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Muscluloskeletal Systems > Fragility Fractures > Flashcards

Fragility Fractures Flashcards

1
Q

What are fragility fractures?

A

Fracture resulting from a simple fall, at standing height or less

(a normal human skeleton should withstand such a force and therefore such an injury is a diagnostic indicator of possible osteoporosis (or other pathological condition of bone))

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2
Q

What are the 5 common osteoporotic fractures?

A 
Vertebral body
Distal radius
Neck of femur
Neck of humerus
Pubic ramus

(any possible - low energy trauma)

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3
Q

Name 5 high energy fractures of young adults that are also seen now as fragility fractures

A

Femoral shaft

Elbow (distal humerus, prox forearm)

Knee (distal femur, proximal tibia)

Ankle (bimalleolar and trimalleolar)

Cervical spine

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4
Q

What would be in a differential diagnosis for fragility fractures?

(someone presents with a fragility fracture what would you consider being a cause?)

A

Osteomalacia

Tumour

Other conditions
-e.g. Paget’s disease, osteogenesis imperfecta etc

Back pain
-Always rule out infection and tumour

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5
Q

What is the difference in bone weakness between osteomalacia and osteoporosis?

A

Osteomalacia
-Qualitative bone weakness

Osteoporosis
-Quantitative bone weakness

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6
Q

Are bone tumours more commonly primary or secondary?

A

Metastatic 25x commoner than primary malignant, but rare distal to elbow or knee

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7
Q

What is the commonest osteoporotic fracture?

A

Vertebral Compression Fracture (VCF)

-half of all osteoporotic fractures

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8
Q

What is the most common location for a vertebral compression fracture in osteoporosis?

A

Thoracic vertebra

wedge fracture

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9
Q

What deformity does vertebral fracture in osteoporosis cause?

A

kyphotic deformity of thoracic spine

“Dowager’s spine”

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10
Q

After the first vertebral compression fracture what is the risk of a subsequent VCF?

A

After first VCF, risk of subsequent VCF increases by more than 5-fold

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11
Q

What are the clinical features of Vertebral compression fracture acutely?

A

Sudden onset of back pain with little or no trauma

e.g. bending, turning, coughing

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12
Q

What are the clinical features of vertebral compression fracture chronically?

A

Spinal deformity - kyphosis
“Dowager’s hump”

Loss of height

Protuberant abdomen
-loss of appetite

Chronic pain, possible nerve root entrapment

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13
Q

What aspect of vertebral compression fracture effects mortality?

A

VCF reduces pulmonary function

  • One thoracic VCF causes 9% loss of FVC
  • One thoracic VCF makes another 5x more likely so downward spiral

-Lung function (FVC, FEV1) is significantly reduced in patients with thoracic and lumbar fracture

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14
Q

How do you treat VCFs?

A

Treat the osteoporosis
-Commenced on drug therapy regardless of T-score

Symptomatic (analgesia)
-Avoid bed rest and braces/supports (only weaken bone and muscle further)

(future? -> surgery: correct deformity by vertebroplasty or kyphoplasty, strengthen with artificial bone substitute or bone cement)

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15
Q

What is the second most common osteoporotic fracture?

A

Wrist

-Colles’ fracture

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16
Q

What is broken in a Colle’s fracture and what is the deformity?

A

Distal radius
-1” proximal to radiocarpal joint, classically with fracture of ulnar styloid process

Deformity:

  • Dorsal displacement
  • Dorsal angulation
  • Shortened
  • Radial deviation
  • Supination
  • (dinner-fork)
17
Q

What is the treatment for wrist break in osteoporosis?

A

Classically Manipulation Under Anaesthesia and PoP; also + K-wires

Or

External Fixator

OR

Open reduction and internal fixation

18
Q

What are the complications of a wrist fracture?

classically Colles’

A

(20% of patients)

Malunion

  • Dorsal angulation
  • Radial deviation and shortening

Stiffness
-Many fractures are I/A

Median nerve entrapment
-Carpal tunnel syndrome

Complex regional pain syndrome type I
-Reflex sympathetic dystrophy

Rupture of tendon of EPL (late)

19
Q

What is the mortality for hip fractures at 1 month, 4 months, 1 year and 2 years?

A

1 month = 10%
4 months = 20%
1 year = 30%
2 years = 50%

20
Q

What is the epidaemiology of hip fracture?

mean age, M:F, incidence

A

Mean age 80 years
M:F = 1:3.5-4

Incidence increasing by 1-3% per year due to the aging population

21
Q

What is the aetiology of hip fracture?

A

Weak bone (usually osteoporosis) + Fall

also other factors - shape of prox. femur, other bone pathology etc

22
Q

What are the types of hip fractures?

2 broad types but expand

A

Intracapsular (50%)

  • Undisplaced
  • Displaced

Extracapsular (50%)

  • Basal cervical
  • Intertrochantic
  • Subtrochanteric
23
Q

How do you treat the different types of intracapsular hip fracture?

A

Undisplaced - ORIF (screws)

Displaced

  • “young” = ORIF (screws or SHS)
  • “elderly” = hemiarthroplasty (or total hip replacement)
24
Q

How do you treat the different types of extracapsular hip fracture?

A

Basal cervical = ORIF (sliding hip screw)

Intertrochantic = ORIF (sliding hip screw)

Subtrochanteric = ORIF (intramedullary nail)

25
Q

What “fast track” protocols are in place in all emergency departments for hip fracture patients

A

50% of patients to be transferred to ward within 2 hours, 100% within 4 hours

Fast track protocol/hip fracture admission form in use

Appropriate patient placement

Inform recieving speciality with 2 hours of arrival in ED

Patients from peripheral hospitals should be transferred within 24 hours of first presentation for definitive care

26
Q

What are the “Big Six” things that should be done/started in ED with someone presenting with a hip fracture?

A
  • Analgesia
  • SEWS chart started
  • Blood samples taken
  • Fluid assessment: oral/IV fluids
  • Cognition screening (4AT- Delirium Screening)
  • Pressure areas assessed
27
Q

Name 4 things to be completed within 24 hours on the ward in hip patients

A

Cogition assessment (AMTS10 or AMT4 or MMSE)

Nutritional assessment

Falls risk assessment

Pressure areas assessment

28
Q

Name 3 complications of a neck of humerous break?

A

Axillary nerve palsy

Malunion

Stiffness

29
Q

How do you treat neck of humerus fracture?

A

Vast majority conservative, with collar and cuff (weight of arm reduces fracture by soft tissue traction - ligamentotaxis)

2 part - conservative or ORIF

3-4 part dislocation - (conservative) or (ORIF) or hemiarthropathy

30
Q

What is the usual presentation of pubic ramus fracture?

type of patient and symptoms

A

Eldery (very) female patient

History of fall

Unable to walk

Pain and tenderness in groin and on leg movement

31
Q

What is the treatment of pubic ramus fracture?

A 
Short period of bed rest (48hr)
Then mobilise (with physio)

Muscluloskeletal Systems (29 decks)

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