis
Leg imaged & taken to theatre w/i 6hrs
-definitive management & irrigation
-plastics input may be required

92
Q

What is the Gustilo & Anderson criteria?

A

Classification system for assessing open fractures

  • 1 = simple fracture, wound <1cm
  • 2 = simple fracture, wound >2cm
  • 3 = multi-fragmented fracture
    • 3A = w/ adequate soft tissue cover
    • 3B = requires plastics input
    • 3C = associated w/ vascular injury

CP3 @ UoN - Musculoskeletal & MDD (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions