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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
What are some NAI red flags?
- 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
26
What are the tests for the nerves?
- ulnar = adducting the fingers - radial = thumbs up - median = OK sign
27
What are some positions for displacing in casts?
Gallows is legs in the air | Spica is legs spread
28
What are the different types of arm sling used for?
- broad arm is support but not traction | - collar and cuff is just traction
29
What are the immobilisation rules for metaphyseal and diaphyseal injuries?
- metaphyseal = adjacent joint immobilised | - diaphyseal = joint above and below immobilised
30
What are the exceptions for conservation management with casting?
- displaced intraairticular fractures - displaced growth plate (Salter Harris) - open fractures
31
What are some common kid's fractures?
- tibial fractures - distal radius fractures - forearm fractures - supracondylar fractures of the elbow - femoral shaft fractures
32
What is a dislocation?
a complete loss of bony contact between two articular surfaces
33
What is a subluxation?
a partial loss of bony contact between two articular surfaces
34
What is primary healing?
minimal fracture gap and the gap is bridged by osteoblasts
35
What is secondary healing?
scaffold is needed temporarily for proper healing to then occur
36
What is the detailed process of secondary healing?
- 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
What is the overview of secondary healing?
1- inflammation 2- soft callus (2-3 weeks) 3- hard callus (6-12 weeks) 4- remodelling
38
What are some factors that promote fracture healing?
- nutrients - oxygen - stem cells - low levels of movement and stress
39
What are some factors that hinder fracture healing?
- tissue in gap - malnutrition - lack of blood - ill health - movement - smoking - gap too big
40
What is the mechanism for a transverse fracture?
bending force (straight break)
41
What is the mechanism for an oblique fracture?
fall from height or deceleration (short and angulate)
42
What is the mechanism for a spiral fracture?
torsion (unstable due to rotation and angulation)
43
What are the features of a comminuted fracture?
- many fragments (3+) - unstable - surgery
44
What are the features of a segmental fracture?
- two breaks so three parts | - unstable
45
What does fracture displacement depend on?
- 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
What are the guidelines for deciding to XR or not?
Ottowa
47
What is the management fo a long bone fracture?
reduction before XR if - displaced bone - obvious dislocation - possible skin damage from too much pressure
48
What are the early local and systemic complications of fractures?
- local: compartment syndrome, vascular injury, nerve compression and skin necrosis - systemic: shock, renal failure, multi-organ dysfunction syndrome and death
49
What are the late local and systemic complications of fractures?
- local: stiffness, LOF, pain, infection, malunion and DVT | - systemic: PE
50
What are the features of compartment syndrome?
- bleeding and exudate compresses venous system causing muscle ischaemia - should be left open 3 days - increased pain on stretching - sever pain outwit context
51
What are the features of vascular injury?
- can occur with penetrating and blunt trauma | - signs such as less distal circulation needs urgent review
52
What are the signs of skin and soft tissue damage due to fracture?
- should be reduced if compression so that there is blanching - fracture blisters due to epidermal blistering can result
53
What are the positive outcomes for healing?
- resolution of pain and function - abscence of point tenderness - no local oedema - resolution of movement
54
What are the negative outcomes for healing?
- ain - oedema - movement of bone - no callus
55
What are hypertrophic and atrophic non-union?
- hypertrophic: instability anf excessive motion | - atrophic: lack of blood, chronic disease, fixation with gap
56
What are the features of complex regional pain syndrome?
- constant burning and throbbing - swelling - stiffness - colour changes - needs pain team - treat with analgesia, antidepressants and steroids
57
What are the antibiotics given urgently for an open fracture?
- flucloxacilin for gram positives - gentamicin for gram negatives - metronidazole for anaerobes
58
What are the grades for ligament injury?
- grade 1 is sprain - grade 2 is partial teat - grade 3 is complete tear
59
What are the main pathogens for septic arthritis?
- s. aureus - strep - E.coli in the elderly, ill or IVDUs
60
What is the special feature of the pelvis?
- fractures like a polo so always more than one fracture | - this is commonly the SI joint
61
What are the three main patterns of injury to the pelvis?
- 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
What usually happens with a posterior wall fracture of the acetabulum?
the femur pushes back, do a CT
63
What are the main risks for intracapsular fractures?
- AVN | - non-union
64
What are the main risks with displaced femoral shaft fractures?
serious blood loss
65
What are the main issues with a true knee dislocation?
- vascular injury, nerve injury and compartment syndrome - multi-ligament damage - can dislocation and relocate
66
What is the most common method of treatment for tibial shaft fractures?
intra-medullary nailing
67
What is the main risk with tibial shaft fractures?
compartment syndrome
68
What are the criteria for ankle management in A&E?
Ottawa ankle guidelines
69
What are some complicated ankle fractures add ons?
- deltoid ligament rupture - talar shift - fractures to medial and lateral malleoli
70
What is a Lisfranc fracture?
fracture of the base of the 2nd metatarsal with dislocation
71
What is the most common situation for a humeral neck fracture?
- fracture of surgical neck - low energy onto osteoporotic bone - sling and internally fix if there is displacement
72
What can be seen with a humeral shaft fracture?
- radial nerve injury so there can be wrist drop | - falls can lead to oblique or spiral fractures
73
What happens with a olecranon fracture?
fall onto elbow point with triceps contraction
74
What is a nightstick fracture?
ulnar shaft
75
What is a monteggia fracture?
ulnar fracture with radial dislocation at elbow
76
What is a galeazzi fracture?
radius fracture and ulnar dislocation
77
What is a colles fracture?
- FOOSH with extended wrist | - median nerve compression?
78
What are the features of a scaphoid fracture?
- FOOSH - tenderness in snuffbox - plaster cast needed
79
What are the most common children's fractures?
- tibial in toddlers - distal radius - forearm (galeazze and monteggia) - supracondylar elbow - femoral shaft

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