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CP3 MDD > Fractures > Flashcards

Fractures Flashcards

1
Q

AABCS approach Xray

A 
Adequacy 
Aligment 
Bone
Cartilage
Soft tissues
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2
Q

Things looking for when looking at cartilage on XR

A

Outline + orientation of joint
Joint space
Loose bodies

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3
Q

What is Lipohaemarthrosis

A

Fat + blood in effusion that has leaked from bone following trauma

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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

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5
Q

Hx fracture (6)

A 
Mechanism 
Site
Assoc injuries 
Joint sx 
NV status 
AMPLE Hx
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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
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7
Q

Translation

A

Shifted sideways/forewards in relation to e/o

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8
Q

Alignement

A

Tilted or angulated, rotated

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9
Q

Simple types of fractures (4)

A

Transverse
Oblique
Spiral
Sagittal

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10
Q

Multi-fractures types (4)

A

Multidirectional
Multi-fragmented
Butterfly
Segmental

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11
Q

What is a Greenstick fracture

A

Paediatric fracture

= On 1 side that is bent on the other

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12
Q

What is a Salter Harris fracture

A

Fracture at the epiphyseal plate

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13
Q

What structures are in danger w/ a supracondylar # (2)

A

Median nn

Brachial aa

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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

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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
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16
Q

3 causes of pathological #

A

Osteoporotic #
Multiple myeloma
Benign bone lesion

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17
Q

What are the 4 stages of bone repair

A

Inflammation
Soft callus
Hard callus
Removelling

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18
Q

Inflammation stage of bone repair

A

1-7 days
# ends bleed
Haematoma forms
Inflammatory response - fibrin + capillaries

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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
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20
Q

Hard callus formation bone repair

A

1-4 m
Calcification soft tissue
Forms rigid tissue

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21
Q

Remodelling in bone repair

A

m-y
Once # solidly united
New bone replaced by lamellar bone

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22
Q

Acute complications of fractures (7)

A 
Compartment syndrome 
Visceral injury 
Nn injury
Vascular injury (Ps)
Infection 
Rhabdomyolysis 
Bleeding
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23
Q

Who to suspect rhabdomyolysis in

A

All pt w/ crush injury

Immoblised pt

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24
Q

How to screen for rhabdomyolysis

A

CK

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25
Q

Why can rhabdomyolysis cause an AKI

A

Myoglobin = nephrotoxin

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26
Q

Late complications fracture (8)

A 
Infection 
DVT/PE 
P sore 
Union issues 
AVN
Joint instability 
OA
Complex regional pain syndrome
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27
Q

RF - delayed union (7)

A 
Local: poor blood supply
Infection 
Poor apposition of bone ends
FB
Systemic: 
Poor nutritional status 
Smoking 
CCS therapy
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28
Q

CF - delayed union

A

Persisting tenderness

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29
Q

XR findings - delayed union

A 
# line remains visible 
Decr callous formation
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30
Q

Mx delayed union (3)

A

Eliminate cause
Immboilise bone in plaster
Incr mm exercise

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31
Q

Def non-union

A 
# wont ever unite w/o intervention 
Not healed after 2x expected time
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32
Q

PS non-union (2)

A

Movement elicited @ site

Pain decr due to pseudoarthritis

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33
Q

XR features hypertrophic non-union

A

Fracture ends = enlarged

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34
Q

XR features atrophic non-union

A

Ends tapered

No suggestion of new bone

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35
Q

Mx non-union

A 
C = splinting 
S = rigid fixation +/- bone graft
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36
Q

What is malunion

A

Bones unit but in unsatisfactory position

I.e. rotation, angulation, shortening

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37
Q

WHy does mal-union occur?

A

D/c inadequate reduction

Or immobilisation

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38
Q

mx mal-union (3)

A

Re-manipulation
Osteotomy + internal fixation
Limb lengthening procedure if neces

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39
Q

What is compartment syndrome

A

Increased pressure within a closed anatomical space due to a post # or ischaemia reperfusion injury

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40
Q

2 areas compartment syndrome is most likely to occur?

A

Supracondylar #

Tibial shaft

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41
Q

How long does it take for death of mm to occur in compartment syndrome?

A

4-6hrs

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42
Q

PS Compartment syndrome (5)

A 
WORST EVER PAIN not relieved by strong opioid. Passive + movement
Parasethesia 
Pallor 
Pulses +/-
Paralysis
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43
Q

How is a diagnosis of compartment syndrome made?

A

Measuring Intracompartmental P

>40 = diagnostic

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44
Q

Normal range intracompartmental P

A

5-10mmHg

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45
Q

Mx compartment syndrome

A

Remove cast
Elevate limb
ER Fasciotomy

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46
Q

Mx compartment syndrome if necrotic after faschiotomy

A

Debridement + amputation

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47
Q

Complication after fasciotomy?

A

Myoglobinuria

–> Renal failure

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48
Q

Mx myoglobuinuria post fasciotomy

A

aggressive fl therapy

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49
Q

Cause of Colles fracture

A

FOOSH

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50
Q

Who gets Colles fractures

A

Old women w/ OP

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51
Q

What are the 3 classical features of Colles #

A

Transverse # distal radius
Within 4cm of radiocarpal joint
Dorsal displacement + angulation
(Dinner fork deformity)

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52
Q

Which test can you do to determine if the median nn has been damaged in a Colles fracture?

A

Froments

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53
Q

Appearance of radius on XR in COlles Fracture

A

Shortened

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54
Q

Initial Mx Colles # (4)

A

Manipulate w/ Traction
Apply moulded plaster for reduction
Anaesthetise w/ haematoma block
Review 7 days + reimage

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55
Q

What position do you want to achieve on Colles fracture Mx

A

Ulnar deviation + flexion

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56
Q

Mx of Colles Fracture once in good position

A

XR @ 1/2 w

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57
Q

Mx unstable Colles #

A

ORIF + locking plate

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58
Q

Early Complications of Colles Fracture (2)

A

Median nn damage

Carpal Tunnel syndrome

59
Q

Late complications of Colles fracture (3)

A

Malunion
Late EPL rupture
Stiffness

60
Q

Cause of Smiths #

61
Q

Features of Smiths #

A

Transverse radial #
Within 4cm of radiocarpal joint
Volar/Palmar displacement of distal radius

62
Q

Which is less stable, Colles or a Smiths #

63
Q

Mx Smiths #

64
Q 
What is the most commonly 
#'d carpal bone
65
Q

Cause of scaphoid #

A

FOOSH w/ hyperextension of wrist

66
Q

What is the most at risk of vascular tears in a scaphoid #

A

Proximal part –> AVN

67
Q

Where is pain maximal in a scaphoid #

A

Over anatomical snuffbox

68
Q

Other features scaphoid #

A

Telescoping = painful

Weak pinch grip

69
Q

XR Scaphoid #

A

Hard to pick up

Must order Scaphoid series

70
Q

Mx Scaphoid #

A

C - immobilise in thumb spica - 6-8w

S

71
Q

Risk of nonunion in Scaphoid #

72
Q

2 types of forearm #

A

Galeazii

Monteggia

73
Q

Features of Galeazzi #

A

Fracture to distal 1/3 radius

Ulnar dislocation @ R-U joint

74
Q

Features of Monteggia #

A

Fracture to the proximal ulnar

Radial head dislocation

75
Q

Cause of Galeazzi #

A

FOOSH + rotational force

76
Q

Cause of Monteggia #

A

FOOSH + forced pronation

77
Q

Mx Galeazzi + Monteggia #

78
Q

O/E - Hip/femoral neck #

A

Hip pain on passive movement

If displaced - shortened + externally rotated

79
Q

Blood supply to the femoral head (3)

A

Intramedullary vessels (inside medullary canal)
Medial/lateral circumflex aa anastomoses
Artery ligamentus teres

80
Q

Which aa is disrupted in all Femoral#

A

Intramedullary vessels

81
Q

Which aa is disrupted in displaced Femoral#

A

Circumflex aa anastomoses

82
Q

What are the 3 main types of Femoral

A

Intracapsular (NOF)
Intertrochanteric
Subtrochanteric

83
Q

Where does a intramedullary # occur

A

ABove intertrochanteric line

84
Q

What criteria is used to classify NOF#

A

Garden criteria

85
Q

Garden 1

A

Incomplete + impacted #

86
Q

Garden 2

A

Complete # across neck, no displacement

87
Q

Garden 3

A

Complete #, some continuity hence remains valgus

88
Q

Garden 4

A

Complete #, no continuity between ends, rests in vaglus position

89
Q

Mx Garden 1/2 #

A

ORIF + Hip screw

90
Q

Mx Garden 3/4

A

Hemiarthroplasty

Or total if v fit

91
Q

Where is an intertrochanteric #

A

Lies between trochanters hence outside capsule

92
Q

Mx intertrochanteric #

93
Q

Were is a subtrochanteric #

A

Below trochanters

Hence = extracapsular

94
Q

Cause subtrochanteric # (2)

A

High energy trauma

Or lytic lesion

95
Q

Mx subtrochanteric #

A

IMN

Or DHS

96
Q

How long after hip surgery should a patient mobilise

A

within 24hrs

97
Q

What is the most common # in adults?

98
Q

Mx of minimally displaced tibial #

A

Full length cast
Mid-thigh to metatarsal neck Knee flexed
Ankle 90’

99
Q

Mx of displaced tibial #

A

Reduction under GA

Cast application

100
Q

What must be done in tibial # Mx to reduce risk of compartment syndrome?

A

Elevate + observe for 48hrs

101
Q

Mx tibial # after 2 weeks

A

Re- XR for position

102
Q

Mx tibial # after 4 weeks

A

Change to below the knee cast + Wt bare to increase healing

103
Q

Who gets ankle #

A

Young adults
Or
Osteoporotic women

104
Q

COmmon mechanism ankle #

A

Abduction + lat rotation of the joint

105
Q

Ix ankle #

A

AP
Lateral
Mortoise view

106
Q

What classification is used for fibular #

107
Q

Weber A

A 
Fracture = below level of syndesmosis 
Hence = intact
108
Q

Weber B

A

Fracture = at level of syndesmosis

Hence partially/not intact

109
Q

Weber C

A

Fracture = above syndesmosis

Hence not intake

110
Q 
What is an important factor in ankle stability after a 
#
A

Degree of Talar shift

111
Q

Mx Weber A

A

6 w plaster of Paris

112
Q

Mx Weber B

A

Trial conservative Mx
Repeat XR 1,2,3w
If doubt –> surgery

113
Q

Mx Weber C

114
Q

Mx if > 1 malleolar #

115
Q

Ottowa rules (Ankle)

A

XR ankle only req when:
pt = unable to W bear
Pain + bony tenderness @ malleoli

116
Q

Ottowa rules (Foot)

A

XR foot = only req if:
Unable to W bear
Bony tenderness over navicular/base 5MT

117
Q

Mechanism of injury - vertebral #

A

Excessive spinal flexion

118
Q

PS vertebral # (3)

A

Marked pain
Incr on movement/W bearing
Improves after m

119
Q

Ix vertebral #

A

XR spine (AP/Lateral)

120
Q

Conservative Mx vertebral #

A

Bed rest 1-2w
Mobilise = mm streghtening
Thoraco-columnar brace

121
Q

Indications - thoracocolumnar brace

A

If >25% anterior height reduction

122
Q

Surgical Mx vertebral #

A

Kyphoplasty

123
Q

What is a Jefferson #

124
Q

Cause of Jefferson fracture

A

Axial compression force on skull transfer to spine

125
Q

Ix Jefferson #

A

Open mouth XR

126
Q

What is a Hangman’s #

127
Q

Cause of Hangman’s #

A

Hyperextension neck

128
Q

Ix Hangmans #

A

Lateral XR

129
Q

What is an odontoid # associated with?

130
Q

Most common type of Salter Harris #

131
Q

Type 1 Salter Harris #

A

Straight across growth plate

132
Q

Type 2 Salter Harris #

A

Above growth plate

133
Q

Type 3 Salter Harris #

A

Lower than growth plate

134
Q

Type 4 Salter Harris #

A

Through everything

135
Q

Type 5 Salter Harris #

136
Q

Closed long bone # Mx (7)

A 
A-E
Pain relief
Image bone + joint above + below 
Manipulation + stabilisation in Plaster of Paris 
Reimage to check 
Check NV status for complications
137
Q

Open long bone # Mx (6)

A 
A-E 
Pain relief Check distal NV status 
ASsess soft tissue injury 
IV ABx +/- tetanus 
Image 
Take to theatre <6hrs
138
Q

What criteria is used for open bone fractures ?

A

Gustillo + Anderson criteria

139
Q

Gustillo + Anderson criteria - 1

A

Simple fracture

Wound <1cm

140
Q

Gustillo + Anderson criteria

- 2

A

Simple fracture

wound >2cm

141
Q

Gustillo + Anderson criteria

- 3a

A

Multifragmented

Adequate soft tissue cover

142
Q

Gustillo + Anderson criteria

3b

A

Multifragmented

Req plastics

143
Q

Gustillo + Anderson criteria

- 3c

A

Multifragmented

Assoc vascular injury

CP3 MDD (13 decks)

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