Fractures & Dislocations Flashcards
what are the possible early local complications of fractures?
compartment syndrome
vascular injury with distal ischaemia
nerve injury
skin necrosis
what is 1st degree nerve injury
neurapraxia, temporary conduction block / demyelination
what is 2nd degree nerve injury
axonotmesis, nerve cell axon dies distally from point of injury (= Wallerian degeneration)
what is 3rd degree nerve injury
neurotmesis, nerve transected
what are the possible early systemic complications of fractures?
Hypovolaemia Fat embolism Acute Respiratory Distress Syndrome Systemic Inflammatory Response Syndrome Multi-Organ Dysfunction Syndrome
what are the possible late local complications?
- Stiffness, loss of function, “fracture disease”
- Post-traumatic arthritis
- Non-union: Atrophic non union or Hypertrophic non-union
- Malunion
- Volkmann’s ischaemic contracture
- Chronic Regional Pain Syndrome
- Osteomyelitis
- Avascular necrosis
- DVT
malunion
fracture has healed in a non-atnatomic position sufficient to cause symptoms
atrophic non-union causes
Poor blood supply to fracture site Fracture gap too big & no movement Systemic disease Smoking Medicines – steroids, NSAIDs, bisphosphonates
hypertrophic non-union causes
Too much movement at fracture site
Abundant callus response but failure union
Infection
what are the possible late systemic complications of a fracture?
PE
femoral shaft fracture
- high energy
- lots of blood loss
- other injuries
what’s the management of a femoral shaft fracture?
Resuscitation
Analgesia – femoral nerve block
Splintage – Thomas splint
Unstable IM Nailing
what’s the management of an extra-articular distal femur fracture?
Unstable - pull of muscles causes flexion at fracture
Can use Thomas splint
If not too distal can nail
Distal plating
what’s the management of an intra-articular distal femur fracture?
Anatomical reduction, rigid fixation
Plate & screws
proximal tibial fractures
- high energy in young, low energy in old
- usually values stress
tibial shaft fracture
- higher risk of compartment syndrome
management of compartment syndrome
urgent, surgical emergency
FASCIOTOMY
distal tibial fracture
- high energy
- associated injuries spine, pelvic, calcaneus
- soft tissue injury
- surgical emergency
intra-articular distal tibial fracture
pilon fracture
proximal humerus fracture
- elderly osteoporotic
- nerve & vascular injuries
- AVN & non-union risks
humeral shaft fracture
radial nerve injury in spiral groove
intra-articular distal humerus fracture treatment
ORIF
geleazzi fracture dislocation
If the radius is fractured in isolation, suspect a dislocation of the ulna at the DRUJ
monteggia fracture dislocation
If the ulna is fractured in isolation, suspect a dislocation of the radial head at the elbow
Colles fracture
- fall onto outstretched hand
- extra-articular #, dorsal angulation, dorsal displacement
Smiths fracture
- fall onto back of hand
- extra-articular, volar displacement & angulation
- ORIF
Barton fracture
- intra-articular, volar/dorsal rim fracture on lateral can lead to subluxation carpus
- ORIF
blood supply to femoral head
- intramedullary artery of shaft of femur
- medial & lateral circumflex branches of profunda femurs
- artery of ligamentum teres
what blood vessels does an intracapsular fracture of the proximal femur affect?
all but ligamentum teres
what would a fall with should in external rotation do to the joint?
humeral head move anterior to the glenoid
- badge area sensory assessment to check axillary nerve
what would a fall with should in internal rotation or a direct blow to anterior shoulder do to the joint?
humeral head move posterior to the glenoid
what would the arm being held in abduction do to the joint?
humeral head move inferior to the glenoid
- promp neurovascular assessment & reduction
what’s the commonest mechanism of injury causing elbow dislocation?
fall onto outstretched hand
what’s the commonest mechanism of injury causing IPJ dislocation?
hyperextension injury or direct axial blow
what direction is an IPJ dislocation normally in?
posterior
what’s the commonest mechanism of injury causing patella dislocation?
sudden quads contraction with a flying knee
what direction is a patella dislocation normally in?
lateral
lateral collateral ligament injury + peroneal nerve injury
knee dislocation
what’s the commonest mechanism of injury causing hip dislocation?
high velocity: RTA dashboard injury, fall from height
what direction is a hip dislocation normally in?
posterior
