General Fractures Flashcards
When would a femoral shaft fracture occur?
due to falling on a flexed knee or rotational bending
bear in mind malignancy
How are femoral shaft fractures in children treated?
<2 yrs - suspect NAI - treat with Gallows traction and hip sica cast
2-6 yrs - thomas splint or hip sica cast
6-12 yrs - flexible intramedullary nails
>12 yrs - adult intramedullary nail is used
What is the most common tibial fracture in toddlers? How is it treated?
spiral fracture
short time in cast
What is a humeral neck fracture often due to?
FOOSH
often in osteoporotic bone
What can a humeral neck fracture result in?
avascular necrosis
What are the management options for a humeral neck fracture depending on the severity?
minimally displaced: sling
persistantly displaced: internal fixation - screws, nails, plates
comminuted: shoulder replacement
What does an anterior shoulder dislocation often result in?
Blankart lesions
stretch of the axillary nerve
What is a Blankart lesion?
detachment of the anterior gelnoid labrum
How are anterior shoulder dislocations managed?
closed reduction under sedation
What are posterior shoulder dislocations caused by?
force on the adducted and laterally rotated arm
What is the sign on an AP xray commonly seen in posterior shoulder dislocations?
lightbulb sign
How are posterior shoulder dislocations managed?
closed reduction
How can a sprain, subluxation or dislocation of the acromioclavicular joint be managed?
reconstruction of the coracoclavicular ligament
How do humeral shaft fractures occur?
direct trauma
fall
What nerve is susceptible to injury in humeral shaft fractures? What sign does this cause?
radial nerve
wrist drop
What is the management of humeral shaft fractures?
brace or interneral fixation
When would an olecranon fracture occur?
due to a fall onto a point inthe elbow with contraction of the triceps muscle
How is an olecranon fracture managed?
open reduction and internal fixation - ORIF
Where do Nightstick fractures occur? Due to what?
Ulnar shaft
Direct blow
How are radial and ulnar fractures managed?
ORIF
What is a Monteggia fracture?
fracture of the ulnar and dislocation of the radial head at the elbow
therefore: XRAY the ELBOW TOO
What is a Galeazzi fracture?
fracture of the radius with dislocation of the ulnar at the radio-ulnar joint
therefore: XRAY the WRIST TOO
How are both Monteggia and Galeazzi fractures managed?
ORIF
What is a Colles fracture?
extra articular fracture of the distal radius due to FOOSH
What is a Smiths fracture?
volarly displaced fracture of the distal radius occuring after falling onto the back of flexed wrist
What is a Barntons fracture?
intra-articular fracture of the distal radius with dislocation of the radiocarpal joint
can be volar or dorsal
How are Colles, Smiths and Barnton fractures all managed?
depending on severity, some need ORIF
What does a Scaphoid fracture present with?
tenderness in the anatomical snuff box after FOOSH
How are Scaphoid fractures managed?
6 weeks plaster cast
What are the 3 ways that the pelvis can fracture?
- lateral compression fracture due to side impact
- verticle shear force due to axial force on hemipelvis
- anteroposterior compression injury - pelvis opens up and fills with blood
What are the risks of intracapsular hip fractures?
avascular necrosis - poor healing
How are intracapsular hip fractures managed?
young - fix
old and fit - total hip replacement
old and frail - hip hemiarthroplasty (just replace femoral head)
How are extracapsular hip fractures managed?
internal fixations using dynamic compression or a hip screw
higher union rate than intracapsular
Why is a knee dislocation a surgical emergency?
increased incidence of vascular injury, nerve injury and compartment syndrome
How are knee dislocations managed?
first - investigate neurlogical damage
then: reduction, external fixation and multilligament reconstruction
How are patella dislocations managed?
temporary splintage and physiotherapy
When do tibial plateau fractures occur?
Young = high energy Old = osteoporsis
What are the ways that a tibial plateau fracture could occur?
intra articular fracture with either:
a split in the bone
a depression of the articular surface
or both
When would a tibial shaft fracture occur?
due to indirect force and either bending or rotating
open fractures are common and can often lead to compartment syndrome
What is the management of tibial shaft fractures?
above the knee cast
internal fixation
How is a stable ankle fracture managed?
walking splint - 6 weeks
How is an unstable ankle fracture managed?
ORIF
What is a Lisfranc fracture?
Midfoot fracture - at the base of the 2nd metatarsal alongside a dislocation of the base of the 2nd metatarsal
How are Lisfranc fractures diagnosed?
CT scan
missed on Xrays
How do Lisfranc fractures present?
swollen foot
cannot weight bear
How are Lisfranc fractures treated?
open or closed reduction
fixation with screws
