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MSK > Fractures > Flashcards

Fractures Flashcards

1
Q

Which sex is more prone to femoral fractures

A

Females - particularly elderly

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2
Q

Which age groups get femoral fractures

A

Vast majority are the elderly (over 60)

Young people occasionally with high energy trauma

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3
Q

List some risk factors for femoral fractures

A 
Age over 50 
Female
Osteoporosis 
Smoking 
Malnutrition 
Excess alcohol 
Neurological impairment 
Impaired vision
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4
Q

What does a fracture require to heal

A

Adequate blood supply

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5
Q

List the blood supply to the femoral head

A

Intramedullary artery of the shaft of femur
Medial and lateral circumflex branches of profundal femoris artery
Artery of the ligamentum teres
Foveal branch of obturator artery

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6
Q

What are the types of proximal femoral fracture

A

Intracapsular - displaced or undisplaced
- subcapitlal and transcervical

Extracapsular - Basicervical, intertrochanteric, subtrochanteric

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7
Q

Which type of femoral fracture is more likely to heal

A

Extracapsular

Both sides of fracture have a blood supply - no disruption

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8
Q

What are the major risks with intracapsular fractures

A

Significant risk of not healing due to disruption of blood supply
AVN

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9
Q

How does a proximal femoral fracture present

A 
History of a fall 
Pain 
Inability to weight bear 
Shortening of limb 
External rotation
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10
Q

What are some complications of immobility after surgery

A

UTI
Pressure sores
DVT

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11
Q

How do you treat an intracapsular fracture

A

Hip replacement
Either total or hemi-arthroplasty
Total replacement reserved for those who are young and fit - better ROM and longevity

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12
Q

How do you treat an extracapsular fracture

A

Pinning - variety of methods

Dynamic hip screw is popular

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13
Q

Why is incidence of hip fractures rising

A

Ageing population

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14
Q

What are the 11 standards of care for hip fractures

A

Transfer to ortho ward within 4 hours
Big 6 intervention in A and E
Receive inpatient bundle of care within 24hrs
Undergo surgery within 36hrs
No repeated fasting and fluids 2hr before op
Cemented arthroplasty (unless otherwise indicated
Geriatric assessment within 3 days
Early mobilisation and physio assessment w2 days post-op
Occupational therapy assessment by 3 days after admission
Bone health assessment prior to leaving ortho ward
Recovery optimised by MDT and discharge within 30 days

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15
Q

What are the big 6 interventions that should be carried out in A and E for a hip fracture

A 
Analgesia 
NEWS
Pressure area inspection 
Blood tests 
Fluid therapy 
Delirium screening
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16
Q

Give examples of pre-op analgesia

A

Strong opiates - morphine
Lots of side effects

Local nerve blocks
- avoids side effects

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17
Q

What makes pressure sores more likely

A

Delays to surgery
Frail or malnourished patients
Failure to mobilise early

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18
Q

Pressure sores take a long time to develop - true or false

A

False

Can start to develop within 30 mins of lying on hard surface

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19
Q

What are some key signs of dehydration

A

Low urine output

Concentrated urine

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20
Q

What are some key signs of fluid overload

A

Oedema

Crackles in the chest

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21
Q

Describe the WHO pain ladder

A

1- paracetamol or NSAID
2- codeine
3- strong opiate such as morphine

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22
Q

What is resuscitation

A

Process of correcting physiological disorders in an acutely unwell patient

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23
Q

List some clinical indicators of a deteriorating patient

A

Tachypnoea
Tachycardia
Hypotension
Reduced conscious level

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24
Q

All patients get high flow oxygen - true or false

A

TRUE

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25
Q

What is hypoxic drive

A

Long term pulmonary disease leads to CO2 retention

High CO2 means breathing switches and becomes driven by oxygen levels

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26
Q

What causes a torus fracture

A

Fall onto outstretched hand

Seen in kids

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27
Q

What is a plastic deformation fracture

A

Unique to children
Bone bends and becomes deformed rather than snapping
Needs manual correction which takes a lot of force

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28
Q

Children’s bones have remodelling potential - true or false

A

TRUE

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29
Q

What is Wollfs Law

A

Healthy bone will adapt to the load under which it is placed

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30
Q

What is Hueter-Volkman’s Law

A

Compression forces inhibit bone growth and tensile forces stimulate growth

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31
Q

List factors that would make you suspect NAI

A

History that doesn’t match nature/severity of injury
Vague or changing stories
Accusation of child hurting themselves deliberately
Delay in seeking help
Child dressed inappropriately for scenario

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32
Q

What are some key signs of NAI

A

Fractures in children under 2 - pre-walking
Injuries in various healing stages
More injuries than you’d expect
Injuries scattered across body
Increased intercranial pressure in infant
Intra-abdominal trauma in child
Injury that doesn’t fit story

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33
Q

What would you look for in a neurovascular exam

A 
Colour 
Cap refill 
Skin temp 
O2 sats 
Pulse 
Sensation 
Sweating 
Skin wrinkling in water - if nerve damaged this wont happen
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34
Q

What hand movement would you do to test the median nerve

A

OK sign

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35
Q

What hand movement would you do to test the radial nerve

A

Thumb’s up or Hitchhiker’s thumb

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36
Q

What hand movement would you do to test the ulnar nerve

A

Star fish

Splay all fingers

37
Q

What injury commonly affects the radial nerve

A

Humeral shaft fracture

38
Q

What injury commonly affects the ulnar nerve

A

supracondylar, forearm and hand fractures

39
Q

What injury commonly affects the median nerve

A

Elbow dislocation

40
Q

What causes fractures to displace?

A

Muscle action and gravity

Initial force on impact

41
Q

What type of splint is used for femoral fractures

A

Thomas splint

42
Q

What is Gallows traction

A

Legs are suspended to apply traction to legs

Used in femoral shaft fractures

43
Q

What are the pros and cons of pinning long bones

A

Gives predictable position for rapid healing and early mobilization

Comes with surgical risks - infection and anaesthetics

44
Q

When would you operate on a child fracture

A

Displaced intra-articular fractures
Displaced growth plate injuries
Open fractures

45
Q

List common fixation techniques and when they are used

A

Flexible nails - diaphysis
K wires - metaphysis
Wires and screws - epiphysis

46
Q

Why can you not put a screw across the physis when fixing a fracture

A

It will cause premature stop in growth

47
Q

Describe the 5 types of Salter-Harris fractures

A

Grade 1 - Straight across physis - separates epiphysis and metaphyis

Grade 2 -Transversely through physis but exits through metaphysis forming triangular fragment

Grade 3 - Crosses physis and exits through epiphysis
at joint space

Grade 4 - Through everything! Extends upwards from the joint line,
through the physis and out the metaphysis

Grade 5 - Crush injury to growth plate

48
Q

What is the most common type of shoulder dislocation

A

Anterior

49
Q

What injury typically causes anterior shoulder dislocation

A

Fall onto outstretched hand with an externally rotated shoulder

50
Q

What injury typically causes posterior shoulder dislocation

A

Direct blow to front of shoulder

Associated with seizures

51
Q

What injury shows up with the light bulb sign

A

Posterior shoulder dislocation

Looks like light bulb on x-ray

52
Q

How do you manage a dislocated shoulder

A

Closed reduction under sedation
Open reduction - severe/complex cases
Stabilisation and rehab

53
Q

Risk of re-dislocation increases as you age - true or false

A

False

Decreases with age

54
Q

What injury typically causes an elbow dislocation

A

Fall onto outstretched hand

55
Q

What directions can an elbow dislocate in

A

Posterior
Anterior
Medial/lateral

56
Q

How do you manage an elbow dislocation

A

Closed reduction under sedation
Open reduction - rarely needed
2 weeks in sling and rehab

57
Q

What injuries can cause an interphalangeal joint dislocation

A

Hyperextension

Direct axial blow

58
Q

What directions do IPJ’s dislocate in

A

almost always pos

59
Q

How do you manage an IPJ dislocation

A

Closed reduction under local nerve block
Open reduction - rare
2 weeks in buddy strapping
If unstable strap into Edinburgh position

60
Q

What injury typically causes a patellar dislocation

A

Sudden quads contraction with a flexing knee

61
Q

Which direction does the patella dislocate in

A

Lateral

62
Q

Who commonly gets patellar dislocations

A

Teenagers

More common in girls

63
Q

What increases your risk of a patellar dislocation

A 
Hypermobility 
Under-developed lateral femoral condyle 
Increased Q angle 
Lateral quads insertions 
Weak vastus medialis
64
Q

What forms the Q angle

A

Line from ASIS to midpoint of patella
2nd line from tibial tuberosity through midline of patella
The angle the 2 lines form is the Q angle

65
Q

How does a patellar dislocation present

A

Clear history
Pain medially
Effusion
Positive patella apprehension test

66
Q

How do you manage a patellar dislocation

A 
Reduce with knee extension 
Radiographs 
Aspirate
Brace 
Physio 
Surgery if repeat dislocations
67
Q

Who is most commonly affected by knee dislocations

A

Teenagers

More common in girls

68
Q

What surrounding structures can be injured in a knee dislocation

A

Popliteal artery or vein
Peroneal nerve
Ligaments

69
Q

How do you manage a knee dislocation

A

Reduction under sedation
Surgical reduction if needed
Stabilise in splint or by external fixation

70
Q

Which injuries can cause a hip dislocation

A

High velocity injury - RTA

Fall from height

71
Q

Which direction does a hip normally dislocate in

A

Posterior

72
Q

which fractures are often associated with a hip dislocation

A

Posterior acetabular wall

Femur

73
Q

How does a dislocated hip present

A

Flexed, internally rotated and adducted knee

74
Q

what urgent management is needed for a dislocated hip

A

neurovascular assessment
radiographs and CT
urgent reduction
stabilise in tractions if required

75
Q

What are the definitive managements for hip dislocations

A

Fixation of associated fractures

Fixation of other injuries in poly-trauma

76
Q

What are some potential complications of a hip dislocation

A

Sciatic nerve palsy
Avascular necrosis of the femoral head
Secondary osteoarthritis of hip

77
Q

What is an open fracture

A

Bone disruption where there is an overlying break in the skin and tissue
High energy injury
The break in sin communicates directly with the fracture and its haematoma

78
Q

What is the other name for an open fracture

A

Compound fracture

79
Q

What is a comminited fracture

A

One with 3 or more pieces

80
Q

What is an avulsion fracture

A

Where a small piece of the bone is pulled off by a muscle or tendon which is attached to it

81
Q

What is meant by the translation of a fracture

A

The extent to which the fracture fragments are not axially aligned - e.g. shifted to the left/right
Typically you describe the displacement of the distal fragment relative to the proximal one
Express as a % of bone width and the direction

82
Q

What is meant by the angulation of a fracture

A

Extent to which fracture
fragments are not
anatomically aligned in a
angular fashion - what is the angle between fragments
Typically you describe the angle that the distal fragment is pointing relative to where it should be
Describe in degrees or as valgus, parallel or varus

83
Q

What is meant by the rotation of a fracture

A

Extent to which fracture fragments are rotated relative to each other
Typically you describe which direction the distal fragment is rotated relative to the proximal portion of the bone

84
Q

Aside from an obvious break in the bone, which other x-ray signs may suggest fracture

A

Periosteal reaction - whiter area on bone
Callus
Visible fat pad in elbow- means there is an effusion in the joint, typically a intraarticular elbow fracture
Lipohaemarthrosis - blood and flat leak out. less dense fat floats on top creating a line

85
Q

What is a segmental fracture

A

A fracture with at least 2 fracture lines which together isolate a segment of bone - have a piece basically floating in the middle, unattached to anything

86
Q

What is ORIF

A

Open reduction and internal fixation

87
Q

What are some of the risks of hemiarthroplasty

A

Dislocation risk
Infection risk
Risk of loosening

88
Q

What is the difference between unipolar and bipolar hemiarthroplasty

A

Unipolar - only the femoral head is replaced and it connects to the natural socket

Bipolar - femoral head is replaced but you also place artificial liners in the socket - better ROM and less likely to erode the acetabulum

89
Q

The higher the grade of salter harris fracture, the more likely they are to cause growth disturbance - true or false

A

True

MSK (21 decks)

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