Fractures (supracondylar, forearm, toddler's) Flashcards
Name 5 things to ask about on Hx of any fracture
Circumstances around injury Level of pain Open/closed Bleeding NV compromise LOF PMx (any risk factors for fracture) Any other injuries Possibility of NAI (obviously don't ask, but keep in mind)
What are the 3 principles of examining a fracture?
Look - look for bone, fat, any skin at risk
Feel - feel for distal pulses, and feel over injured site for focal tenderness (need to do this to localise fracture). Also feel to elicit sensation.
Move - look for LOF
What is the main Ix for a fracture? What should you do before you do this Ix?
Plain X-ray. Before X-ray, make sure you’ve localised the fracture, that there’s definitely a fracture and not just a dislocation, and that you’ve immobilised and provided adequate analgesia before X-ray
What score is used to grade a fracture through a growth plate?
Salter-Harris score - grades depth of fracture through growth plate
Name 6 different types of analgesia you can give a kid with a fracture (depending on severity). Name 2 analgesics you shouldn’t use on kids
Panadol NSAIDs (ibuprofen) Oxycodone Intranasal fentanyl IV morphine Inhaled NO
Don’t use codeine or tramadol
What is a supracondylar fracture? How do they usually occur? Which way does the distal fragment usually displace? Clincally, what does it usually look like? What nerves and arteries can be affected? What Ix should you order?
Fracture through distal humerus above level of growth plate. Occur from fall on outstretched hand, causing hyperextension of elbow. Distal fragment usually displaces posteriorly.
Looks like an S shape deformity with pain, swelling, limited elbow ROM. Median, radial and ulnar nerves and radial artery can be affected.
Order AP and lateral Xrays of distal humerus
Name 3 things to comment on with a forearm fracture
Location (proximal, middle, distal)
Deformity (‘plastic’ deformity = bowing without cortical disruption)
Greenstick fracture (incomplete fracture through outer cortex of bone)
Complete fracture
One or both bones affected
How does a forearm fracture usually occur?
Fall on outstretched hand
What Ix should you order of a forearm fracture?
AP and lateral views including both elbow and wrist
Name 4 reasons to refer any fracture to orthopedics
Open fracture
NV injury
Extreme swelling/compartment syndrome
Can’t achieve reduction
What’s the difference between a Monteggia and Galeazzi fracture-dislocation?
Monteggia = dislocation of radial head + fracture of proximal ulna Galeazzi = dislocation of distal ulna + fracture of distal radius
GRIMUS - Galeazzi Radial Inferior (radius fractured distally) Monteggia Ulna Superior (ulna fractured proximally)
What does a toddler fracture refer to? Who gets them and how? How will they present? What Ix should you order?
Spiral/oblique undisplaced fracture of distal shaft of tibia with intact fibula. Occur in young, ambulatory children (9 months - 3 years) from a twisting injury.
Present with pain and swelling of lower leg, unable to weight bear. Order AP and lateral views of lower leg including knee and ankle.
