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MDD > Fractures > Flashcards

Fractures Flashcards

1
Q

what are the acute complications of fractures

A

Compartment syndrome

visceral injury

Vascular Injury

Nerve Injury

Infection

Rhabdomyolysis

Bleeding

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2
Q

what is compartment syndrome

A

increased pressure in osteofascial compartment leading to ischaemia and necrosis due to a viscous cycle of increased pressure forcing fluid out of capillaries which causes increased pressure forcing out further fluid and so on

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3
Q

when does damage tend to occur in compartment syndrome

A

6 hours

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4
Q

what compartments are usually affected with compartment syndrome

A

forearm/leg flexor

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5
Q

what are the clinical features of compartment syndrome

A

worst pain ever - described as bursting

not relieved by strong opioid analgesia

still a pulse and limb is warm and red

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6
Q

how do you diagnose compartment syndrome

A

lot done clinically but if there is doubt compartment pressure can be done

> 30 over diastolic blood pressure means immediate fasciotomy is required

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7
Q

what is the management for compartment syndrome

A

Remove cast/bandage/dressing
Elevate limb
Immediate fasciotomy if high clinical suspicion or positive pressure readings
Debridement if any necrosis present
Aggressive IV fluids due to risk of myoglobinuria and AKI
Leave wound open and inspect in 2 days for potential closure

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8
Q

what suggests vascular injury in a fracture

A

6 Ps

pain
pulseless
perishingly cold
parasthesia
paralysis
pale
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9
Q

what are chronic complications of fractures

A

Infection

DVT/PE

Pressure sores

Delayed union

non-union

mal-union

avascular necrosis

joint instability

OA

complex regional pain syndrome

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10
Q

what are local risk factors for delayed union of a fracture

A

poor blood supply

infection

poor apposition of bone ends

presence of foreign bodies

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11
Q

what are systemic risk factors for delayed union of a fracture

A

poor nutritional status

smoking

corticosteroid therapy

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12
Q

what are clinical features of delayed union of a fracture

A

persisting fracture tenderness

on XR - very little callous formation, fracture line still visible

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13
Q

what’s the treatment for delayed union of a fracture

A

elimiate any local or systemic cause

immobilise bone in plaster

promote muscular exercise within the cast to encourage union

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14
Q

when is fracture non-union diagnosed

A

when the fracture hasn’t healed over 2x the time expected

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15
Q

clinical features on non-union of a fracture

A

Movement can be elicited at the site
Pain dimishes as the site gap becomes a pseudoarthritis
XR – fracture is clearly visible

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16
Q

what are the subtypes of non-union of a fracture

A

hypertrophic non-union where the fracture ends are enlarged

atrophic non union where there is no evidence of bone growth and the ends are tapered

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17
Q

how do you treat non union of a fracture

A

Conservative
Splinting
Functional bracing

Surgical
Rigid fixation +/- bone graft

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18
Q

what is mal-union of a fracture

A

bones unite in the wrong position

usually due to inadequate reduction or immobilisation

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19
Q

what are the treatments for mal-union of a fracture

A

remanipulation

osteotomy

internal fixation

limb lengthening procedures

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20
Q

what is a colles fracture

A

fracture of distal radius with dorsal displacement of the distal fracture

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21
Q

what mechanism of injury causes a colles fracture

A

FOOSH (fall on outstretched hand)

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22
Q

what patient group is most commonly associated with colles fracture

A

elderly women with osteoporosis

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23
Q

what physical change change is seen in colles fracture

A

Dorsal displacement of radius and radial impaction leading to a shortened radius compared to the ulna

Classically called a dinner fork deformity

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24
Q

whats the treatment for a colles fracture

A

initial manipulation and traction

application of a plaster to maintain traction

if good position = XR 1 + 2 weeks after to assess

if not positioned well or is a communated fracture = open reduction/internal fixation via a plate

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25
Q

what are common complications of colles fracture

A

median nerve damage/post traumatic carpal tunnel syndrome

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26
Q

what is a smiths fracture

A

opposite of colles - FOOSH but with back of hand striking floor first

distal radial fracture with volar displacement of the distal fragment

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27
Q

how do you treat a smiths fracture

A

generally more unstable so open reduction + internal fixation

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28
Q

what is the most commonly fractured carpal bone

A

scaphoid fracture

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29
Q

what mechanism of injury causes a scaphoid fracture

A

similar to colles - FOOSH, usually hyperextension of wrist

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30
Q

where is the pain worse in scaphoid fractures and what movements are weak

A

anatomical snuffbox

weak pinch grip

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31
Q

how is a ?scaphoid fracture investigated

A

scaphoid series of x rays

AP, lateral, + 2 oblique views

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32
Q

what should be done if you suspect a patient has had a scaphoid fracture but initial investigations are normal

A

treat as a fracture patient with repeat XRs out of plaster at 2 weeks and repeat clinical exam

33
Q

what is the treatment of scaphoid fracture

A

plaster + thumb immobilisation

34
Q

what time period is a scaphoid fracture expected to get better for

A

6-8 weeks

35
Q

what are the risks of scaphoid fractures

A

10% non union

avascular necrosis

36
Q

what is the monteggia fracture

A

proximal ulnar fracture with associated dislocation of the proximal radial head

(MUrderous)

37
Q

what is the galaezzi fracture

A

proximal radial fracture with asociated dislocation of the proximal ulnar head

38
Q

what is more common between the monteggia and galeazzi fracture

A

monteggia

39
Q

what is a complication of monteggia and galeazzi fractures

A

anterior interosseus nerve injury

40
Q

what would an anterior interosseus nerve injury cause

A

loss of pinch grip between thumb and forefinger due to flexor digitorum profundus and flexor pollicus longus

41
Q

what is a barton’s fracture

A

distal radius fracture involving the articular surface with dislocation of the radiocarpal joint

42
Q

what is a bennets fracture

A

intra-articular fracture of base of thumb metacarpal

43
Q

what would you expect to find on examination in a femoral neck fracture

A

hip pain on passive movements

if fracture displaced: shortened, externally rotated leg

44
Q

what arterys supply the femoral head

A

intramedullary vessels

medial/lateral circumflex artery

artery of ligamentum teres

45
Q

what blood supply is interrupted in displaced femur fractures

A

circumflex blood supply
intermedullary

remaining artery of ligamentum teres is not enough

46
Q

what blood supply if interrupted in non displaced femur fractures

A

intermedullary

47
Q

what are the 3 subtypes of femur fractures

A

intracapsular

intertrochanteric

subtrochanteric

48
Q

what is defined as an intracapsular fracture of the femur

A

NOF fractures

proximal to capsular insertion of the femoral head just above intertrochanteric line

49
Q

what is the garden criteria and what is each subheading in the criteria

A

criteria used when assessing intracapsular femur fractures

1 = incomplete impacted fracture

2= complete fracture across neck but not displaced

3 = complete fracture, partial dislocation with some continuity between heads

4 = complete fracture, no continuity between heads

50
Q

how do you manage garden 1-2 intracapsular fractures of the femur

A

Open reduction and internal fixation

Low risk of AVN so with cannulated hip screws

51
Q

how do you manage garden 3-4 intracapsular fracture of the femur + why is it different to garden 1-2

A

hemiarthoplasty if not that mobile or independent, total hip replacement if patient is mobile and competent with ADLs

however in younger patients open reduction and internal fixation generally done due to better prognosis

high risk of avascular necrosis

52
Q

what is defined as an intertrochanteric fracture of the hip

A

fracture line is between trochanters and is therefore extracapsular

53
Q

how do you manage intertrochanteric fractures

A

dynamic hip screw

54
Q

how do you manage subtrochanteric fractures

A

intermedullary nail and hip screw

55
Q

what is defined as a subtrochanteric fracture

A

fracture line is below the trochanters

56
Q

what vertebral fractures are common

A

wedge fractures from osteoporosis

otherwise mainly trauma

57
Q

how does a vertebral wedge fracture present

A

marked pain - worse on movement

spine kyphosis

58
Q

what investigations should be done if you suspect osteoporitic fractures

A

AP + lateral x rays of spine

59
Q

whats the treatment of osteoporotic fractures

A

Bed rest 1-2 weeks until pain subsides

Conservative
Mobilisation and muscle strengthening exercises
Marked wedging (>25% anterior height reduction) then a thoraco-columnar brace for 3 months may be used

Surgical
Kyphoplasty
Cement is injected into the collapsed vertebrae
Indicated in patients with ongoing pain that is confirmed to be at the level of the fracture

60
Q

what’s a jeffersons fracture

A

C1 spinal fracture due to axial compression forces

61
Q

how do you diagnose a jeffersons fracture

A

open mouth XR

62
Q

whats a hangmans fracture

A

C2 fracture due to hyperextension of the neck

63
Q

whats highly associated with an odontoid fracture

A

spinal cord injury

64
Q

what is the most common fracture in adults

A

tibial

65
Q

how do you treat tibial fractures

A

undisplaced/minimally undisplaced = full length cast

displaced fracture = reduction under anaethesia with XR guidance before cast application
limb is elevated and observed for 48 hours to assess for compartment syndrome
check with XR at 2 weeks
at 4 weeks change to below knees to allow weight bearing

66
Q

what patients tend to get ankle fractures

A

young athletes, osteoporitic older women

67
Q

how is a lateral ankle fracture classified

A

Weber classification

Weber A
Fracture is below the level of syndesmosis (tibulofibular joint)
Syndesmosis intact

Weber B
Fracture at the level of the syndesmosis
Syndesmosis partially intact

Weber C
Fracture above the level of the syndesmosis
Syndesmosis non-intact

68
Q

what is a sign of ankle instability

A

talar shift

69
Q

how do you manage a Weber A ankle fracture

A

Generally stable and therefore rarely requires operative management

6 weeks plaster usually sufficient

70
Q

how do you manage a Weber B ankle fracture

A

Trial of conservative management if only one malleoli affected

Repeat XR at weeks 1,2+3 if any doubt remains about displacement

More than one malleoli fractures are never stable and therefore should be treated surgically (open reduction/internal fixation)

71
Q

How do you manage a Weber C fracture

A

Never stable

Open reduction/internal fixation

If patient is able to tolerate

72
Q

what are the ottowa rules for scanning an ankle fracture

A

XR of ankle only required if the patient is unable to weight bear, has pain and bony tenderness at the lateral/medial malleoli

XR of foot only required if if patient is unable to weight bear and has bony tenderness over navicular or base of 5th metatarsal

73
Q

what are the salter harris classifications

A

I - Straight across the epiphyseal plate

II - part of it is above

III - part of it is below

IV - fracture is above + below (or through)

V - crush injury (erasure of the growth plate)

74
Q

what is the general management of a closed long bone fracture

A

A to E resus

Pain relief

Imaging of whole bone, with joint above and below

Manipulation and stabilisation in a cast

Ensure ankle at 90 degrees dorsiflexion

Reimage to check positioning

Check for complications

Distal neurovascular status

Further management depends on the positioning post-manipulation

If fracture is well reduced conservative management may be used with long term immobilisation and prolonged follow up

If it has not, surgical management indicated

75
Q

what is the general management of open long bone fractures

A

A-E resus

Pain relief

Checking of neurovascular status

Assess degree of soft tissue injury

IV ABx +/- tetanus prophylaxis

Imaging + theatre within 6 hours for definitive management and irrigation

Plastic surgery input may be required

76
Q

what is the gustilo + anderson criteria

A

Gustilo + anderson criteria used

1 - Simple fracture, wound <1cm

2 – simple fracture, wound >2cm

3 – multifragmented fracture

3A: with adequate soft tissue cover

3B: requiring plastics input

3C: associated with vascular injury

77
Q

what is the general management of every hip fracture patient

A

Full falls history should be done

Any previous fractures/bone pain before fall

Malignancy/osteoporosis

How long patient was on floor

Bloods 
Coagulation 
G+S 
FBC 
U+E 
CK if long lie

ECG

CXR

AP pelvis/lateral Xray

Whole femur should be imaged if a pathological fracture is suspected

78
Q

whats the prognosis of hip fractures

A

10-20% of patients require a change to a more dependent residental status

10-50% die within a year of a hip fracture

Mobilisation within 24 hours of treatment gives best outcomes

MDD (22 decks)

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