Fractures etc Flashcards
OLD ACID Mnemonic for describing fractures
Open vs Closed Location Degree (complete/incomplete) Articular extension Comminution/Pattern Intrinsic Bone Quality Displacement/Angulation/Rotation
LARA Mnemonic for describing fractures
Location
Apposition (displacement)
Rotation
Angulation
Classify open fractures
Gustillo-Anderson Classification
I: <1cm wound, uncontaminated, adequate tissue
II: 10cm wound, high energy fracture, adequate tissue
IIIa: extensive soft tissue lacerations and high energy trauma but adequate soft tissue covering
IIIb: extensive periosteal stripping, inadequate soft tissue cover
IIIc: vascular injury requiring repair
Antibiotics for open fractures
I and II: 1st generation cephalosporin
III: 1st generation cephalosporin + Aminoglycoside/Gentamycin
Farm injury/bowel contamination/ etc: Add metronidazole
Complications of Casts
burns (exothermic reaction) ischaemic injury compartment syndrome pressure necrosis nerve palsy contractures
Indications for Surgery in fractures
- can’t get a reduction
- can’t maintain a reduction
- intra-articular fractures
- polytrauma patient
- head injury
- pathological fracture
- vascular injuries requiring repair
Define Colles’ Fracture
Fracture of distal 2.5cm of radius, associated with ulnar styloid or ulnarcollateral ligament tears.
Occurs commonly in older patients
Fall on outstretched hand
Dinner fork deformity
Colles’ Fracture Complications
Early: swelling of fingers/hand, carpal tunnel syndrome, compartment syndrome
Late: malunion, stiffness, sudeck’s atrophy, extensor pollicus longus rupture
Define Smith’s Fracture
Reverse Colles’
Fracture of Distal Radius with anterior displacement
Garden spade deformity
Fall on back of hand
Complications of Finger Fractures
- Stiff finger
- Joint contracture
- Tenodesis
- Malrotation
- Non-union
Classification used for growth plate fractures
Salter Harris
I: transepiphyseal fracture
II: fracture through physis exiting into metaphysis with small triangular bone attached to physeal plate
III: intra-articular, traverses physis and exits through epiphysis
IV: vertical intra-articular through physis, epiphysis and metaphysis
V: crush injury to physis
VI: localised injury to perichondral ring
Complications: growth plate fractures
complete growth arrest –> limb length discrepancy
partial growth arrest –> angulation deformity, joint incongruity
Components of Balanced Traction
Thomas splint Skin traction Weight of child Bed elevation Balkan frame Weights
Signs of compartment syndrome
Pain out of proportion Pain not responsive to analgesia Crescendo pain Pain on passive stretching of muscle Parasthesia Tense compartment Pallor Motor deficit
Highly Specific Signs of Non-Accidental Injury (in children)
Metaphyseal fractures Rib fractures Scapula fractures Vertebral fractures Distal clavicle fractures Bilateral fractures Fractures of different ages Complex skull fractures Finger fractures in non-walking children
