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My MSK > Fractures > Flashcards

Fractures Flashcards

1
Q

What is an important bone to assess if the ankle is hurt?

A

fibula

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2
Q

What is a FOOSH?

A

fall onto outstretched hand

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3
Q

What is acute compartment syndrome?

A
  • interstitial pressure increases in osseofascial compartments
  • there can be muscle necrosis and loss of function
  • pain on passive stretch of muscles in compartment
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4
Q

What is acute compartment syndrome common in?

A
  • anterior and deep posterior leg, volar forearm

- tibial fractures, IVDUs, male, 10-35y, anti-coagulation

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5
Q

What is the classification for an ankle fracture?

A
  • Weber B = foot

- Weber C = worse, soft tissue damage, fibula fracture, women can have permanent damage

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6
Q

What is a bad sign in an ankle fracture?

A

pain on both sides means there could be an unstable fracture

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7
Q

What are the features of a hip fracture?

A
  • women due to lower bone mass
  • MRI sometimes needed
  • get two angles on XR
  • replace with either a cheap option for inactive or expensive for the active
  • ceramic on plastic
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8
Q

What are the principles of treating open injuries?

A
  • ABCDE
  • stop blood and splint
  • neurovascular status
  • IV antibiotics in an hour
  • take pictures and do a saline soak
  • scan with contrast
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9
Q

What can a flexion distraction injury in a car lead to?

A

only using the lap strap

pancreas damage

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10
Q

Why is splinting beneficial?

A

to limit pain and open spaces for bleeding

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11
Q

What are the risk factors for proximal femur fracture?

A 
osteoporosis
smoking
malnutrition
excess alcohol
neurological impairment
impaired vision
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12
Q

What are the classifications of femur fracture?

A
  • intracapsular= displaced or undisplaced

- extracapsular= subtrochanteric or intertochanteric

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13
Q

What are the options for treating intracapsular femur fractures?

A
  • fixation
  • hemi-arthroplasty
  • THR
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14
Q

What are the options for treating extra capsular femur fractures?

A
  • dynamic hip screw (intertorchaniteric)

- intramedullary nail (sub T or reverse oblique)

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15
Q

What does A in ABCDE include as well as airway?

A

C-spine control

control of bleeding

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16
Q

What are some common causes for airway obstruction in trauma?

A
  • facial fractures
  • vomit
  • tongue in back of throat
  • direct laryngeal trauma
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17
Q

What is the best way to open an airway if there is potential C-spine injury?

A

jaw thrust not a head tilt chin lift

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18
Q

What is a flail chest?

A

on or more ribs is broken in more than one place so there is pulmonary contusion and pain

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19
Q

What is the lowest blood pressure to give a radial pulse?

A

80/90 systolic

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20
Q

What is the best resuscitation technique?

A

blood through a short, fat cannula into a central vein with a 1:1 ration of blood to FFP

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21
Q

What drug is given in resus to stop bleeding?

A

tranexamic acid

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22
Q

What are the peak ages for fractures in children?

A

7 and 13

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23
Q

What are the main fractures that are unique to children?

A
  • greenstick
  • torus = FOOSH
  • plastic deformation = bending of bones
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24
Q

What is different about the way that kids bones heal?

A
  • thicker periosteum
  • remodelling occurs more readily
  • less invasive treatment needed
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25
Q

What are some NAI red flags?

A
  • injury doesn’t fit description of cause
  • history doesn’t fit severity
  • “child injured themselves”
  • delay in seeking treatment
  • less than 2 years and not walking
  • injuries in many stages of healing
  • many body areas
  • increased intracranial pressure
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26
Q

What are the tests for the nerves?

A
  • ulnar = adducting the fingers
  • radial = thumbs up
  • median = OK sign
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27
Q

What are some positions for displacing in casts?

A

Gallows is legs in the air

Spica is legs spread

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28
Q

What are the different types of arm sling used for?

A
  • broad arm is support but not traction

- collar and cuff is just traction

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29
Q

What are the immobilisation rules for metaphyseal and diaphyseal injuries?

A
  • metaphyseal = adjacent joint immobilised

- diaphyseal = joint above and below immobilised

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30
Q

What are the exceptions for conservation management with casting?

A
  • displaced intraairticular fractures
  • displaced growth plate (Salter Harris)
  • open fractures
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31
Q

What are some common kid’s fractures?

A
  • tibial fractures
  • distal radius fractures
  • forearm fractures
  • supracondylar fractures of the elbow
  • femoral shaft fractures
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32
Q

What is a dislocation?

A

a complete loss of bony contact between two articular surfaces

33
Q

What is a subluxation?

A

a partial loss of bony contact between two articular surfaces

34
Q

What is primary healing?

A

minimal fracture gap and the gap is bridged by osteoblasts

35
Q

What is secondary healing?

A

scaffold is needed temporarily for proper healing to then occur

36
Q

What is the detailed process of secondary healing?

A
  • haematoma with inflammation
  • macrophages and osteoclasts remove debris and resorb bone ends
  • granulation tissue with fibroblasts and new vessels
  • chondroblasts from cartilage
  • osteoblasts lay down bone matrix
  • calcium mineralisation makes immature bone
  • remodelling to lamelar bone
37
Q

What is the overview of secondary healing?

A

1- inflammation
2- soft callus (2-3 weeks)
3- hard callus (6-12 weeks)
4- remodelling

38
Q

What are some factors that promote fracture healing?

A
  • nutrients
  • oxygen
  • stem cells
  • low levels of movement and stress
39
Q

What are some factors that hinder fracture healing?

A
  • tissue in gap
  • malnutrition
  • lack of blood
  • ill health
  • movement
  • smoking
  • gap too big
40
Q

What is the mechanism for a transverse fracture?

A

bending force (straight break)

41
Q

What is the mechanism for an oblique fracture?

A

fall from height or deceleration (short and angulate)

42
Q

What is the mechanism for a spiral fracture?

A

torsion (unstable due to rotation and angulation)

43
Q

What are the features of a comminuted fracture?

A
  • many fragments (3+)
  • unstable
  • surgery
44
Q

What are the features of a segmental fracture?

A
  • two breaks so three parts

- unstable

45
Q

What does fracture displacement depend on?

A
  • translation: of distal fragment
  • angulation: of distal fragment, direction of point, measures in degrees from longitudinal axis of diaphysis
  • rotation: of distal fragment, needs corrected if unstable
46
Q

What are the guidelines for deciding to XR or not?

A

Ottowa

47
Q

What is the management fo a long bone fracture?

A

reduction before XR if

  • displaced bone
  • obvious dislocation
  • possible skin damage from too much pressure
48
Q

What are the early local and systemic complications of fractures?

A
  • local: compartment syndrome, vascular injury, nerve compression and skin necrosis
  • systemic: shock, renal failure, multi-organ dysfunction syndrome and death
49
Q

What are the late local and systemic complications of fractures?

A
  • local: stiffness, LOF, pain, infection, malunion and DVT

- systemic: PE

50
Q

What are the features of compartment syndrome?

A
  • bleeding and exudate compresses venous system causing muscle ischaemia
  • should be left open 3 days
  • increased pain on stretching
  • sever pain outwit context
51
Q

What are the features of vascular injury?

A
  • can occur with penetrating and blunt trauma

- signs such as less distal circulation needs urgent review

52
Q

What are the signs of skin and soft tissue damage due to fracture?

A
  • should be reduced if compression so that there is blanching
  • fracture blisters due to epidermal blistering can result
53
Q

What are the positive outcomes for healing?

A
  • resolution of pain and function
  • abscence of point tenderness
  • no local oedema
  • resolution of movement
54
Q

What are the negative outcomes for healing?

A
  • ain
  • oedema
  • movement of bone
  • no callus
55
Q

What are hypertrophic and atrophic non-union?

A
  • hypertrophic: instability anf excessive motion

- atrophic: lack of blood, chronic disease, fixation with gap

56
Q

What are the features of complex regional pain syndrome?

A
  • constant burning and throbbing
  • swelling
  • stiffness
  • colour changes
  • needs pain team
  • treat with analgesia, antidepressants and steroids
57
Q

What are the antibiotics given urgently for an open fracture?

A
  • flucloxacilin for gram positives
  • gentamicin for gram negatives
  • metronidazole for anaerobes
58
Q

What are the grades for ligament injury?

A
  • grade 1 is sprain
  • grade 2 is partial teat
  • grade 3 is complete tear
59
Q

What are the main pathogens for septic arthritis?

A
  • s. aureus
  • strep
  • E.coli in the elderly, ill or IVDUs
60
Q

What is the special feature of the pelvis?

A
  • fractures like a polo so always more than one fracture

- this is commonly the SI joint

61
Q

What are the three main patterns of injury to the pelvis?

A
  • lateral compression fracture (side impact)
  • vertical shear fracture (axial force on one side of pelvis so it displaces superiorly)
  • anteroposterior compression injury (opens up like book pages with lots of bleeding)
62
Q

What usually happens with a posterior wall fracture of the acetabulum?

A

the femur pushes back, do a CT

63
Q

What are the main risks for intracapsular fractures?

A
  • AVN

- non-union

64
Q

What are the main risks with displaced femoral shaft fractures?

A

serious blood loss

65
Q

What are the main issues with a true knee dislocation?

A
  • vascular injury, nerve injury and compartment syndrome
  • multi-ligament damage
  • can dislocation and relocate
66
Q

What is the most common method of treatment for tibial shaft fractures?

A

intra-medullary nailing

67
Q

What is the main risk with tibial shaft fractures?

A

compartment syndrome

68
Q

What are the criteria for ankle management in A&E?

A

Ottawa ankle guidelines

69
Q

What are some complicated ankle fractures add ons?

A
  • deltoid ligament rupture
  • talar shift
  • fractures to medial and lateral malleoli
70
Q

What is a Lisfranc fracture?

A

fracture of the base of the 2nd metatarsal with dislocation

71
Q

What is the most common situation for a humeral neck fracture?

A
  • fracture of surgical neck
  • low energy onto osteoporotic bone
  • sling and internally fix if there is displacement
72
Q

What can be seen with a humeral shaft fracture?

A
  • radial nerve injury so there can be wrist drop

- falls can lead to oblique or spiral fractures

73
Q

What happens with a olecranon fracture?

A

fall onto elbow point with triceps contraction

74
Q

What is a nightstick fracture?

A

ulnar shaft

75
Q

What is a monteggia fracture?

A

ulnar fracture with radial dislocation at elbow

76
Q

What is a galeazzi fracture?

A

radius fracture and ulnar dislocation

77
Q

What is a colles fracture?

A
  • FOOSH with extended wrist

- median nerve compression?

78
Q

What are the features of a scaphoid fracture?

A
  • FOOSH
  • tenderness in snuffbox
  • plaster cast needed
79
Q

What are the most common children’s fractures?

A
  • tibial in toddlers
  • distal radius
  • forearm (galeazze and monteggia)
  • supracondylar elbow
  • femoral shaft

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