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MSK SB > Fractures and Dislocations > Flashcards

Fractures and Dislocations Flashcards

1
Q

2 ways for fractures to heal

A

Primary bone healing

Secondary bone healing

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2
Q

what are features of secondary bone healing

A 
fracture gap fills with granulation tissue
then cartilage (soft callus)
then bone (enchondral ossification, hard callus)

this is used for most cases

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3
Q

worries of comminuted breaks

A

high energy usually so watch soft tissue and for compartment syndrome
also left with poor quality bone

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4
Q

what are peri articular fractures

A

fractures that occur in or immediately adjacent to a joint

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5
Q

if is a high energy break or there is substantial soft tissue swelling what should be avoided

A

ORIF

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6
Q

what are intra articular fractures

A

fractures which the break crosses into the surface of a joint. They always result in some degree of cartilage damage

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7
Q

how should displaced intra-articular fractures be treated

A

anatomic reduction
rigid internal fixation
prevents post OA

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8
Q

what are risks with peri-articular fractures and how can then be treated to avoid this

A

non-union or AVN

Tx – joint replacement

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9
Q

Tx for open fractures

A

Antibiotics - normally co-amoxiclav
Tetanus
Early debridement
Operative stabilisation

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10
Q

Tx for compartment syndrome

A

Fasciotomy

Operative stabilisation

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11
Q

Tx for vascular injury

A

reduction, stabilisation and then reassess circulation

may need revascularisation procedure

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12
Q

Tx for nerve injury

A

Open #&raquo_space; explore

Closed #&raquo_space; reduce fracture, hold, recheck and observe

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13
Q

extra-articular distal femur fractures Tx

A

Unstable - pull of muscles causes flexion at #
Thomas splint
Can nail/plate it

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14
Q

intra-articular distal femur fractures Tx

A

anatomical reduction, rigid fixation

plate and screws

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15
Q

what are extra-articular #

A

fractures that do not involve the joint surface

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16
Q

Mx of proximal tibial fractures

A

anatomical reduction

rigid fixation

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17
Q

what Ix can be used after x-ray if more info is needed

A

CT scan

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18
Q

what is the slowest healing fracture in the body

A

tibial shaft #
16 weeks to union
> 1 year non-union

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19
Q

what is poor tolerated in tibial shaft #

A

internal rotation

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20
Q

what is an intra-articular distal tibial # called

A

pilon #

fracture of the distal part of the tibia, involving its articular surface at the ankle joint

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21
Q

what type of proximal humerus # risk AVN and non-union

A

comminuted #

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22
Q

what can be considered in proximal humerus # for head splitting #

A

arthroplasty

will provide pain relief but ROM poor

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23
Q

what is at risk in humeral shaft #

A

radial nerve injury

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24
Q

when is internal fixation used in humeral shaft #

A 
non-union
pathological #
poly-truama 
open #
high energy
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25
Q

intra-articular distal humerus #Tx

A

ORIF

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26
Q

what is responsible for supination/pronation at the elbow

A

radial head

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27
Q

radial head fracture - what is can occur with and treatment

A

can occur with dislocated elbow

minimally displaced&raquo_space; treated conservatively

comminuted&raquo_space; excise +/- replacement

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28
Q

what sign seen on an x-ray in radial head fractures

A

fat pad sign

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29
Q

Radius fractured in isolation, suspect a dislocation of the distal RU joint

A

Galeazzi fracture dislocation

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30
Q

Ulna fractured in insolation, suspect a dislocation of the radial head

A

Monteggia fracture dislocation

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31
Q

Tx for Galeazzi/Monteggia

A

ORIF fractured bone

then dislocation should be reduced

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32
Q

what is nightstick fracture

A

direct blow to ulna causing isolated ulna fracture

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33
Q

Colles fracture

A

FOOSH
extra-articular # of distal radius
dorsal angulation
dorsal displacement

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34
Q

Tx for Colles fracture

A

Stable, minimally displaced / angulated  POP
Displaced simple #  MUA
Displaced, comminution  MUA & K-wiring, ORIF

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35
Q

complications of colles fracture

A

median nerve compression
EPL rupture
CRPS - Complex regional pain syndrome
loss grip strength

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36
Q

appearance of Colles fracture on x-ray

A

dinner fork deformity

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37
Q

fall onto back of hand

extra-articular, volar displacement and angulation

A

Smiths #

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38
Q

Barton #

A

Intra-articular, Volar or dorsal rim # of the distal radius&raquo_space; subluxation carpus

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39
Q

what are early local complications of fractures

A
  • compartment syndrome
  • vascular injury w/ distal ischaemia
  • nerve injury
  • skin necrosis
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40
Q

3 types of nerve injury

A

1st degree - Neurapraxia
2nd degree - Axonotmesis
3rd degree - Neurotmesis

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41
Q

features of neurapraxia

A

Temporary conduction block / demyelination

Should resolve within 28 days

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42
Q

features of axonotmesis

A

Nerve cell axon dies distally from point of injury = Wallerian degeneration
Structure of nerve (endoneurial tubes) intact
Regenerates at 1mm per day

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43
Q

what is Wallerian degeneration

A

when Nerve cell axon dies distally from point of injury

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44
Q

features of neurotmesis

A

Nerve transected – rare with # or dislocation

No recovery without surgery

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45
Q

what are indications for exploration of nerve injury

A

open fracture
penetrating injury
neuralgic pain&raquo_space; ongoing compression

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46
Q

if no function returns, what can be done for nerve injury

A

NCS - provides info on recovery potential and prognosis
Nerve grafting
Tendon transfers

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47
Q

what are early systemic complications of fractures

A 
Hypovolaemia
Fat embolism
Acute Respiratory Distress Syndrome
Systemic Inflammatory Response Syndrome
Multi-Organ Dysfunction Syndrome
48
Q

late local complications of fracture

A 
stiffness, loss of function 
post-trumatic OA
Non union - atrophic/hypertrophic
Malunion
CRPS
AVN
DVT
Osteomyelitis
Volkmann's ischaemic contracture
49
Q

what does malunion cause

A

pain
stiffness
loss of function
deformity

50
Q

what fractures get x-rays to confirm union

A

diaphyseal fractures of major long bones

51
Q

signs of fracture healing

A

pain improved
no tenderness
no movement at fracture site
no swelling or oedema

52
Q

what causes atrophic non-union

A 
Poor blood supply to fracture site
Fracture gap too big and no movement
Systemic disease
Smoking
Medicines – steroids, NSAIDs, bisphosphonates
53
Q

what is difference between atrophic and hypertrophic non-union

A

atrophic - no callus formed

hypertrophic - callus formed

54
Q

causes of hypertrophic non-union

A

too much movement at fracture site

Abundant callus response but failure union

55
Q

what can cause both type of non-union

A

infection

56
Q

what is volkmann’s ischaemic contracture

A

permanent shortening of forearm flexor muscles
causes clawlike deformity of the hand, fingers, and wrist.
more common in children

57
Q

causes of volkmann’s ischaemic contracture

A

ischemia to the forearm

occurs when there is increased pressure due to swelling i.e. compartment syndrome

58
Q

signs/symptoms of volkmann’s ischaemic contracture

A

5 P’s

Pain (earliest manifestation), especially accentuated by passive stretching
Pallor
Pulselessness
Paresthesias
Paralysis
59
Q

what is CRPS and Tx

A

exaggerated pain response after injury

Tx - pain specialists

60
Q

definition of allodynia

A

experience of pain from non-painful stimuli

61
Q

late systemic complications of fractures

A

pulmonary embolus

62
Q

what is the blood supply to femoral head

A

Intramedullary artery of shaft of femur
Medial & lateral circumflex branches of profunda femoris
Artery of ligamentum teres

63
Q

Hx of proximal femoral fractures

A

fall
pain
unable to weight bear

64
Q

Signs of proximal femoral fracture

A

shortening

external rotation

65
Q

why do children’s bones bend before they will snap

A

periosteum is much thicker

66
Q

what is Wolfs law

A

Bone in a healthy person or animal will adapt to the loads under which it is placed

67
Q

what is Heuter-Volkmann principle

A

Compression forces inhibit growth and tensile forces stimulate growth

68
Q

features of Hx indicative of NAI

A

MOI/Hx does not match nature or severity of injury
Inconsistency in Hx
Delay in seeking help

69
Q

NAI features

A

Any obvious or suspected fractures in a child under

70
Q

what are the 3 movements that can be done to test nerve supply in the hand

A

Thumbs up - Radial
Starfish - Ulnar
Ok sign - Median

71
Q

principles of fracture management

A

Reduce
Retain
Rehabilitate

72
Q

most commonly used treatment in kids

A

plaster of paris

73
Q

Tx for diaphyseal fracture in kids

A

immobilize joint above and below to prevent rotation

74
Q

Tx for metaphyseal fractures in kids

A

rotation not an issue immobilise adjacent joint

75
Q

internal fixation used in kids

A

less invasive and rigid than in adults

e.g. Percutaneous K wires, cannulated screws

76
Q

what is used for long bone fixation

A

flexible nails

used for femur

77
Q

adv and disadv for flexible nails

A

ADV
Predictable position rapid healing
Early joint mobilisation and weight bearing

DISADV
Infection risk
Risk of anaesthesia

78
Q

when is fixation usually indicated

A

Displaced Intra articular fractures
Displaced growth plate injuries
Open fractures
Multiple injuries

79
Q

when is external fixation indicated

A

Contaminated wounds
Acute vascular injury
Burns
Multiple injuries

80
Q

is dislocations, what must be examined and documented

A

vascular supply
neurology

so can determine if intervention has helped

81
Q

most common shoulder dislocation

A

anterior

humeral head anterior to the glenoid

82
Q

MOI of anterior shoulder dislocation

A

fall with shoulder with external rotation

83
Q

what is at risk in anterior shoulder dislocations

A

axillary nerve

84
Q

MOI of posterior shoulder dislocation (humeral head posterior to glenoid)

A

Fall with shoulder in internal rotation

Direct blow to anterior shoulder

85
Q

what do people with inferior shoulder dislocations look like

A

arm held in abduction i.e. above their head

86
Q

what needs to be checked in inferior shoulder dislocations

A

brachial plexus

brachial artery

87
Q

x-ray sign of posterior dislocation

A

light bulb sign

88
Q

Mx of shoulder dislocations

A

closed reduction under sedation

for locked posterior dislocation - open reduction

chronic - stabilisation and rehabilitation

89
Q

what are some reduction methods for shoulder dislocations

A

Hippocratic, Kocher’s, in-line traction

90
Q

what does the recurrent instability risk depend on

A

Related to age,

risk of recurrence decreases with age

91
Q

MOI for elbow dislocation

A

fall onto outstretched hand

92
Q

what is at risk in elbow dislocations

A

Radial head #

Coronoid process #

93
Q

what is the types of elbow dislocation and what is most common

A

Posterior (most common)
Anterior
Medial/Lateral

94
Q

special type of dislocation seen in children

A

Pulled elbow

lax annular ligament around radial head, radial head has escaped

95
Q

Mx of elbow dislocation

A

Closed reduction under sedation
Open reduction rarely required
2 weeks in sling & rehabilitation

96
Q

traction methods in elbow dislocation and risk of recurrent instability

A

Traction in extension +/- pressure over olecranon

Low

97
Q

MOI of IPJs dislocation

A

hyperextension injury; direct axial blow

always posterior

98
Q

possible complications of IPJs dislocations

A

Head of phalanx button-holes through volar plate

Recurrent instability due to associated fracture

99
Q

Mx of IPJs dislocations

A

closed reduction under digital or metacarpal block
2 weeks in neighbour strapping

volar slab in Edinburgh position if unstable

100
Q

MOI of patella dislocations

A

sudden quads contraction with a flexing knee
always lateral
most common in teens, F > M

101
Q

what is patella dislocations associated with

A

hypermobility
under developed lateral femoral condyle
increased Q angle (genu vaglum or increased femoral neck ante version)
Weak vastus medialis

102
Q

what is torn in patella dislocations

A

medial retinaculum

causes pain

103
Q

what is seen on examination of a patella dislocation

A

effusion - haemarthrosis

patella apprehension test is positive

104
Q

Mx of patella dislocation

A

reduce with knee extensions
aspirate - large effusions of the knee are very uncomfortable
brace
physio

105
Q

Mx of repeat patella dislocations

A

lateral release/medial reefing

patella tendon realignment

106
Q

what are the signs suggestive of a spontaneous relocation of a dislocated knee

A

Lat collateral lig injury + peroneal nerve injury

107
Q

what can be injured in a knee dislocation

A

popliteal artery/vein

peroneal nerve

108
Q

Mx of knee dislocation

A

Reduction under sedation

Stabilise in splint or External-Fixation

109
Q

Ix of knee dislocation

A

plain radiography - associated #

MRI

110
Q

Surgical treatment for the knee

A

Vascular repair (6hr window)
Nerve repair
Sequential ligamentous repair

111
Q

complications of knee dislocation

A

Arthrofibrosis (excessive scar tissue, painful restriction of joint movement) and stiffness
Ligament laxity
Nerve or arterial injury

112
Q

Hip dislocation associated #

A

posterior

posterior acetabular wall #
femoral #

113
Q

presentation of hip dislocation

A

flexed, internally rotated and adducted knee

114
Q

Mx of Hip dislocation

A 
Neurovascular assessment (particularly the Sciaitic nerve)
Radiographs (changes can be subtle)
Urgent reduction
Stabilise in tractions if required
Further imaging (CT)
115
Q

complications of hip dislocation

A

Sciatic nerve palsy
Avascular necrosis of the femoral head
Secondary osteoarthritis of hip
Myositis ossificans

MSK SB (15 decks)

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