Frailty- fractures Flashcards
General approach to interpreting x-rays of large bones 1
- Check patient demographics: name, DOB, hospital number
- Comment on projections (remember 2 views are normally obtained): AP, lateral, oblique, axial
- Comment on technical adequacy: entire area of concern included, exposure (over exposed, under exposed), rotation
- Cortical margins: is there a breach or disruption of the cortex- fracture, periosteal reaction (malignancy, infection, trauma, subperiosteal haematoma)
- Bone surface/contours: irregular, erosive, osteophytes, smooth, osteochondral defect, subchondral cysts
General approach to interpreting x-rays of large bones 2
- Bone density: normal, increased (sclerotic), decreased (osteopenia), lucent- malignancy? Osteoporosis?
- Joint space- narrowed, widened, presence or absence of an effusion
- Alignment- subluxation, dislocation
- Soft tissue- swelling, laceration, presence of gas, debridement, muscle atrophy
- Artefact: foreign body, loose bony fragment, replacement, resurfacing, metalwork
Osteoarthritis classification criteria
- Grade I (doubtful): small osteophyte formation, normal joint space
- Grade II (mild): definite osteophyte formation, normal joint space
- Grade III (moderate): moderate joint space reduction
- Grade IV (severe): joint space greatly reduced, subchondral sclerosis
Shoulder x-ray AP view
Shoulder joint/glenohumeral: Articular surface between humeral head and glenoid should be parallel. Smooth arch from medial aspect of proximal humerus to lateral aspect of the scapula
Acromioclavicular joint: inferior aspect of the distal clavicle and acromion should align.
Shoulder x-ray: axial view
Patient needs to abduct arm, x-ray plate below armpit, x-ray taken from above the shoulder down towards the armpit. The humeral head should sit on the glenoid (like a golf ball sitting on a golf tee). Coracoid and acromion should point anteriorly.
Shoulder x-ray: Y view
The patient extends their upper arm and the x-ray is taken from the medial aspect of the scapula, obliquely, towards the humeral head. The coracoid, scapular spine/acromion and scapular blade form a Y shape and the humeral head should sit directly over the centre of the Y.
Anterior shoulder dislocation
- Humeral head is displaced medially and overlies the glenoid
- The articular surface between the humeral head and the glenoid is interrupted
Posterior shoulder dislocation
Lightbulb sign: fixed internal rotation of the humeral head which takes on a rounded appearance
Hip dislocation
- Posterior hip dislocation: most common- 85%
- Anterior hip dislocation: 10%
- Central hip dislocation: always associated with acetabular fracture
Approach to fracture
- Anatomy: which bone, which part of the bone, which side
- Fracture type: open/closed, transvers, oblique, spiral, comminuted
- Number of fragments
- Displacement: translation, angulation, rotation, shortening and distraction
- Joint involvement: intra or extra articular
- Associated dislocation?
- Neurovascular assessment
Assessment of fracture patient
- History: mechanism of injury, associated injuries, patient demographics, medical history
- Clinical signs: pain/tenderness, swelling, deformity, abnormal movement, crepitus, broken skin
How to manage a patient with a fracture
- IV access
- Analgesia: paracetamol, NSAID’s, Codeine, Tramadol, Morphine
- Bloods: FBC, U&E, group and save, cross match
- Resuscitation: fluids, blood components, major trauma, transfusion pack
How to manage a patient with a fracture: open and closed
- Closed fracture: assess neurovascular status, assess soft tissues, splint, back-slab
- Open fracture: assess neurovascular status, assess soft tissues, photograph open wound, dress open wound, back-slab, tetanus booster, IV antibiotics, emergency
Types of fractures
- Transverse- straight line across
- Linear- straight line up the bone
- Oblique non-displaced: at a diagnonal angle
- Oblique displaced
- Spiral- at a diagonal angle due to twisting of line
- Greenstick- normally occurs in paeds as there bones are more bendy, incomplete fracture where the bone is bent
- Comminuted- lots of crushed bone
How do fractures happen
- Trauma i.e. falls
- Fatigue/stress
- Pathalogical: tumour, bone cysts, metabolic disorders
Treatment of fractures
- Reduce: put it back in line. You should reduce before x-ray except for in the wrist
- Hold (until healed): cast or splint
- Rehabilitate
Risk factors for hip fractures
- Menopause- in the absence of HRT or Ca/ vitamin D supplementation, early menopause has increased risk
- Bone density- nutrition, exercise, race, smoking, number of children
- Pathological- unprovoked by injury
