Brainscape's Knowledge GenomeTM

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


See full index

Orthopedics > Fractures > Flashcards

Fractures Flashcards

1
Q

Fracture description

A
  1. Name of injured bone
  2. Integrity of skin/soft tissue
    Closed, open
  3. Location
    epiphyseal, metaphyseal, diaphyseal (proximal, middle, distal), physis (growth plate)
  4. Orientation/fracture pattern
    • transverse: fracture line perpendicular (<30° of angulation) to long axis of bone; result of direct high energy force
    • oblique: angular fracture line (30°- 60° of angulation); result of angulation and compressive force, high energy
    • butterfly: fracture site fragment which looks like a butterfly
    • segmental: a separate segment of bone bordered by fracture lines; result of high energy force
    • spiral: complex, multi-planar fracture line; result of rotational force, low energy
    • comminuted/multi-fragmentary: >2 fracture fragments
    • intra-articular: fracture line crosses articular cartilage and enters joint
    • avulsion: tendon or ligament tears/pulls off bone fragment; often in children, high energy
    • compression/impacted: impaction of bone; typical sites are vertebrae or proximal tibia
    • torus: a buckle fracture of one cortex, often in children
    • greenstick: an incomplete fracture of one cortex, often in children
    • pathologic: fracture through bone weakened by disease/tumour
  5. Alignment of fracture fragments
    • non-displaced: fracture fragments are in anatomic alignment
    • displaced: fracture fragments are not in anatomic alignment
    • distracted: fracture fragments are separated by a gap (opposite of impacted)
    • impacted: fracture fragments are compressed, resulting in shortened bone
    • angulated: direction of fracture apex (e.g. varus/valgus)
    • translated/shifted: percentage of overlapping bone at fracture site
    • rotated: fracture fragment rotated about long axis of bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Signs of open fracture

A

continuous bleeding from puncture site or fat droplets in blood are suggestive of an open fracture

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

How to describe displacement

A

Refers to position of the distal fragment relative to the proximal fragment

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

Varus angulation

A

Apex away from midline

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

Valgus angulation

A

Apex toward midline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Xray rule of 2s

A

2 sides - bilateral

2 views - AP and lat

2 joints - joint above and below

2 times - before and after reduction

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

Reasons for spinting

A

Pain control

Reduces further damage to vessels, nerves and skin and may improve vascular status

Decreases risk of inadvertently converting closed to open fracture

Facilitates patient transport

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

Approach to fractures

A
  1. Clinical assessment
    - ABCs
    - R/o other fractures/injuries
    - rule out open fracture
    - SAMPLE
    - Physical exam (deformity, soft tissue integrity, maximal tenderness, NVS, avoid ROM/moving injured area to prevent exacerbation)
  2. Analgesia
  3. Imaging
  4. Splint extremity
  5. Management: Closed vs. Open Reduction
  6. obtain the reduction (see appropriate IV sedation)
    ■ closed reduction
    ◆ apply traction in the long axis of the limb
    ◆ reverse the mechanism that produced the fracture
    ◆ reduce with IV sedation and muscle relaxation (fluoroscopy can be used if available)
    ■ indications for open reduction
    ◆ “NO CAST”
    ◆ other indications include – failed closed reduction – not able to cast or apply traction due to site (e.g. hip fracture) – pathologic fractures – potential for improved function with ORIF
    ■ ALWAYS re-check and document NVS after reduction and obtain post-reduction x-ray
  7. maintain the reduction
    ■ external stabilization: splints, casts, traction, external fixator
    ■ internal stabilization: percutaneous pinning, extramedullary fixation (screws, plates, wires), IM fixation (rods)
    ■ follow-up: evaluate bone healing
  8. rehabilitate to regain function and avoid joint stiffness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Indications for open reduction

A

NO CAST

Non-union 
Open fracture 
Neurovascular Compromise 
Displaced intra-Articular fracture 
Salter-Harris 3,4,5 
PolyTrauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Buck’s Traction

A

system of weights, pulleys, and ropes that are attached to the end of a patient’s bed exerting a longitudinal force on the distal end of a fracture, improving its length, alignment, and rotation

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

Normal progression of fracture healing

A

Weeks 0-3
Hematoma, macrophages surround fracture site

Weeks 3-6
Osteoclasts remove sharp edges, callus forms within hematoma

Weeks 6-12
Bone forms within the callus, bridging fragments

Months 6-12
Coritcal gap is brdiged by bone

Years 1-2
Normal architecture is achieved through remodelling

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

Evaluation of fracture healing

A

Tests of union

  • clinical: no longer tender to palpation or stressing on physical exam
  • x-ray: trabeculae cross fracture site, visible callus bridging site on at least 3 of 4 cortices
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Local early fracture complications

A

Compartment syndrome

Neurological injury

Vascular injury

Infection

Implant failure

Fracture blisters

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

Local late fracture complications

A

Mal/non-union

AVN

Osteomyelitis

Heterotopic ossification

Post traumatic OA

Joint stiffness/adhesive capsulitis

CRPS type I/RSD

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

Systemic early fracture complications

A

sepsis

DVT

PE

ARDS secondary to fat embolism

Hemorrhagic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is heterotopic ossification

A

The formation of bone in abnormal locations (e.g. in muscle), secondary to patho

17
Q

What is Wolff’s Law

A

Bone remodels itself to over time in response to mechanical load to better withstand loading stressors placed upon it

18
Q

Articular cartilage properties

A
  • 2-4 mm layer covering ends of articulating bones, provides nearly frictionless surface
  • avascular (nutrition from synovial fluid), aneural, alymphatic
19
Q

Avascular necrosis definition and commonly affected areas

A

Avascular Necrosis Ischemia of bone due to disrupted blood supply; most commonly affecting the femoral neck, talus neck, or proximal scaphoid

20
Q

Fracture blister definition

A

Formation of vesicles or bullae that occur on edematous skin overlying a fractured bone

21
Q

Osteochondritis dissecans

A

Osteonecrosis of subchondral bone most often occurring in children and adolescents and causing pain and potentially hindering joint motion

22
Q

Articular cartilage defects etiology

A
  • overt trauma, repetitive minor trauma (such as repetitive ankle sprains or patellar maltracking); common sports injury
  • degenerative conditions such as early stage OA or osteochondritis dissecans
23
Q

Articular cartilage defects clinical features

A
  • similar to symptoms of OA (joint line pain with possible effusion, etc.)
  • often have predisposing factors, such as ligament injury, malalignment of the joint (varus/valgus), obesity, bone deficiency (AVN, osteochondritis dissecans, ganglion bone cysts), inflammatory arthropathy, and familial osteoarthropathy
  • may have symptoms of locking or catching related to the torn/displaced cartilage
24
Q

Articular cartilage defects investigations

A
  • x-ray (to rule out bony defects and check alignment)
  • MRI
  • diagnostic arthroscopy (treatment is often guided by what is seen during arthroscopy)
25
Q

Outerbridge Classification of Chrondral Defects

A

Grade 1 - Softening and swelling of cartilage

II - Fragmentation and fissuring <1/2” in diameter

III- fragmentation and fissuring >1/2” in diameter

IV- Erosion of cartilage down to bone

26
Q

Articular cartilage defects treatment

A

• individualized
■ patient factors (age, skeletal maturity, activity level, etc.)
■ defect factors (Outerbridge Classification, subchondral bone involvement, etc.)

• non-operative
■ rest, NSAIDs, bracing

• operative
■ microfracture, osteochondral grafting (autograft or allograft) autologous chondrocyte implantation

Orthopedics (19 decks)

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