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Fractures Flashcards

1
Q

Definition of an open fracture

A

A fracture in which there is a direct communication between the external environment and the fracture

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2
Q

Importance of open fractures

A

higher energy injury
increased infection rate
soft tissue complications
long term morbidity

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3
Q

Gustilo classification of open fractures

A 
type 1
- wound < 1cm 
- clean 
- simple fracture pattern 
type 2
- wound > 1cm 
- moderate soft tissue damage 
- adequate skin coverage
- simple fracture pattern 
type 3 
- extensive soft tissue damage
- complex fracture pattern 
- 3A = adequate peritoneal coverage 
- 3B = tissue loss requiring soft tissue covering procedure (such as flap or graft)
- 3C = vascular injury requiring repair
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4
Q

Management of open fractures

A

Full ATLS assessment and treatment
tetanus and antibiotic prophylaxis
repeated exam n/v status
wounds only handled to remove gross contamination
photograph/cover (saline swab) and stabilise limb
no provisional irrigation/exposure
radiographs

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5
Q

Indications for emergency urgent surgery in open fractures

A 
polytraumatised patient 
marine or farmyard environment 
Gross contamination 
Neurovascular compromise 
compartment syndrome
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6
Q

What is a polytraumatised patient?

A

Multiple fractures that start the affect the physiology of the patient

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7
Q

What is compartment syndrome?

A

increasing pressure within a compartment -> causes swelling until it cannot swell anymore -> this increases the pressure and then the blood supply is cut off

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8
Q

4Cs of surgical debridement and fixation

A

colour
contraction
consistency
capacity to bleed

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9
Q

What are multiple debridements associated with?

A

poorer outcomes

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10
Q

scoring system to identify chance of amputation looks at…..

A

limb ischaemia
age range of patient (older = less likely to recover)
shock
injury mechanism

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11
Q

What counts as a low energy injury?

A

stab
gunshot
simple fracture

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12
Q

What counts as a medium energy injury?

A

Dislocation

open/multiple fractures

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13
Q

What counts as a high energy injury?

A

High speed MVA

rifle shot

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14
Q

What consists of a very high energy injury?

A

high speed trauma with gross contamination

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15
Q

Types of fracture patterns

A

transverse/short oblique
communication/butterfly fragments
segmental
with bone loss

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16
Q

types of soft tissue injury patterns

A

skin loss such that direct tension free closure is not possible
Degloving
injury to the muscles
injury to 1 or more major arteries

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17
Q

Definition of dislocation

A

complete joint disruption

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18
Q

Definition of subluxation

A

partial dislocation - not fully out of the joint

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19
Q

Investigations of dislocation

A

clinical

radiological

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20
Q

What ways does the shoulder dislocate?

A

Anterior

Posterior

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21
Q

Deformity of a dislocated shoulder

A

squared off

locked in internal rotation

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22
Q

deformity of a dislocated elbow

A

olecranon prominent posterior

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23
Q

which ways does the elbow dislocate?

A

posterior

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24
Q

which ways does the hip dislocate?

A

posterior

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25
Q

Deformity of a dislocated hip

A

Leg short, flexed
internal rotation
adduction

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26
Q

what way does the knee dislocate?

A

anteroposterior

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27
Q

deformity of a dislocated knee

A

loss of normal contour

extended

28
Q

Which is the most common dislocation of the ankle?

29
Q

Deformity of a dislocated ankle

A

externally rotated

prominent medial malleous

30
Q

Most common dislocation of subtalar joint

31
Q

deformity of a dislocated subtalar joint

A

lateral displaced os calcis

32
Q

indications for rib fracture fixation

A 
large flail segments 
paradoxical breathing 
multiple rib fractures
significant displacement 
intrathoracic pathology e.g. herniation 
chest wall deformity
inability to control pain conventionally (including thoracic epidural)
33
Q

Management of rib fracture

A

Conservatively with adequate analgesia

34
Q

Risk factors of rib fracture

A 
Blunt trauma to chest wall 
Major trauma
Osteoporosis
Steriod use
COPD
Cancer metastases
35
Q

Presentation of rib fracture

A

Severe sharp chest wall pain - pain more severe with deep breaths or coughing
Chest wall tenderness over fracture sites
Crackles / reduced breath sounds if underlying lung injury - can also cause a drop in sats

36
Q

What is flail chest?

A

A serious consequence of multiple rib fractures that can occur during trauma

37
Q

What causes flail chest?

A

Two or more rib fractures along 3 or more consecutive ribs, usually anteriorly

38
Q

What can flail chest cause if left untreated?

A

Serious contusional lung injury

39
Q

Treatment of flail chest

A

Invasive ventilation

Surgery

40
Q

Investigations of rib fracture

41
Q

Why is a CT the best investigation for rib fracture?

A

Shows the fractures in 3D and also the associated soft tissue injuries

42
Q

What may inadequate ventilation predispose to?

A

Chest infections

43
Q

When should surgical fixation of a rib fracture be considered?

A

If pain is still an issue and failed to heal within 12 weeks conservative management

44
Q

When does compartment syndrome occur?

A

Following fractures

Following reperfusion injury in vascular patients

45
Q

What is compartment syndrome?

A

Raised pressure within a closed anatomical space - which eventually compromises tissue perfusion resulting in necrosis

46
Q

Two main fractures that have compartment syndrome as a complication

A

Supracondylar fractures

Tibial shaft injuries

47
Q

Presentation of compartment syndrome

A 
Pain especially on movement (even passive)
Paraesthesia
Pallor
Arterial pulsation may still be felt
Paralysis of the muscle group may occur
48
Q

Investigations of compartment syndrome

A

Measurement of intracompartmental pressure measurements

  • excess > 20mmHg abnormal
  • > 40 mmHg diagnostic
49
Q

Treatment of compartment syndrome

A

Prompt and extensive fasciotomies

50
Q

How long does death of muscle groups occur in compartment syndrome?

A

4 - 6 hours

51
Q

Intra vs extra capsular hip fracture

A

Intra - fracture proximal to the intertrochanteric line (line between greater and lesser trochanters)
Extra - fracture distal to this line

52
Q

Treatment of intra vs extra capsular hip fractures

A

Intra
- internal fixation (cannulated hip screw) - (good pre morbid function)
- hemiarthroplasty (poor pre morbid function)
- total hip replacement if displaced
Extra - Dynamic hip screw

53
Q

Presentation of scaphoid fracture

A

Tenderness in the anatomical snuffbox dorsally or

Tenderness in the scaphoid scaphoid tubercle volarly

54
Q

Xray of scaphoid fractures

A

Occult on initial x ray

Becomes evident on repeat xrays 14 - 21 days following injury

55
Q

Which type of fractures is compartment syndrome most associated with?

A

Supracondylar

Tibial shaft

56
Q

Management for subluxation of radial head

A

Passive supination of elbow joint whilst elbow flexed to 90 degrees

57
Q

Management of a trochanteric fracture

A

Sliding hip screw

58
Q

Management of a sub trochanteric fracture

A

Intramedullary nail

59
Q

What are the extracapsular fractures?

A

Trochanteric fractures

Subtrochanteric fractures

60
Q

What is vital to be done in rib fractures?

A

Adequate analgesia - to ensure breathing is not affected by pain - inadequate ventilation may predispose to chest infections

61
Q

Management of an open fracture

A
  1. IV Ax
  2. Photography
  3. Application of saline soaked gauze with impermeable dressing
62
Q

What would excessive use of breakthrough analgesia make you think of the diagnosis?

A

Compartment syndrome

63
Q

When does fat embolism syndrome occur?

A

Between 12 and 72 hours

64
Q

Triad of fat embolism

A

Resp distress
Cerebral signs
Petechial rash

65
Q

What is used to classify neck of femur fractures?

A

Garden classification system

MSK (25 decks)

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