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Musculoskeletal System > Fractures and Dislocations > Flashcards

Fractures and Dislocations Flashcards

1
Q

Number of fractures that occur annually in the UK

A

1 million

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2
Q

State the serious complications of fractures

A

Fat embolism, compartment syndrome and complex regional pain syndrome type 1

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3
Q

What is a fracture

A

A break in the structural continuity of bone which may be a crack, break, split, crumpling or buckle

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4
Q

What should be considered when describing a fracture

A 
Mechanism and energy of the injury 
Skin and soft tissue involvement
Site
Shape
Communication 
Deformity 
Associated injuries
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5
Q

2 Main aims of treating fractures

A

Relieving Pain

Restoring function

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6
Q

When in the skin damaged in fractures

A

Open fractures, degloving, ischaemic necrosis

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7
Q

When are muscles damaged in fractures

A

Crush injury and compartment syndromes

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8
Q

In how many fractures is healing delayed or imparied

A

5-10%

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9
Q

How do soft tissues heal

A

By replacing injured tissue with a fibrous scar

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10
Q

How does bone heal

A

Regeneration of normal bone anatomy

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11
Q

Primary Bone Union

A

this is when cortical bone ends accurately and closely apposed and ridgidly immobilised. There is no callus. It is essentially the remodelling of the bone but is very slow

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12
Q

If a patient is treated with Open reduction internal fixation how does the bone heal

A

Via primary bone healing. The process is slow but rehabilitation is rapid.

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13
Q

If a patient is treated with nailing or external fixation how does the fracture heal

A

Via callus. This is a rapid process, and rehabilitation is rapid

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14
Q

Upper limb repair in adult

A

6-8 weeks

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15
Q

Upper limb repair in child

A

3-4 weeks

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16
Q

Lower limb repair in adult

A

12-16 weeks

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17
Q

Lower limb repair in child

A

6-8 weeks

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18
Q

How can the amount of healing of a fracture be measured

A

clinically, radiologically (bridging callus formation or remodelling), biochemically (amout of stiffness)

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19
Q

When is a fracture healed

A

When a patient can bear weight and proven by the X-ray. Remodelling will be complete.

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20
Q

State an early systemic problem of fractures

A

Hypovolaemia, crush syndrome and fat embolism

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21
Q

State a late systemic problem of fractures

A

Psychological and social aspects

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22
Q

State possible systemic complications of fractures

A

Bed rest complications (DVT, PE), tetanus

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23
Q

State some early local problems of fractures

A

neurovascular damage
skin/wound problems
compartment syndrome

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24
Q

State the late local problems of fractures

A

delayed union
nonunion
avascular necrosis

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25
Q

State the possible local complications of fractures

A 
Infection,
malunion
CRPS type 1
implant failure
joint stiffness
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26
Q

Host factors influencing fracture repair

A

Nutritional and hormonal status/drugs/CNS injury

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27
Q

Local factors influencing fracture repair

A

Soft tissue injury, bone loss, radiation, tumour, blood supply, infection, type of bone, synovial fluid

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28
Q

When will treatment of fractures result in delayed or non-union

A

inadequate
immobilisation

distraction of # by fixation device or traction
repeated manipulations

periosteal stripping & soft tissue damage at operation

anatomical vascular suspectibility, eg. femoral neck, scaphoid, talus, (distal tibia)

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29
Q

Atrophic non-union

A

This is bone loss - soft tissue interposition or pathological bone via infection or tumour

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30
Q

Hypertrophic non-union

A

Attempt at healing but the fracture site is too mobile

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31
Q

Risk factors for infected non-union

A 
contamination in open fracture
introduction at time of operation
multiple operations
unstable fixation
metastatic sepsis on foreign body implant
immunologically compromised patients
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32
Q

Treatment of infected non-union

A 
suspect
diagnose
remove dead, devitalised and infected tissue 
obtain organism (if possible)
treat infection and stabilise fracture
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33
Q

Avascular necrosis

A

Loss of blood supply

34
Q

Common fractures in which avascular necrosis is found

A

Hip (intracapsular neck of the femur), scaphoid and talus

35
Q

Transverse fracture

A

This is caused by a force applied directly to the site at which the fracture occurs.

36
Q

Spiral or oblique fracture

A

Produced by a twisting force. Usually at each end of a long bone

37
Q

Greenstick fracture

A

This occurs in children whose bones are soft. The bone bends without fracturing across completely.

38
Q

Crush fracture

A

This occurs in cancellous bone as a result of a compression force

39
Q

Burst Fracture

A

This occurs in a short bone, such as vertebra from strong direct pressure

40
Q

Avulsion fracture

A

Caused by traction, a bony fragment usually being torn off by a tendon or ligament

41
Q

Fracture dislocation or subluxation

A

This is a fracture which involves a joint and results in malalignement of the joint surfaces

42
Q

when is a fracture termed complicated

A

When there is soft tissue damage to nerves, vessels, or internal organs

43
Q

Impacted fracture

A

when fragements of bone are driven into eachother

44
Q

Stable fracture

A

When the fracture is held firmly by soft-tissue attachments, usually periosteum

45
Q

Unstable fracture

A

One which is displaced or has the potential to displace

46
Q

Displacement

A

Shortening, rotation, sideways shift or tilt, and reduction of the fracture will usually involve reversing these displacements

47
Q

Dislocation

A

Complete loss of congruity of the joint surfaces

48
Q

Subluxation

A

Partial loss of contact of the joint surfaces

49
Q

Salter and harris type 1

A

The fracture line passes cleanly along the epiphyseal line with no metaphyseal fragment,. This type tends to occur in young children and in pathological conditions such as spina bifida and scurvy

50
Q

Salter and harris type 2

A

The commonest type in which the fracture line runs across the epiphyseal line and then obliquely shearing off a small triangle of metaphysis

51
Q

Salter and Harris type 3

A

The epiphysis may be split vertically and a fragment displaced along the epiphyseal line

52
Q

Salter and Harris type 4

A

The fracture extends through the epiphyseal line from the metaphysis into the epiphysis. This type may interfere with growth because union may take place across the growth plate.

53
Q

Salter and Harris type 5

A

Severe crushing of the epiphysis may occur from longitudinal compression and this is very likely to result in growth arrest and deformity

54
Q

Symptoms of fractures

A

Pain, loss of function, loss of sensation or motor power,

55
Q

Signs of fractures

A

Tenderness, deformity, swelling, local temperature increase, abnormal mobility or crepitus, loss of function

56
Q

Main investigation conducted into fractures

A

X-ray, CT for pelvic fractures

57
Q

Three principles of management of fractures

A

Reduce
Maintain reduction
Rehabilitate

58
Q

Treatment of open fractures

A

Debridement to prevent osteomyelitis which could result in non-union. The wounds should be left open and covered with sterile dressing. Antibiotics should always be given after culture swabs have beem talem.

59
Q

Technique of reduction used normally

A

Manipulation under anaesthesia

60
Q

Traction

A

Some fractures and dislocations can be reduced slowly by traction. This is usually when manipulation is is inappropriate if anaestetic is dangerous (subluxation or dislocation of one or more facets of the cervical spine)

61
Q

Open reduction

A

Allows accurate reduction. It is usually used in cases where closed reduction will not be effective enough.

62
Q

Closed reduction and fixation

A

For some fractures, such as those treated by intramedullary nailing or external fixation, the reduction is indirectly achieved, with traction and the fracture stablisied with a nail or a fixator

63
Q

3 ways of maintaining fracture reduction

A

Intrinsic stability
External splintage
Internal Fixation

64
Q

Cast Bracing

A

Hinged or jointed cast. It has been used for fractures of the femur and the tibia. In femoral fractures the fracture will usually be healed by traction for around 3-6 weeks until it is considered to be stable and then the cast wil be fitted and the patient will be able to mobilise.

65
Q

Traction

A

Pulling bones directly or indirectly in order to reduce and hold fractures.

66
Q

Skin traction

A

The force is exerted along the skin by using strapping to attach the chord and the weight.

67
Q

Skeletal traction

A

This is applied by means of a pin or similar device applied directly through bone

68
Q

Fixed Traction

A

The traction is applied aginst a counter foce applied to the patients body.

69
Q

Sliding or balanced traction

A

The patients weight is balanced against an applied load, utilising frictional and gravitational forces to counterbalance the applied traction

70
Q

Simple Traction

A

Useful for the hip

71
Q

Longitudinal traction

A

This is used for fractures of the femur.

72
Q

Hamilton-Russel Traction

A

This was designed to apply a traction force in line with the shaft of the femur whilst allowing movement of the hop and the knee.

73
Q

Why is internal fixation beneficial

A

Promotes soft tissue repair

74
Q

Screw Fixation

A

This is usually used to attach small bony fragments like the malleoli

75
Q

Intramedullary Nail

A

Involves the passage of a rod into the medullary canal of a long bone and across the fracture site.

76
Q

Wires

A

These are used to hold bone fragments (Kirschner wires for Colles fractures)

77
Q

Fracture Fixation should be used in the following situations

A
  1. When adequate redution cannot be maintained by external splintage (involving joint surfaces)
  2. Allow early movement of a limb or a joint
  3. To avoid long period of immobilisation in bed
  4. Multiple trauma
    5 certain pathological fractures - malignancy
78
Q

Rehabilitation

A

Movement of the joint immediately, physiotherapy is often required

79
Q

Crush syndrome

A

This is associated with extensive soft tissue damage or ischaemia of a large volume of tissues. Results in acute tubular necrosis with renal failure. Can be prevented by amputation of the limb. Dialysis may be necessary

80
Q

Compartment syndrome

A

Occurs in tibial fractures where swelling causes venous engorgement in the compartment rcausing muscle necrosis. Presents as increased pain and paraesthesia and pain on passive movement of the toes.

Musculoskeletal System (34 decks)

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