Brainscape's Knowledge GenomeTM

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


See full index

Muscluloskeletal Systems > Fractures and Dislocations 2 > Flashcards

Fractures and Dislocations 2 Flashcards

1
Q

What is the other name for open fractures?

A

“Compound fractures”

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

What is the definition of an open fracture?

A

Direct communication between fracture and external environment

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

What two important respects differentiate closed and open fractures?

(why are open fractures seen as worse?)

A

Higher risk of infection

Higher energy injury
-In general with consequences for soft tissue and bone healing etc)

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

Give two fracture locations that sound odd but still count as open fractures?

A

Facial fractures into the nose

Pelvic fractures into the rectum

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

Is a graze on the skin that does not penetrate the dermis over a fracture class as an open fracture?

A

No

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

Give 4 determinants of fracture classification

A

Mechanism and velocity
Degree of soft tissue damage
Fracture configuration
Degree of contamination

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

List the classifications for open fracture Gustilo grading

no need to give a definition of each grade

A 
Type I
Type II
Type III
-IIIA
-IIIB
-IIIC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the definition of Type I Gustilo Grading?

A

Low energy

Wound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the definition of Type II Gustilo grading?

A

Moderate soft tissue damage

Wound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the definition of Type III Gustilo grading?

not covering each division

A

High energy
Extensive soft tissue damage
Severe fracture (comminution displacement)
Wound >10cm

ANY:

  • Gunshot
  • Farm accident
  • Segmental fracture
  • Bone loss
  • Severe crush injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the definition of Type IIIA Gustilo grading?

A

Soft tissue damage +++ but not grossly contaminated

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

What is the definition of Type IIIB Gustilo grading?

A

Periosteal stripping
Extensive muscle damage
Heavy contamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the definition of Type IIIC Gustilo grading?

A

Associated neurovascular complication

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

Fingers and tibial shaft fractures account for what percentage of total fractures?

A

> 50%

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

What two specialities are key in managing open fractures particularly severe tibial fractures?

A

Plastic and orthopaedic

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

Describe the management of open fractures

A

Full ATLS

Tetanus and antibiotics prophylaxis

Photograph, cover and stabilise limb

Surgical emergency (operation within 6hrs)

  • Early and thorough wound excision and toilet
  • DO NOT CLOSE WOUND

Repeat wound review and toilet every 24-48hrs

Early definitive skin cover (5-7 days)

Stabilise fracture definitely

? bone grafting

Fasciotomies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Give some antibiotics you can consider to give prophylactically

A

Cefuroxime
Augmentin
Clindamycin
Gentamycin at time of fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What open fracture patients should be operated on within 6hrs?

(5 marks)

A

Polytraumatised patients

Marine and farmyard environment

Gross contamination

Neurovascular compromise

Compartment syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why do you not need to rush to operate within 6 hours for all open fracture patients?

A

Outcome better if you assemble a proper team including ortho and plastics

Jumping in unprepared is not needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Give some different methods for wound closure

5 marks

A

Split skin graft

Myofasciocutaneous
-Muscle, fat and skin

Fasciocutaneous
-Fat and skin

Rotation

Free flaps
-Muscle group with skin taken and plugs hole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the 4 C’s of surgical debridement?

A

Colour

Contraction (diathermy and twitch)

Consistency

Capacity to bleed

(Tissue should be taken away until thses 4 are met)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the 4 broad criteria for the MESS score?

A

Limb ischaemia

Patient age range

Shock

Injury mechanism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the difference between dislocation and subluxation?

A

Dislocation = complete joint disruption

Subluxation = partial dislocation
-Not fully out of joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Anterior and posterior shoulder dislocations are characterised by which deformity?

A

Anterior
-Squared off

Posterior
-Locked in internal rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Elbow dislocation is characterised by which deformity?

A

Olecranon prominant posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Posterior hip dislocation is characterised by which deformity?

A

Leg short
Flexed
Internal rotation
Adduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Knee dislocation is characterised by which deformity?

A

Loss of normal contour

Extended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Ankle dislocation (lateral most common) is charcaterised by which deformity?

A

Externally rotated

Prominent medial malleolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Subtalar joint dislocation (lateral most common) is characterised by what deformity?

A

Laterally displaced os calcis

30
Q

Give some other names for Complex Regional Pain Syndrome Type 1

A 
Reflex sympathetic dystrophy
Causalgia
Algodystrophy
Sudeck's atrophy
Post-traumatic dystrophy
Shoulder Hand syndrome
Reflex neurovascular dystrophy
31
Q

Give 7 aetiologies of Complex regional pain syndrome type 1

A

Trauma (minor)

Surgery

Infections

Repetitive motion disorders

IHD, MI

Specific genetic predisposition

Nothing at all

32
Q

Describe the epidemiology of CRPS Type 1

incidence, incidence compared to type II, what do they commonly occur after, M:F, Age

A

Actual indicence unknown
-Higher than CRPS type 2 (causalgia)

1-5% after peripheral nerve injury

15-30% after Colles’ fracture

Higher incidence in women

Rare in children

33
Q

What is CRPS I?

A

Syndrome characterised by PORT:

  • Pain
  • Oedema
  • Reduced ROM
  • Temp and colour changes

Extremity
Disproportionate to the inciting event
Aggravated by activity

34
Q

What are the clinical features of CRPS 1?

A 
Pain
Swollen +++
Skin Shiny
Discoloured
Hot
Very Stiff
Bone osteoporotic +++ (rapid)
Joints osteoarthritis ++ (rapid)
Muscles wasted
35
Q

Describe the pain in CRPS I

A

Severe
Constant
Worse with touch/ movement
Disproportionate

Pain occurs as two components:

  • Spontaneous or continuous pain
  • Evoked pain = allodynia or hyperalgesia
36
Q

Describe the two stages of CRPS type I and the differences between them

A

Acute: (6 months)

  • Cooler
  • Skin perfusion lower on affected side
37
Q

What is allodynia?

A

Painful response to a normally innocuous stimulus

38
Q

What is hyperalgesia?

A

Increased response to a painful stimulus

39
Q

What are the general rules of treatment for CRPS I?

A

Early active movement +++
-Encourage normal use of limb

Regular analgesia:

  • Minimise pain
  • Educate patient about therapeutic goals

Frequent supervised physiotherapy

40
Q

How successful is treatment in CRPS I?

when should it be given

A

Better if treated early (6 months

PREVENTION

41
Q

Describe the treatment protocol for CRPS 1

A

MOBILITY OF LIMB
Improved pain and function with mobilisation
-Conservative care

OPTIMISE MEDICATION
Series of sympathetic blocks
-Physical therapy evaluation
-Sympathectomy
-Trial of spinal cord stimulator
-Trial of strong opioids
-Psychological evaluation
42
Q

What pharacological therapy can you use for CRPS 1?

6 marks

A
  • Traditional analgesics
  • Tricyclic antidepressants
  • Gabapentin (other anticonvulsants)
  • Glucocorticoids
  • Transdermal clonidine
  • Intravenous bisphosphonates
43
Q

What is crush syndrome also called?

A

Traumatic rhabdomyolysis

44
Q

What is crush syndrome?

What causes it, what does it lead to?

A

Crush injury to a large muscle mass (thigh, calf, etc)

Direct muscle injury +
Muscle ischaemia +
Cell death with release of myoglobin

ATN (acute tubular necrosis of kidneys)
ARF (acute renal failure)

45
Q

What are the clinical features of crush syndrome?

A

Dark amber urine

  • tests +ve for Hb
  • Request specific test for Mb

Acute renal failure

  • Hypovolaemia
  • Metabolic acidosis
  • Hyperkalaemia
  • Hypocalcaemia
  • DIC
46
Q

How do you manage crush syndrome?

A

IV FLUIDS +++

Early (protect kidney and prevent ARF)

Fluid expansion + osmotic diuresis (to maintain high tubular volume +urine flow - aim: 100mls urine per hour until Mb cleared)

Alkalisation of urine with sodium bicarbonate reduce tubular precipitation of myoglobin

47
Q

Give some aetiologies of acute compartment syndrome

A

Occurs after trauma

  • Usually with a fracture (70%)
  • But can be soft tissue trauma alone

Also seen in vascular reperfusion of acutely ischaemic limb

Burns (circumferential eschar)

Crush injuries

Haemorrhage
-10% on anti-coagulants or have bleeding disorder)

Drug injection

(plus chronic exertional)

48
Q

What is the definition of acute compartment syndrome?

A

A compartment syndrome develops when intramuscular pressure is elevated sufficiently to reduce nutritional blood flow significantly to tissues within the involved compartment

49
Q

What sites are at risk from acute compartment syndrome?

A 
LOWER LEG
Forearm
Hand
Foot
Thigh

(NOTE: you can get a compartment syndrome anywhere where there is a compartment -> bum, abdominal wall)

50
Q

What is the effect of acute compartment syndrome?

why can it go unnoticed?

A

Blood vessels compressed (lowest pressure first) and blood flow stops
-Tissue (muscle) becomes ischaemic

Smallest vessels = capillaries compress first

Foot still pink warm and has pulse

51
Q

Describe the two categories of patients who are at risk of acute compartment syndrome?

A

Trauma

  • Young, fit, male
  • 25% of adolescent tibial fractures have a compartment syndrome

No trauma

  • Older medically unfit patients
  • Greater Proportion female
52
Q

Is acute compartment syndrome more frequent in high or low energy injuries?

A

More common in LOW energy tibial fractures as fascial compartments more likely to be intact

53
Q

Can ACS occur in open fractures?

A

Yes, compartments will often remain intact in open fractures

54
Q

What are the 9 Ps of acute compartent syndrome?

A 
PAIN
Passive Dorsiflexion
Parasthesiae
Paresis or Paralysis
Pallor
Pulselessness
Perishing Cold
Pressure
(Prompt decompression)
55
Q

Describe the pain in acute compartment syndrome

A

Severe (disproportionate)
Worsening
Out-growing analgesia
Deep ache, crushing/tight

Made worse by
-passive dorsiflexion of the digits of the limb

56
Q

What causes parasthesiae in acute compartment syndrome?

A

Both direct pressure on nerve + ischaemia of nerve

57
Q

If compartment syndrome goes untreated what can it lead to?

4 things

A

Muscle ischaemia and necrosis

Muscle contractures

Delayed fracture healing

May nessecitate limb amputation

58
Q

How can you diagnose acute compartment syndrome?

A

Threshold for fasciotomy:

(persistent) Delta P

59
Q

When is fat embolism syndrome seen?

A

Occurs after trauma
-Always with a fracture of a long bone (usually 24-72 hrs)

Also seen in instrumentation of long bone
-e.g. intramedullary nailing

60
Q

What is the difference between fat embolism and fat embolism syndrome?

A

Fat within the systemic circulation that produces embolic phenomena, with or without clinical sequelae

When associated with an identifiable clinical pattern of symptoms and signs, it is known as Fat Embolism Syndrome (FES)

61
Q

How common is fat embolism?

How common is fat embolism syndrome?

A

Evidence of fat embolism (marrow fat + debris from fracture site) in 90% of patients with traumatic injury

But only 3-4% of long bone fractures result in “fat embolism syndrome”

62
Q

Give 5 risk factors for fat embolism syndrome

A

Long bone fractures

Conservative management of long bone fractures

Multiple trauma

Associated abdominal injuries

Severe blood loss

63
Q

What is the mechanical theory of fat embolism syndrome?

A

Bone marrow enters venous circulation and lodges in the lungs, smaller particles penetrate pulmonary capillaries and enter arterial circulation

64
Q

What is the biochemical theory of fat embolism syndrome?

A

Circulating fatty acids directly affect pneumocytes altering gas exchange

65
Q

How do you diagnose fat embolism syndrome?

A

Clinical

Blood investigations:

  • Hypoxia on ABGs
  • Fall in haemoglobin
  • Thrombocytopaenia
  • Fat droplets within blood clots

CXR

66
Q

What are the clinical features of fat embolism syndrome?

A

24-72 hours post insult

HYPOXIA!!
(PaO2

67
Q

What is the organ most sensitive to hypoxia?

A

Brain

68
Q

What is the classic triad of fat embolism syndrome?

A 
Hypoxia (Pulmonary)
Cerebral disfunction (Brain)
Petechial rash (Cutaneous)
69
Q

Describe the skin rash of fat embolism syndrome

A

60%

Petechial

Only in distribution of SVC
(chest/neck/axillae/eyes/mouth)

Fleeting - gone within 12-24h

70
Q

What is the treatment for fat embolism syndrome?

A

No current “treatment” (i.e. cure)

```
Only supportive
-Steroids
-Dextran
-Heparin
-Ethanol
limited evidence
~~~

71
Q

How do you manage fat embolism syndrome?

A

Aim: Maintain cerebral and pulmonary perfusion

Oxygen!

May require intensive gas and circulatory monitoring -> seen by ITU staff

If necessary:

  • mechanical ventilation
  • advanced circulatory support
72
Q

How do you prevent fat embolism syndrome?

A

Immobilisation/fixation of long bone fractures

Possible role for prophylaxis with steroids?

Monitoring with pulse oximetry

Muscluloskeletal Systems (29 decks)

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