Fractures (toronto) Flashcards
How do you describe a fracture?
- Name of injured bone
- Integrity of skin/soft tissue
- Location
- Orientation/fracture pattern
- Alignment of fracture fragments
Name fracture locations
Epiphyseal (end of bone)
Metaphyseal (flared end)
Diaphyseal (shaft)
Physis (growth plate)
Name fracture patterns
Transverse Oblique Butterfly Segmental Spiral Comminuted Intra-articular Compression Torus Greenstick Pathological
Define a transverse fracture
Fracture line perpendicular (<30 of angulation) to long axis of bone due to direct high energy force
Define an oblique fracture
Angular fracture (30-60) line due to angulation and high energy compressive force
Define a butterfly fracture
Triangular/wedge-shaped fragment commonly between two main fracture fragments in comminuted long bone fractures
Define a segmental fracture
A separate segment of bone bordered by fracture lines
Define a spiral fracture
Complex, multi-planar fracture line due to low energy rotational force
Define a comminuted fracture
> 2 fracture fragments
Define an intra-articular fracture
Fracture line crosses articular cartilage and enters joint
Define a compression fracture
Impaction of bone
Name typical sites of compression fractures
Vertebrae
Proximal tibia
Define a torus fracture
Compression of bony cortex on one side while the other remains intact
Define a greenstick fracture
Compression of one side with fracture of the opposite cortex
Name alignments of fracture fragments
Non-displaced Displaced Distracted Translated Angulated Rotated Shortened Avulsion
What is the rule of 2s with orthopedic XR?
2 sides
2 views
2 joints
2 times
Name advantages to closed reduction and splinting
Pain control Reduces further neurovascular damage Reduces point loading on articular surfaces Decreased risk of converting to open Facilitates patient transport
Give the mnemonic for indications for open reduction
NO CAST Non-union Open Neurovascular compromise Displaced intra-articular Salter-harris 3,4, 5 Polytrauma
What is Buck’s skin traction?
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
Describe your approach to fractures
- Clinical assessment
- Analgesia
- Imaging
- Reduction
- recheck NVS
- post-reduction XR - Immobilization
- Follow-up
- Rehabilitation
What are methods of external stabilization?
Splints
Casts
Traction
External fixator
What are methods of internal stabilization?
Percutaneous pinning Extramedullary fixation (screws, plates, wires) Intramedullary fixation (rods)
What is Wolff’s Law?
Bone adapts to the amount of force applied by increasing or decreasing its mass to resist the applied stress
Describe normal healing of bone
- 0-3w
- hematoma
- macrophages surround fracture site - 3-6w
- osteoclasts remove sharp edges
- callus forms within hematoma - 6-12w
- bone forms within the the callus to bind fragments - 6-12m
- cortical gap bridged by bone - 1-2y
- normal architecture via remodelling
What is a fracture blister?
Formation of vesicles/bullae that occur on edematous skin overlying a fractured bone
What is heterotopic ossification?
The formation of bone in abnormal sites secondary to pathology
What is CRPS?
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)
What was CRPS originally called?
RSD (reflex sympathetic dystrophy)
How do you evaluate union?
Clinically - non-tender to palpation XR - trabeculae cross fracture site - visible callus bridging site on >2/4 cortices
Name early local complications of fractures
Compartment syndrome Neurological injury Vascular injury Infection Implant failure Fracture blisters
Name late local complications of fractures
Malunion Non-union AVN Osteomyelitis Heterotopic ossification Post-traumatic OA Joint stiffness CRPS
Name systemic complications of fractures
Sepsis DVT PE ARDS Hemorrhagic shock
Define avascular necrosis
Ischemic of bone due to disrupted blood supply
Which sites are most commonly affected by avascular necrosis?
Femoral head
Talus
Proximal scaphoid
What is osteochondritis dissecans?
Avascular necrosis of subchondral bone usually in children/adolescent and causing pain and decreased ROM
What are the properties of articular cartilage?
Hyaline cartilage 2-4mm layer Avascular Aneural Alymphatic
Name causes of articular cartilage defects
Overt trauma
Repetitive minor trauma
Degenerative conditions
Name predisposing factors to articular cartilage defects
Ligament injury Joint malalignment Obesity Avascular necrosis Inflammatory arthropathy
How are chondral defects classified?
Outerbridge classification
Discuss the Outerbridge Classification of Chondral Defects
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
What is the treatment of articular cartilage defects?
Individualised Non-operative - rest - NSAIDs - bracing - PT Operative
Name XR views that should be requested in shoulder injuries
AP
Axillary w/wo stress
Trans-scapular
Zanca
Name XR views requested in arm injuries
AP
Lateral
Name XR views requested in forearm injuries
AP
Lateral
Name XR views requested in wrist injuries
AP
Lateral
Clenched fist
Name XR views requested in pelvis injuries
AP
Inlet
Outlet
Judet
Name XR views requested in hip injuries
AP
Lateral
Frog-leg lateral
Dunn
Name XR views requested in knee injuries
AP
Lateral
Skyline
Name XR views requested in leg injuries
AP
Lateral
Name XR views requested in ankle injuries
AP
Lateral
Mortise
What is a Judet view?
For acetabular fractureres
Obturator oblique
Iliac oblique
What is a clench fist view for?
Scapholunate dissociation
What is a Skyline view?
Tangential view with knees flexed at 45 to see patellofemoral joint
What is a Mortise view?
Ankle at 15 degrees internal rotation
Name XR views requested in foot injuries
AP
Lateral
Oblique
Lateral Harris axial
Name XR views requested in spinal injuries
AP spine AP odontoid Lateral Oblique Swimmer's Lateral flexion Lateral extension
What is a Swimmer’s view?
Lateral view with arm abducted 180 degrees to evaluate C7-T1 junction
