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Orthopaedics > Fractures Overview > Flashcards

Fractures Overview Flashcards

1
Q

When do fractures heal by 1st intention (primary healing)?

A

If there is a minimal fracture gap

- e.g. in hairline fractures or if fixed with compression screws + plates

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2
Q

When do fractures heal by secondary healing?

A

When there is a gap (most fractures)

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3
Q

Describe the process of secondary healing?

A

Gap is filled temporarily with cells acting as a scaffold for new bone
Inflammation –> soft callus (2-3 weeks) –> hard callus (6-12 weeks) –> remodelling

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4
Q

Why might non-union of a fracture occur?

A 
Lack of blood supply
No movement
Too big a gap
Tissue in the gap
Smoking
Vascular disease
Ill health
Malnutrition
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5
Q

Name the different types of fracture pattern

A 
Transverse
Oblique
Spiral 
Comminuted (3 or more fragments)
Segmental (bone fractured in two separate places)
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6
Q

What are the different ways to describe the site of fracture?

A

Proximal, middle or distal 1/3
Diaphyseal (shaft), metaphyseal, epiphyseal
Intra or extra articular

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7
Q

Which two terms are used to describe the way the fracture parts are positioned?

A

Displacement

Angulation

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8
Q

What are the mean components of assessing an injured/fractured limb?

A

Open or closed?
Distal neurovascular status
Compartment syndrome?
Status of skin + soft tissue envelope

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9
Q

How do you assess distal neurovascular status?

A 
Pulses
Cap refill
Temperature
Colour
Sensation
Power
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10
Q

Which signs my indicate a fracture?

A 
Localised bony (marked) tenderness
Swelling
Deformity
Crepitus
Cannot weight bare (lower limb)
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11
Q

Which investigation in usually done for a suspected fracture?

A

Xray –> AP and lateral views

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12
Q

When might a CT be used to assess a fracture?

A

Complex bones e.g. vertebrae, pelvis, calcaneous, scapular glenoid
Can help with surgical planning for intra-articular fractures e.g. tibial plateau, distal tibia

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13
Q

When might MRI be used to assess a fracture?

A

To detect occult fractures when xray is normal but a high clinical suspicion e.g. hip, scaphoid

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14
Q

What is the initial management of a long bone fracture?

A

Analgesia (IV morphine)
Splintage/immobilisation
Xray

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15
Q

Why does management of open fractures differ from closed fractures, and how?

A

Increased risk of infection

  • broad spectrum antibiotics
  • prompt surgery –> debridement + internal/external fixation
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16
Q

What are the early local complications of fractures?

A

Compartment syndrome
Vascular compromise/ischaemia
Nerve damage
Skin necrosis

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17
Q

What are the early systemic fracture complications?

A 
Hypovolaemia
Fat embolism
ARDS
AKI
SIRS
MODS
18
Q

What are the late local fracture complications?

A 
Stiffness
Loss of function
Chronic regional pain syndrome
Infection
Non-union
Mal-union
OA 
Volkmann's ischaemic contracture
DVT
19
Q

What are the late systemic fracture complications?

A

PE (although can be an early complication)

20
Q

What is compartment syndrome?

A

Increased pressure within tight fascial compartment –> ischaemia of the muscle
SURGICAL EMERGENCY

21
Q

What are the clinical features of compartment syndrome?

A

Increased pain on passive stretching of involved muscle
Severe pain outwith anticipated severity in clinical context
Intensely swollen and tender
Paraesthesia common
Loss of pulses at end stage –> too late

22
Q

How is compartment syndrome managed?

A

Emergency fasciotomies

- incisions left open, reassess after 24-48 hours

23
Q

What needs to be monitored after a patient has compartment syndrome and why?

A

Renal function

–> effects of rhabdomyolysis or reperfusion injury

24
Q

What is the general prognosis of nerve injury due to fracture?

A

Usually resolves/improves with time unless nerve is completely transected

25
Q

Which nerve is commonly injured in a Colles fracture?

A

Median nerve

26
Q

Which nerve is commonly injured in an anterior shoulder dislocation?

A

Axillary nerve

27
Q

Which nerve is commonly injured in a humeral shaft fracture and where does it lie?

A

Radial nerve in spiral groove

28
Q

Which nerve is commonly injured in a supracondylar fracture of the elbow?

A

Median nerve (anterior interosseous branch)

29
Q

Which nerve might be injured in a posterior hip dislocation?

A

Sciatic nerve

30
Q

Which nerve may be injured in a ‘bumper’ injury to lateral knee?

A

Common peroneal nerve

31
Q

What should be done if there are any signs of reduced distal circulation after a fracture?

A

Urgent vascular surgical review + emergency theatre

  • angiography in theatre might help localise
  • vascular shunt/bypass
32
Q

Which artery may be occluded after a knee dislocation?

A

Popliteal artery

33
Q

Which artery may be occluded following a paediatric supracondylar elbow fracture?

A

Brachial artery

34
Q

Which artery may be damaged in shoulder trauma?

A

Axillary artery

35
Q

How might the skin be threatened following a fracture?

A

Tension on skin from displaced/angulated bones (tenting + blanching) –> devitalisation + necrosis with skin breakdown
Degloving removes skin from blood supply –> ischaemia and necrosis

36
Q

How should you manage a fracture which shows signs of skin tenting/blanching?

A

Reduce fracture as an emergency

37
Q

Which signs might indicate non-union of a fracture?

A

Ongoing pain + oedema

Movement at fracture site

38
Q

Which bones take an especially long time to heal?

A 
Tibia (slowest to heal, 16+ weeks)
Femoral shaft (3-4 months)
39
Q

Name some common sites of fracture non-union?

A

Scaphoid waist
Distal clavicle
Subtrochanteric femur
Jones fracture of 5th metatarsal

40
Q

What is fracture disease?

A

Stiffness + weakness at the site of a previous fracture

41
Q

Which sites are particularly susceptible to AVN when fractured?

A

Scaphoid
Femoral neck
Talus

42
Q

What is complex regional pain syndrome?

A

Persistent and debilitating pain experienced long after an injury has healed - poorly understood

Orthopaedics (18 decks)

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