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MBChB IV Orthopaedics > Fractures (toronto) > Flashcards

Fractures (toronto) Flashcards

1
Q

How do you describe a fracture?

A
  1. Name of injured bone
  2. Integrity of skin/soft tissue
  3. Location
  4. Orientation/fracture pattern
  5. Alignment of fracture fragments
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2
Q

Name fracture locations

A

Epiphyseal (end of bone)
Metaphyseal (flared end)
Diaphyseal (shaft)
Physis (growth plate)

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3
Q

Name fracture patterns

A 
Transverse
Oblique
Butterfly
Segmental
Spiral
Comminuted
Intra-articular
Compression
Torus
Greenstick
Pathological
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4
Q

Define a transverse fracture

A

Fracture line perpendicular (<30 of angulation) to long axis of bone due to direct high energy force

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5
Q

Define an oblique fracture

A

Angular fracture (30-60) line due to angulation and high energy compressive force

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6
Q

Define a butterfly fracture

A

Triangular/wedge-shaped fragment commonly between two main fracture fragments in comminuted long bone fractures

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7
Q

Define a segmental fracture

A

A separate segment of bone bordered by fracture lines

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8
Q

Define a spiral fracture

A

Complex, multi-planar fracture line due to low energy rotational force

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9
Q

Define a comminuted fracture

A

> 2 fracture fragments

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10
Q

Define an intra-articular fracture

A

Fracture line crosses articular cartilage and enters joint

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11
Q

Define a compression fracture

A

Impaction of bone

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12
Q

Name typical sites of compression fractures

A

Vertebrae

Proximal tibia

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13
Q

Define a torus fracture

A

Compression of bony cortex on one side while the other remains intact

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14
Q

Define a greenstick fracture

A

Compression of one side with fracture of the opposite cortex

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15
Q

Name alignments of fracture fragments

A 
Non-displaced
Displaced
Distracted
Translated
Angulated
Rotated
Shortened
Avulsion
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16
Q

What is the rule of 2s with orthopedic XR?

A

2 sides
2 views
2 joints
2 times

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17
Q

Name advantages to closed reduction and splinting

A 
Pain control
Reduces further neurovascular damage
Reduces point loading on articular surfaces
Decreased risk of converting to open 
Facilitates patient transport
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18
Q

Give the mnemonic for indications for open reduction

A 
NO CAST
Non-union
Open 
Neurovascular compromise
Displaced intra-articular 
Salter-harris 3,4, 5
Polytrauma
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19
Q

What is Buck’s skin traction?

A

A system of weights, pulleys and ropes attached to end of patient’s bed exerting longitudinal force on distal end of the fracture
Improves length, alignment and rotation temporarily while awaiting fixation

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20
Q

Describe your approach to fractures

A
  1. Clinical assessment
  2. Analgesia
  3. Imaging
  4. Reduction
    - recheck NVS
    - post-reduction XR
  5. Immobilization
  6. Follow-up
  7. Rehabilitation
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21
Q

What are methods of external stabilization?

A

Splints
Casts
Traction
External fixator

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22
Q

What are methods of internal stabilization?

A 
Percutaneous pinning
Extramedullary fixation (screws, plates, wires)
Intramedullary fixation (rods)
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23
Q

What is Wolff’s Law?

A

Bone adapts to the amount of force applied by increasing or decreasing its mass to resist the applied stress

24
Q

Describe normal healing of bone

A
  1. 0-3w
    - hematoma
    - macrophages surround fracture site
  2. 3-6w
    - osteoclasts remove sharp edges
    - callus forms within hematoma
  3. 6-12w
    - bone forms within the the callus to bind fragments
  4. 6-12m
    - cortical gap bridged by bone
  5. 1-2y
    - normal architecture via remodelling
25
Q

What is a fracture blister?

A

Formation of vesicles/bullae that occur on edematous skin overlying a fractured bone

26
Q

What is heterotopic ossification?

A

The formation of bone in abnormal sites secondary to pathology

27
Q

What is CRPS?

A

Complex regional pain syndrome
Exaggerated response to an insult in the extremities characterised by symptoms of hyperalgesia and allodynia with signs of autonomic dysfunction (temperature assymetry, mottling, hair/nail changes)

28
Q

What was CRPS originally called?

A

RSD (reflex sympathetic dystrophy)

29
Q

How do you evaluate union?

A 
Clinically
- non-tender to palpation 
XR
- trabeculae cross fracture site
- visible callus bridging site on >2/4 cortices
30
Q

Name early local complications of fractures

A 
Compartment syndrome
Neurological injury
Vascular injury
Infection
Implant failure
Fracture blisters
31
Q

Name late local complications of fractures

A 
Malunion
Non-union
AVN
Osteomyelitis
Heterotopic ossification
Post-traumatic OA
Joint stiffness
CRPS
32
Q

Name systemic complications of fractures

A 
Sepsis
DVT
PE
ARDS
Hemorrhagic shock
33
Q

Define avascular necrosis

A

Ischemic of bone due to disrupted blood supply

34
Q

Which sites are most commonly affected by avascular necrosis?

A

Femoral head
Talus
Proximal scaphoid

35
Q

What is osteochondritis dissecans?

A

Avascular necrosis of subchondral bone usually in children/adolescent and causing pain and decreased ROM

36
Q

What are the properties of articular cartilage?

A 
Hyaline cartilage
2-4mm layer 
Avascular
Aneural
Alymphatic
37
Q

Name causes of articular cartilage defects

A

Overt trauma
Repetitive minor trauma
Degenerative conditions

38
Q

Name predisposing factors to articular cartilage defects

A 
Ligament injury
Joint malalignment
Obesity
Avascular necrosis
Inflammatory arthropathy
39
Q

How are chondral defects classified?

A

Outerbridge classification

40
Q

Discuss the Outerbridge Classification of Chondral Defects

A

Grade 1 - softening and swelling of cartilage
Grade 2 - fragmentation and fissuring <1.3cm in diameter
Grade 3 - fragmentation and fissuring >1.3cm in diameter
Grade 4 - erosion of cartilage down to bone

41
Q

What is the treatment of articular cartilage defects?

A 
Individualised 
Non-operative
- rest
- NSAIDs
- bracing
- PT 
Operative
42
Q

Name XR views that should be requested in shoulder injuries

A

AP
Axillary w/wo stress
Trans-scapular
Zanca

43
Q

Name XR views requested in arm injuries

A

AP

Lateral

44
Q

Name XR views requested in forearm injuries

A

AP

Lateral

45
Q

Name XR views requested in wrist injuries

A

AP
Lateral
Clenched fist

46
Q

Name XR views requested in pelvis injuries

A

AP
Inlet
Outlet
Judet

47
Q

Name XR views requested in hip injuries

A

AP
Lateral
Frog-leg lateral
Dunn

48
Q

Name XR views requested in knee injuries

A

AP
Lateral
Skyline

49
Q

Name XR views requested in leg injuries

A

AP

Lateral

50
Q

Name XR views requested in ankle injuries

A

AP
Lateral
Mortise

51
Q

What is a Judet view?

A

For acetabular fractureres
Obturator oblique
Iliac oblique

52
Q

What is a clench fist view for?

A

Scapholunate dissociation

53
Q

What is a Skyline view?

A

Tangential view with knees flexed at 45 to see patellofemoral joint

54
Q

What is a Mortise view?

A

Ankle at 15 degrees internal rotation

55
Q

Name XR views requested in foot injuries

A

AP
Lateral
Oblique
Lateral Harris axial

56
Q

Name XR views requested in spinal injuries

A 
AP spine
AP odontoid
Lateral
Oblique
Swimmer's
Lateral flexion
Lateral extension
57
Q

What is a Swimmer’s view?

A

Lateral view with arm abducted 180 degrees to evaluate C7-T1 junction

MBChB IV Orthopaedics (15 decks)

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