Fractures & Dislocations Flashcards
Fracture of the distal third of ulna is AKA
Colles fracture
What’s the X-ray abnormality associated with a Colles’ fracture?
Dinner-fork abnormality
Describe a communited fracture
Break or splintering of bone into more than 2 segments
Which fracture presents a particular risk of compartment syndrome?
Tibial fractures
Non-angulated, oblique tibial fractures around the diaphysis are best treated with which method?
IM nailing
What’s the emergency care for femur fractures?
Thomas splinting
Humeral shaft fractures present particular risk to which nerve & how does this commonly present if damaged?
Radial nerve & wrist drop
What’s more common - anterior or posterior shoulder dislocation?
Anterior
Damage to the axillary nerve is a common sequelae of anterior shoulder dislocation. What is the indicative sign?
Numbness in the regimental badge area
By definition, if the knee is dislocated, at least how many ligaments must be ruptured?
At least 3
Damage to the popliteal artery in knee dislocation is a surgical emergency. True/false?
True
Supracondylar fractures of the knee in children require what treatment?
Immediate reduction & pinning
Anterior shoulder dislocations are commonly managed how?
Closed reduction & sling 3 weeks
Which type of shoulder dislocation commonly presents from falling onto elbow?
Anterior dislocation
Detachment of the anterior labrum of the glenohumeral joint is termed what?
Bankart lesion
A shoulder injury where the glenoid labrum is detached AND the posterior humeral head is fractured is termed what?
Hill-Sachs lesion
Rotator cuff tears are common sequelae in Hill-Sachs lesions, true or false?
True
Re-dislocation of the shoulder is inversely proportional to age. True or false?
True - the younger you are the more likely to dislocate, the older the less likely to dislocate
If you’re <20 and dislocate your shoulder, what’s the chance of a re-dislocation?
80%
Is an X-ray required to confirm reduction in anterior shoulder dislocation?
Yes
Describe a neuropraxia: severity, duration, pathophysiology (3)
1) Mildest form of nerve injury 2) Usually lasts <28 days (if more, consider a axontomesis) 3) Myelin sheath intact, caused by crushing damage leading to a block without degeneration
Which manoeuvre is useful in closed reduction of shoulder dislocation?
Kocher
Posterior shoulder dislocation commonly results from what injury?
A posterior force applied on an ADDUCTED and INTERNALLY ROTATED shoulder
What’s the x-ray sign associated with posterior shoulder dislocation?
Light bulb sign
Posterior shoulder dislocation is treated how?
Closed reduction & sling with physiotherapy
Axillary nerve injury is commonly associated with loss of power in which muscle?
Deltoid
Describe an axonotmesis
Loss of myelin and Wallerian degeneration of nerve. Recovery is possible without surgery (1mm per day).
Describe a neurotmesis
Most severe form of nerve injury - when the nerve has been wholly transected
A fall onto shoulder commonly results in which joint dislocating?
AC joint
If the AC joint is only mildly displaced, how is it managed?
Conservatively
Anterior or posterior SC joint dislocation is more serious?
Posterior - can compress trachea (worry about dyspnoea, dysphagia, venous congestion)
A pure elbow dislocation (no fracture) requires what treatment?
Reduction and casting for 1 week, followed by physio
Galeazzi fracture is of…
Radius fracture, ulnar dislocation (GRUsome)
Monteggia fracture is of…
Ulnar fracture with radial head dislocation (MURder)
Which dislocation is common in cricketers?
Dorsal PIPJ
Dorsal PIPJ dislocation is best treated how?
Immediately with reduction on pitch (common in cricketers) under a LA
Finger dislocation is long-term managed how?
Splintage for 3 weeks
High energy hip dislocation is associated with posterior/anterior wall acetabulum fracture?
Posterior
Femoral head avulsion fractures require emergency reduction, true or false
True
What are the complications of hip fracture (2)
1) AVN of femoral head 2) Hetertropic ossification
Hip dislocation presents a risk to which nerve?
Sciatic nerve
Patellar dislocation commonly occurs toward which side?
Laterally from a sudden quadriceps contraction with or without direct blow to patella
An osteochondral fracture of the patella gives a risk of what, visible on X-ray?
Lipohaemarthrosis within joint
Predisposing factors to patellar dislocation include (6)
1) Female 2) <20 yo 3) Ligamentous laxity 4) Genu valgum 5) Shallow trochela 6) Femoral neck anteversion
Treatment for patellar dislocation (3)
1) Reduction 2) Splintage for 3 weeks 3) Physio
Which nerve can be injured in knee injury?
Common fibular nerve
Subtalar dislocations frequently occur toward which direction?
Median side
Subtalar fractures are treated how?
Casting for 3 weeks
What’s serious complication of subtalar fractures?
Fracture of talar neck AKA “aviators astragalus” (high risk of AVN)
A Lisfranc fracture dislocation is technically what dislocation
Tarso-metatarsal dislocation
Lisfranc injuries commonly result while foot is what?
Rotated while hyperplantarflexed
Lisfranc injuries are treated how?
Internal fixation
Can neurotmesis recover without surgery?
No
“Nerve axon dies distal to injury” describes what type of injury & degeneration?
Axonotmesis and “Wallerian degeneration”
What % of function is expected to return from patients who suffered an axonotmesis injury?
70-80%
Describe the EARLY and systemic complications of any fracture (4)
1) Hypovolaemia 2) Fat embolism 3) ARDS / SIRS 4) MODS
Atrophic non-union of bone is commonly due to which factors (3)
1) Lack of nutrition (e.g. smoking) 2) Reduction in blood supply 3) Fracture gap too big to repair
Which drugs can cause atropic non-union? (3)
1) NSAIDs 2) Steroids 3) Bisphosphonates
Malunion is technically defined as….
When a fracture heals in a non-anatomic position sufficient to cause symptoms
Primary bone healing occurs when bone is…
Able to fill gap (often minimal gap, <1mm)
Secondary bone healing fills the gap in bone initially with X then Y, then Z.
X = Granulation tissue Y = Cartilage Z = Bone
Label the fracture types
A = Transverse
B = Oblique
C = Spiral
D = Communited
E = Segmental
In fracture, angulation is reported according to the distal/proximal segment?
Distal
Describe this fracture in terms of angulation & displacement?
Lateral displacement (around 50%) and lateral angulation (around 45 degrees)
If a fracture is extra-articular, with minimal displacement, how is it best managed?
Conservatively (splintage)
Which surgical fixation is contraindicated in significant soft-tissue swelling?
ORIF
Do all intra-articular fractures require surgical stabilisation?
No. Undisplaced, intra-articular fractures may be stable and treated non-operatively
How are displaced, intra-articular fractures managed?
Urgent reduction and internal fixation to prevent OA
Which procedure is done to treat compartment syndrome?
Fascicotomy
Unstable femoral shaft fractures are surgically stabilised using which method?
IM nail
What are the risks associated with femoral shaft fracture? (2)
1) Blood loss (usually >1L)
2) Fat embolism
Proximal tibial fractures are surgically managed how
Anatomical reduction & internal fixation
Tibial shaft fractures are associated with what seriosu complication?
Compartment Syndrome
A pilon fracture occurs where?
Distal tibia
Bimalleolar fractures are treated surgically using which method?
ORIF
Most proximal humerus fractures are caused by what?
Osteoporosis
Distal humerus fractures generally require which surgical method to correct?
ORIF
The radial head of the elbow is responsible for which movements of the arm?
Supination/ pronation
“FOOSH” is a buzzword for which fracture?
Colles
Complications of Colles’ fracture (4)
1) Median nerve injury
2) CRPS
3) Rupture of EPL
4) Loss of grip strength
A minimally displaced Colles fracture is treated how?
Plastering
A communited Colles’ fracture requires which surgical method to treat?
ORIF
Smith’s fracture commonly results from falling onto what?
Back of hand
Smith’s fracture is surgically treated how?
ORIF
A Barton fracture is intra or extra-articular?
Intra-articular
