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Musculoskeletal > Fractures & Dislocations > Flashcards

Fractures & Dislocations Flashcards

1
Q

what are the possible early local complications of fractures?

A

compartment syndrome
vascular injury with distal ischaemia
nerve injury
skin necrosis

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2
Q

what is 1st degree nerve injury

A

neurapraxia, temporary conduction block / demyelination

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3
Q

what is 2nd degree nerve injury

A

axonotmesis, nerve cell axon dies distally from point of injury (= Wallerian degeneration)

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4
Q

what is 3rd degree nerve injury

A

neurotmesis, nerve transected

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5
Q

what are the possible early systemic complications of fractures?

A 
Hypovolaemia
 Fat embolism
 Acute Respiratory Distress Syndrome
 Systemic Inflammatory Response Syndrome
 Multi-Organ Dysfunction Syndrome
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6
Q

what are the possible late local complications?

A
  • 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
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7
Q

malunion

A

fracture has healed in a non-atnatomic position sufficient to cause symptoms

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8
Q

atrophic non-union causes

A 
Poor blood supply to fracture site
Fracture gap too big & no movement
Systemic disease
Smoking
Medicines – steroids, NSAIDs, bisphosphonates
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9
Q

hypertrophic non-union causes

A

Too much movement at fracture site
Abundant callus response but failure union
Infection

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10
Q

what are the possible late systemic complications of a fracture?

A

PE

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11
Q

femoral shaft fracture

A
  • high energy
  • lots of blood loss
  • other injuries
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12
Q

what’s the management of a femoral shaft fracture?

A

Resuscitation
Analgesia – femoral nerve block
Splintage – Thomas splint

Unstable  IM Nailing

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13
Q

what’s the management of an extra-articular distal femur fracture?

A

Unstable - pull of muscles causes flexion at fracture
Can use Thomas splint
If not too distal can nail
Distal plating

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14
Q

what’s the management of an intra-articular distal femur fracture?

A

Anatomical reduction, rigid fixation

Plate & screws

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15
Q

proximal tibial fractures

A
  • high energy in young, low energy in old

- usually values stress

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16
Q

tibial shaft fracture

A
  • higher risk of compartment syndrome
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17
Q

management of compartment syndrome

A

urgent, surgical emergency

FASCIOTOMY

18
Q

distal tibial fracture

A
  • high energy
  • associated injuries spine, pelvic, calcaneus
  • soft tissue injury
  • surgical emergency
19
Q

intra-articular distal tibial fracture

A

pilon fracture

20
Q

proximal humerus fracture

A
  • elderly osteoporotic
  • nerve & vascular injuries
  • AVN & non-union risks
21
Q

humeral shaft fracture

A

radial nerve injury in spiral groove

22
Q

intra-articular distal humerus fracture treatment

A

ORIF

23
Q

geleazzi fracture dislocation

A

If the radius is fractured in isolation, suspect a dislocation of the ulna at the DRUJ

24
Q

monteggia fracture dislocation

A

If the ulna is fractured in isolation, suspect a dislocation of the radial head at the elbow

25
Q

Colles fracture

A
  • fall onto outstretched hand

- extra-articular #, dorsal angulation, dorsal displacement

26
Q

Smiths fracture

A
  • fall onto back of hand
  • extra-articular, volar displacement & angulation
  • ORIF
27
Q

Barton fracture

A
  • intra-articular, volar/dorsal rim fracture on lateral can lead to subluxation carpus
  • ORIF
28
Q

blood supply to femoral head

A
  • intramedullary artery of shaft of femur
  • medial & lateral circumflex branches of profunda femurs
  • artery of ligamentum teres
29
Q

what blood vessels does an intracapsular fracture of the proximal femur affect?

A

all but ligamentum teres

30
Q

what would a fall with should in external rotation do to the joint?

A

humeral head move anterior to the glenoid

- badge area sensory assessment to check axillary nerve

31
Q

what would a fall with should in internal rotation or a direct blow to anterior shoulder do to the joint?

A

humeral head move posterior to the glenoid

32
Q

what would the arm being held in abduction do to the joint?

A

humeral head move inferior to the glenoid

- promp neurovascular assessment & reduction

33
Q

what’s the commonest mechanism of injury causing elbow dislocation?

A

fall onto outstretched hand

34
Q

what’s the commonest mechanism of injury causing IPJ dislocation?

A

hyperextension injury or direct axial blow

35
Q

what direction is an IPJ dislocation normally in?

A

posterior

36
Q

what’s the commonest mechanism of injury causing patella dislocation?

A

sudden quads contraction with a flying knee

37
Q

what direction is a patella dislocation normally in?

A

lateral

38
Q

lateral collateral ligament injury + peroneal nerve injury

A

knee dislocation

39
Q

what’s the commonest mechanism of injury causing hip dislocation?

A

high velocity: RTA dashboard injury, fall from height

40
Q

what direction is a hip dislocation normally in?

A

posterior

Musculoskeletal (22 decks)

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