Fractures & management Flashcards
How does a fractured hip usually present?
Pain in the hip, groin & knee Unable to weight bear Shortened and externally rotated leg
What will an X-Ray of a hip fracgure show?
A break in shentons line
what is the difference between an intra-capsular and extra-capsular fracture?
intracapsular = neck of femur and within the joint capsulre
extracapsular = fractures outside the joint capsule
What are the 2 types of extra-capsular hip fractures? How are they managed?
trochanteric and subtrochanteric
Dynamic hip screw and IM nail
Management of an intra-capsular hip fracture?
THR or hemiarthroplasty if patient was already immobile bc increased risk of dislocation in THR
What is the usual mechanism of injury in femoral shaft fractures?
High energy trauma e.g. RTA
What are 2 potential complications of femoral shaft fracture?
Substantial blood loss
Fat embolus
Management of femoral shaft fracture?
Thomas splint initially to stabilise
Closed reduction and IM nail
What is a tibial plataeu fracture and what can it present with/lead to?
Proximal tibial fracture involving the articular surface of the knee joint
Associations:
- lots of swelling
- compartment syndrome
- common fibular nerve injury
What is the slowest healing fracture in the body?
Tibial shaft
What is the mechanism of injury in tibial shaft fractures?
Rotational forces +/- compression from sudden deceleration
Management of tibial plataeu and tibial shaft fractures?
Internal fixation
What is a pilon fracture and what is their mechanism of injury?
Distal tibial fracture involving articular surface of ankle
High impact fracture - fall from height
Management of pilon fractures?
External fixation ASAP
What is an avulsion fracture?
When a bit of bone is pulled away from the main bone by the muscles that attach to it
What is at risk in a supracondylar fracture?
Brachial artery
What is Volkmann’s contracture?
complication of elbow fractures (usually in children) - contraction of the forearm muscles due to ischeamia following trauma
What movements are affected in radial head fracture?
Loss of pronation and supination
What is the difference between a Gellazi fracture and a Monteggia fracture?
Gellazi = radial fracture with ulnar dislocation
Monteggia = Ulnar fracture with radial dislocation
What is a Colles fracture and what is a classic presentation?
fracture of the distal radius (not involving the wrist joint) due to FOOSH with wrist extended
Dinner fork deformity
What structure is at risk in a Colles fracture?
Median nerve compression
Management of a Colles fracture?
Reduction and cast
What is a Smiths fracture?
Distal radial fracture (not involving wrist joint) - FOOSH with wrist flexed (opposite of a Colles fracture)
Management of a Smiths fracture?
open reduction and internal fixation - v unstable fracture
What is a bartons fracture?
Intra-articular fracture of the wrist
What is compartment syndrome?
When bleeding from a fracture/swelling of muscles due to trauma increase the pressure in the limb compartment affected - will compress vasculature and nerves
Symptoms of compartment syndrome?
More severe pain expected from injury alone
Swollen limb
Altered sensation
Extreme pain on passive stretching of the muscles in the affected compartment
Management of compartment syndrome?
Immediate removal of cast/dressings
urgent fasciotomy
Fractures of the distal radius that heal in malunion can result in reduced grip strength, is this due to loss of flexion or extension at the wrist?
Extension (try to make a fist without extending wrist - not as strong)
What nerve is at risk in a humeral shaft fracture?
Radial nerve
What nerve is at risk in anterior dislocation of the shoulder?
Axillary nerve
What nerve is at risk in colles fractures?
Median nerve
What nerve is at risk in supracondylar fracture of the humerus?
Median nerve
Give 4 risk factors for a proximal femoral fracture?
Osteoporosis (3x more common in females)
Smoking
Malnutrition
Excess alcohol
What is the management of fractured femoral shafts in children under 3 and why is it different to adult management?
Traction - stops the muscles going into spasm and pulling the bone segments away
