Fractures Flashcards
1
Q
AABCS approach Xray
A
Adequacy Aligment Bone Cartilage Soft tissues
2
Q
Things looking for when looking at cartilage on XR
A
Outline + orientation of joint
Joint space
Loose bodies
3
Q
What is Lipohaemarthrosis
A
Fat + blood in effusion that has leaked from bone following trauma
4
Q
Things looking for when looking at bone on XR
A
Check cortical outline on all bones
Check for any breach in outline
Bone texture - trabecular pattern
5
Q
Hx fracture (6)
A
Mechanism Site Assoc injuries Joint sx NV status AMPLE Hx
6
Q
Description of XR
A
Site Simple/multi-fragmented Displaced or non-dispalced Always describe according to position of distal bone Open or compound
7
Q
Translation
A
Shifted sideways/forewards in relation to e/o
8
Q
Alignement
A
Tilted or angulated, rotated
9
Q
Simple types of fractures (4)
A
Transverse
Oblique
Spiral
Sagittal
10
Q
Multi-fractures types (4)
A
Multidirectional
Multi-fragmented
Butterfly
Segmental
11
Q
What is a Greenstick fracture
A
Paediatric fracture
= On 1 side that is bent on the other
12
Q
What is a Salter Harris fracture
A
Fracture at the epiphyseal plate
13
Q
What structures are in danger w/ a supracondylar # (2)
A
Median nn
Brachial aa
14
Q
What is the criteria used for supracondylar #
A
Garland criteria
Looking for anterior humeral line
Is it in line w/ anterior 1/3 capitulum
15
Q
CRITOE
A
What age parts of the elbow form Capitulum - 2 Radial head - 4 Int epicondyle (med) - 6 Trochlea - 8 Olecranon - 10 Ext epicondyle = 12
16
Q
3 causes of pathological #
A
Osteoporotic #
Multiple myeloma
Benign bone lesion
17
Q
What are the 4 stages of bone repair
A
Inflammation
Soft callus
Hard callus
Removelling
18
Q
Inflammation stage of bone repair
A
1-7 days
# ends bleed
Haematoma forms
Inflammatory response - fibrin + capillaries
19
Q
Soft callus formation bone repair
A
1-3 weeks Movement fracture end decr Vascular network expands Fibrous tissue replaces haematoma Subperiosteal new bone forms
20
Q
Hard callus formation bone repair
A
1-4 m
Calcification soft tissue
Forms rigid tissue
21
Q
Remodelling in bone repair
A
m-y
Once # solidly united
New bone replaced by lamellar bone
22
Q
Acute complications of fractures (7)
A
Compartment syndrome Visceral injury Nn injury Vascular injury (Ps) Infection Rhabdomyolysis Bleeding
23
Q
Who to suspect rhabdomyolysis in
A
All pt w/ crush injury
Immoblised pt
24
Q
How to screen for rhabdomyolysis
A
CK
25
Why can rhabdomyolysis cause an AKI
Myoglobin = nephrotoxin
26
Late complications fracture (8)
```
Infection
DVT/PE
P sore
Union issues
AVN
Joint instability
OA
Complex regional pain syndrome
```
27
RF - delayed union (7)
```
Local: poor blood supply
Infection
Poor apposition of bone ends
FB
Systemic:
Poor nutritional status
Smoking
CCS therapy
```
28
CF - delayed union
Persisting tenderness
29
XR findings - delayed union
```
# line remains visible
Decr callous formation
```
30
Mx delayed union (3)
Eliminate cause
Immboilise bone in plaster
Incr mm exercise
31
Def non-union
```
# wont ever unite w/o intervention
Not healed after 2x expected time
```
32
PS non-union (2)
Movement elicited @ site
| Pain decr due to pseudoarthritis
33
XR features hypertrophic non-union
Fracture ends = enlarged
34
XR features atrophic non-union
Ends tapered
| No suggestion of new bone
35
Mx non-union
```
C = splinting
S = rigid fixation +/- bone graft
```
36
What is malunion
Bones unit but in unsatisfactory position
| I.e. rotation, angulation, shortening
37
WHy does mal-union occur?
D/c inadequate reduction
| Or immobilisation
38
mx mal-union (3)
Re-manipulation
Osteotomy + internal fixation
Limb lengthening procedure if neces
39
What is compartment syndrome
Increased pressure within a closed anatomical space due to a post # or ischaemia reperfusion injury
40
2 areas compartment syndrome is most likely to occur?
Supracondylar #
| Tibial shaft
41
How long does it take for death of mm to occur in compartment syndrome?
4-6hrs
42
PS Compartment syndrome (5)
```
WORST EVER PAIN not relieved by strong opioid. Passive + movement
Parasethesia
Pallor
Pulses +/-
Paralysis
```
43
How is a diagnosis of compartment syndrome made?
Measuring Intracompartmental P
| >40 = diagnostic
44
Normal range intracompartmental P
5-10mmHg
45
Mx compartment syndrome
Remove cast
Elevate limb
ER Fasciotomy
46
Mx compartment syndrome if necrotic after faschiotomy
Debridement + amputation
47
Complication after fasciotomy?
Myoglobinuria
| --> Renal failure
48
Mx myoglobuinuria post fasciotomy
aggressive fl therapy
49
Cause of Colles fracture
FOOSH
50
Who gets Colles fractures
Old women w/ OP
51
What are the 3 classical features of Colles #
Transverse # distal radius
Within 4cm of radiocarpal joint
Dorsal displacement + angulation
(Dinner fork deformity)
52
Which test can you do to determine if the median nn has been damaged in a Colles fracture?
Froments
53
Appearance of radius on XR in COlles Fracture
Shortened
54
Initial Mx Colles # (4)
Manipulate w/ Traction
Apply moulded plaster for reduction
Anaesthetise w/ haematoma block
Review 7 days + reimage
55
What position do you want to achieve on Colles fracture Mx
Ulnar deviation + flexion
56
Mx of Colles Fracture once in good position
XR @ 1/2 w
57
Mx unstable Colles #
ORIF + locking plate
58
Early Complications of Colles Fracture (2)
Median nn damage
| Carpal Tunnel syndrome
59
Late complications of Colles fracture (3)
Malunion
Late EPL rupture
Stiffness
60
Cause of Smiths #
FOOSH
61
Features of Smiths #
Transverse radial #
Within 4cm of radiocarpal joint
Volar/Palmar displacement of distal radius
62
Which is less stable, Colles or a Smiths #
Smiths
63
Mx Smiths #
ORIF
64
```
What is the most commonly
#'d carpal bone
```
Scaphoid
65
Cause of scaphoid #
FOOSH w/ hyperextension of wrist
66
What is the most at risk of vascular tears in a scaphoid #
Proximal part --> AVN
67
Where is pain maximal in a scaphoid #
Over anatomical snuffbox
68
Other features scaphoid #
Telescoping = painful
| Weak pinch grip
69
XR Scaphoid #
Hard to pick up
| Must order Scaphoid series
70
Mx Scaphoid #
C - immobilise in thumb spica - 6-8w
| S
71
Risk of nonunion in Scaphoid #
10%
72
2 types of forearm #
Galeazii
| Monteggia
73
Features of Galeazzi #
Fracture to distal 1/3 radius
| Ulnar dislocation @ R-U joint
74
Features of Monteggia #
Fracture to the proximal ulnar
| Radial head dislocation
75
Cause of Galeazzi #
FOOSH + rotational force
76
Cause of Monteggia #
FOOSH + forced pronation
77
Mx Galeazzi + Monteggia #
ORIF
78
O/E - Hip/femoral neck #
Hip pain on passive movement
| If displaced - shortened + externally rotated
79
Blood supply to the femoral head (3)
Intramedullary vessels (inside medullary canal)
Medial/lateral circumflex aa anastomoses
Artery ligamentus teres
80
Which aa is disrupted in all Femoral#
Intramedullary vessels
81
Which aa is disrupted in displaced Femoral#
Circumflex aa anastomoses
82
What are the 3 main types of Femoral
Intracapsular (NOF)
Intertrochanteric
Subtrochanteric
83
Where does a intramedullary # occur
ABove intertrochanteric line
84
What criteria is used to classify NOF#
Garden criteria
85
Garden 1
Incomplete + impacted #
86
Garden 2
Complete # across neck, no displacement
87
Garden 3
Complete #, some continuity hence remains valgus
88
Garden 4
Complete #, no continuity between ends, rests in vaglus position
89
Mx Garden 1/2 #
ORIF + Hip screw
90
Mx Garden 3/4
Hemiarthroplasty
| Or total if v fit
91
Where is an intertrochanteric #
Lies between trochanters hence outside capsule
92
Mx intertrochanteric #
DHS
93
Were is a subtrochanteric #
Below trochanters
| Hence = extracapsular
94
Cause subtrochanteric # (2)
High energy trauma
| Or lytic lesion
95
Mx subtrochanteric #
IMN
| Or DHS
96
How long after hip surgery should a patient mobilise
within 24hrs
97
What is the most common # in adults?
Tibial
98
Mx of minimally displaced tibial #
Full length cast
Mid-thigh to metatarsal neck Knee flexed
Ankle 90'
99
Mx of displaced tibial #
Reduction under GA
| Cast application
100
What must be done in tibial # Mx to reduce risk of compartment syndrome?
Elevate + observe for 48hrs
101
Mx tibial # after 2 weeks
Re- XR for position
102
Mx tibial # after 4 weeks
Change to below the knee cast + Wt bare to increase healing
103
Who gets ankle #
Young adults
Or
Osteoporotic women
104
COmmon mechanism ankle #
Abduction + lat rotation of the joint
105
Ix ankle #
AP
Lateral
Mortoise view
106
What classification is used for fibular #
Weber
107
Weber A
```
Fracture = below level of syndesmosis
Hence = intact
```
108
Weber B
Fracture = at level of syndesmosis
| Hence partially/not intact
109
Weber C
Fracture = above syndesmosis
| Hence not intake
110
```
What is an important factor in ankle stability after a
#
```
Degree of Talar shift
111
Mx Weber A
6 w plaster of Paris
112
Mx Weber B
Trial conservative Mx
Repeat XR 1,2,3w
If doubt --> surgery
113
Mx Weber C
ORIF
114
Mx if > 1 malleolar #
ORIF
115
Ottowa rules (Ankle)
XR ankle only req when:
pt = unable to W bear
Pain + bony tenderness @ malleoli
116
Ottowa rules (Foot)
XR foot = only req if:
Unable to W bear
Bony tenderness over navicular/base 5MT
117
Mechanism of injury - vertebral #
Excessive spinal flexion
118
PS vertebral # (3)
Marked pain
Incr on movement/W bearing
Improves after m
119
Ix vertebral #
XR spine (AP/Lateral)
120
Conservative Mx vertebral #
Bed rest 1-2w
Mobilise = mm streghtening
Thoraco-columnar brace
121
Indications - thoracocolumnar brace
If >25% anterior height reduction
122
Surgical Mx vertebral #
Kyphoplasty
123
What is a Jefferson #
C1
124
Cause of Jefferson fracture
Axial compression force on skull transfer to spine
125
Ix Jefferson #
Open mouth XR
126
What is a Hangman's #
C2
127
Cause of Hangman's #
Hyperextension neck
128
Ix Hangmans #
Lateral XR
129
What is an odontoid # associated with?
SC injury
130
Most common type of Salter Harris #
Type 2
131
Type 1 Salter Harris #
Straight across growth plate
132
Type 2 Salter Harris #
Above growth plate
133
Type 3 Salter Harris #
Lower than growth plate
134
Type 4 Salter Harris #
Through everything
135
Type 5 Salter Harris #
cRush
136
Closed long bone # Mx (7)
```
A-E
Pain relief
Image bone + joint above + below
Manipulation + stabilisation in Plaster of Paris
Reimage to check
Check NV status for complications
```
137
Open long bone # Mx (6)
```
A-E
Pain relief Check distal NV status
ASsess soft tissue injury
IV ABx +/- tetanus
Image
Take to theatre <6hrs
```
138
What criteria is used for open bone fractures ?
Gustillo + Anderson criteria
139
Gustillo + Anderson criteria - 1
Simple fracture
| Wound <1cm
140
Gustillo + Anderson criteria
| - 2
Simple fracture
| wound >2cm
141
Gustillo + Anderson criteria
| - 3a
Multifragmented
| Adequate soft tissue cover
142
Gustillo + Anderson criteria
| 3b
Multifragmented
| Req plastics
143
Gustillo + Anderson criteria
| - 3c
Multifragmented
| Assoc vascular injury
