Fractures generally & ankle Flashcards
what is a transverse fracture
a straight break through a bone at a right angle, caused by a force applied directly to the site of the fracture
what is a spiral fracture
a corkscrew type fracture due to a rotational injury
what is an oblique fracture
a rare fractrue; straight break through the bone but at an angle
what is subluxation
malalignment of the joint surface
what is a greenstick fracture
fracture that occurs in children due to the soft bone making it flexible; bone bends without fracturing across the cortex
name the nerve affected in the following fractures
- midshaft humerus
- supracondylar fracture
- shoulder dislocation
- hip dislocation
- fibula neck fracture
- radial nerve
- median nerve
- axillary nerve
- sciatic nerve
- common peroneal
name 5 causes of pathological fractures
- osteoporosis
- osteopaenia
- tumours
- infection
- metabolic bone disease
when should stabilisation be achieved by in a traumatic fracture in a and e
within 24 hours on a daytime trauma list
which opioid out of; morphine, fentanyl and pethidine is preferred in known renal failure, and why?
fentanyl
because it is shorter acting so therefore prevents accumulation of active metabolites
what is the clinical presentation of a hip fracture?
hip shortened and externally rotated
what are the 3 steps in managing a fracture?
- Reduce
- Stabilise
- Rehabilitation
what is reduction of a fracture?
surgical procedure to correct the alignment of the bone so that the fracture can heal with minimal deformity
what are the 2 types of reduction?
open and closed
what is open reduction of a fracture?
fracture segments are exposed surgically by dissecting the tissue
what is closed reduction of a fracture?
manipulation of the bone fragments without surgical exposure of the fragments
how is a reduced fracture maintained?
either internal or external fixation
what is external fixation?
stabilising frames, metal pins or screws placed into the bone through small incisions into the skin and muscle
what is internal fixation?
plates, screws, nails, rods, wires, pins
what is ORIF?
open reduction internal fixation
open surgery, fixation with screws/plates/intramedullary bone nails
what is closed reduction infernal fixation
reduction without surgery
what do you do if manipulation and external mobilisation devices are unsuccessful in managing a trauma fracture
surgical reduction of internal fixation
what prophylaxis should be given for open wounds?
tetanus
when should open fractures be debrided and lavaged by?
by 6 hours of the injury
what is delayed union defined as?
failure to reach bony union @ 6 months post injury
what is compartment syndrome?
when the pressure within the fascial compartment exceeds the perfusion pressure within the compartment resulting in ischaemia of the tissues within that compartment
what are the early signs of compartment syndrome? (3)
- does not respond to analgesia
- associated with skin mottling
- severe pain on passive stretch
late signs of compartment syndrome?
- pulselessness
- paraesthesia
what are the indications for an ankle x-ray?
Pain in the malleolar zone & one of following
- bony tenderness at lateral malleolar zone
- bony tenderness at medial malleolar zone
- inability to walk 4 weight bearing steps immediately after the injury & in ED
name of classification of ankle fractures
weber
What is weber classification A & typical mechanism of injury
fracture of fibula below the level of syndemosis
typically from an inversion injury
What is weber classification B & typical mechanism of injury
fracture at level of syndesmosis & extends proximally in oblique fashion
typically eversion injury
What is weber classification C & typical mechanism of injury
fracture above the syndesmosis
may be associated wtih an avulsion fracture or rupture of deltoid ligament
always unstable - requiring fixation
what type of bacteria is staph aureus
gram positive cocci
1st and 2nd most common isolated organisms of most series
- strep pyrogens
- group B strep
name 2 gram negative rods
- E.coli
- Klebsiella
which organism is most commonly seen in septic arthritis in IVDU?
Pseudonomas aeruginosa
abx course duration in septic arthritis
6 weeks
abx of choice for gonococcal arthritis
ceftriaxone
what causes tibial plateau fractures?
- high energy trauma in young
- low energy falls in elderly
