FRACTURES Flashcards
What are the different causes of fracture in normal bone?
Direct force
Indirect force (twist of a bone)
Repetitive stress fracture
What is a callous?
A mass of new bone at the site of fracture
What is the process of bone healing?
Haematoma, cell injury, release of gf and cytokines leading to inflammation
Mesenchymal precursors differentiate to osteoblasts
Osteoblasts then lay down osteoid which is primitive bone tissue (soft callus)
The soft callus then ossifies into hard callus.
What are some factors that affect healing of bone?
Energy transfer in injury / soft tissue injury Infection Avascularity (hip, scaphoid, talus) Smoking NSAIDs Systemic disease
What is a mal-union?
When the bone doesn’t heal in the anatomical position.
According to Perkin’s rule of thumb, how quickly should a child upper limb fracture heal?
3 weeks
According to Perkin’s rule of thumb, how quickly should a child lower limb fracture heal?
6 weeks
According to Perkin’s rule of thumb, how quickly should an adult upper limb fracture heal?
6 weeks
According to Perkin’s rule of thumb, how quickly should a adult lower limb fracture heal?
12 weeks
What is a spiral fracture?
A fracture from a twist injury will break in a spiral shape
What is an oblique fracture?
A fracture caused by compression leading to a roughly 30 degree break across the bone.
What is a comminuted fracture?
When the bone has fractured into several pieces, maybe too many to count.
If you see fat coming out of an open fracture wound, where has it Mort likely come from?
The bone marrow
What the two surgical emergencies in orthopedics?
Septic arthritis
Compartment syndrome
How is compartment syndrome caused?
A fracture may lead to an internal bleed. This leads to increase in pressure in the fascial compartment. This eventually blocks the venous return from the compartment as the veins collapse. This further increases the pressure in the compartment as the arterial supply continues.
What are the principles of fracture management?
Reduction
Stabilisation
Rehabilitation
What factors promote bone healing?
Good blood supply
Loading and micro motion
Nutritional status, vitamin D
Local growth hormones BMP
What are some factors that impair bone healing?
Diabetes Corticosteroids NSAIDs Radiotherapy Distraction of the fracture Soft tissue interposition
What is a transition fracture?
When the distal part of the bone has moved away from the proximal part so that the two fractured ends no longer communicate.
What is an angulation fracture?
When the distal part of the bone has bent in a direction away from the anatomical position. The two ends of the fracture are still communicating sightly.
How do you treat an open fracture, before the reduction of the fracture?
Pain killers Clean wound Antibiotic prophylaxis Anti-tetanus injection Take a photograph (maybe) Dress wound
What is de-gloving?
When the flesh is stripped off the bone. Often happens in a car accident when a tyre goes over the patient.
What is the gold standard treatment of open wounds?
Theatre within 6 hours for debridement followed by reduction.
What are the complications of intrarticular fractures?
Arthritis
Define a fracture.
Soft tissue injury associated with a break in bone.
What is the difference between primary and secondary ossification?
Secondary ossification is when callus is put down first. This is what happens naturally. Primary ossification is the direct formation of new bone to fuse the two ends together. This only happens with absolute stability.
When can you not use compression to fix a bone?
When the break is not across the shaft, so if the epiphysis is involved.
If the fracture is communited, and the individual pieces are hard to put back together.
What are some examples of early complications of a fracture?
Haemorrhage Nerve damage Soft tissue damage - tendons, muscles, skin, organs such as lung, liver, urethra and bladder. Pain Compartment syndrome
What are the six Ps of compartment syndrome?
Parasthesia Pallor Paralysis Poikilothermia Pulselessness Pain
What is Volkmann’s ischaemic contracture?
A permanent sign of compartment syndrome. Passive movement of the hand will be painful and restricted.
What are the later complications of a fracture?
Infection
Mal-union and deformity
Avascular necrosis
What is haematogenous osteomyelitis?
Inflammation of the bone marrow due to infection where the microorganism originally came from the blood, rather than an open wound.
What is the Ilizarov technique?
External apparatus used to lengthen and remodel limb bones.
What are some more systemic complications of fractures?
DVT, PE
Infection (chest, uti, soft tissue)
Pressure sores
What are the risk factors for femoral fracture?
Age over 65 years Female Comorbidities such as osteoporosis Nutrition such as lack of calcium Smoking Alcohol
How would someone with a hip fracture present?
Pain Bruising Swelling Unable to weight bear Shortened and externally rotated leg
What investigations would you carry out on someone with a suspected hip fracture?
Assess per ATLS X ray of sacrum and of chest Routine bloods Group and hold ECG
What important factors do you need to find out in the history of a patient with hip fracture?
Syncope
Arrhythmia
What other injuries might you need to look out in a patient who has fractured their hip?
Subdural hemotoma
What is the treatment of someone with a hip fracture?
IV fluids Analgesia Traction Low molecular weight heparin Surgery
What is the different between an intra and an extra capsular fracture?
Extra is distal to the femoral capsule (tronchateric line).
Why is the distinction between extra and intra capsular femoral fracture important?
Because the treatment is different. The blood supply to the femoral head is more likely to be affected by an intra capsular fracture.
What is the chance of avascular necrosis in a displaced fracture?
20-45%
What are the three intracapsular fractures?
Subcaptial
Transcervical
Basicervical
What is does Garden I signify in the garden classification?
Incomplete fracture of the femoral neck
What is Garden II?
Complete fracture without displacement
What is GARDEN III?
Complete fracture with partial displacement
What is garden IV?
Complete fracture with full displacement
What is the clinical significance of garden III, IV?
String likelihood of avascular necrosis.
How quickly do you need to operate of a fracture femoral head?
Within 6-12 hours
What are the surgical treatment options?
Cannula red hip screw
Dynamic hip screw
Cephalo-medullary device
Hemiarthroplasty - most standard treatment
Total hip replacement - often used in younger patients because they use their hip so much more. Hemiarthroplasty will wear out too quickly in someone who moves a lot
How many screws we used in a cannula red screws procedure?
3
When would you use a hemiarthroplasty to treat a hip fracture?
Poor general health Osteoporosis Age over 70 Inadequate closed reduction Pre existing hip disease
What are the contraindications for hemiarthroplasty?
Pre existing sepsis
Younger patients
What are the indications for a total hip replacement to treat a fractured hip?
Complete displacement
Signs of necrosis of the femoral head
What might increased the Iikelihood of avascular necrosis in a femoral head following fracture?
Inadequate reduction
Delayed reduction
Associated hip disease
What is the seinsheimer classification?
A way of classifying sub tronchateric fracture.
What is IM nailing?
Look it up
What is a pertrochonteric fracture?
The same as an intracapsular fracture.
How would you treat a displaced intracapsular fracture in a 32 year old?
DHS - maybe cannulated screws
What is the difference between a break and a fracture?
There is no difference
