how to manage orthopaedic conditions Flashcards
need to 1) describe fracture radiographs 2) explain their management 3) know some risks to assess for from fractures in specific locations
what is a fracture
a break in the structure of bone associated with a soft tissue injury
what investigations are key for fractures
1) PLAIN RADIOGRAphs (x rays) from at least 2 views
2) special tests:
-CT
- MRI ( in stress fracture can see oedema and swelling )
- USS ( not as useful as the others)
- blood tests
when is a fracture complex/ simple
complex : multifragmented vs simple: not multifragments
when is a fracture stable vs unstable
unstable: when its at risk of further displacement with simple weightbearing so you need to intervene
stable: non need to intervene on the bone you can mobilise maybe cast and its fine
what are the things you need to consider when describing bone fracture radiographs?
1) demographics of patient, age ect all the info at bottom of xray
2) ABC (general): adequacy (of imaging planes),
Bones young/ old can tell form osteoarthritis),
Cartilage- joint space asses if intact
specific:
3) which bone, and Location on specific bone: proximal, distal, mid shaft, intra articular, (physis diaphysis in younger people)
4) type of fracture:
A) simple vs complex/ comminuted (many pieces),
B) greenstick,
C) open/ closed
5) types of patterns:
transverse, oblique, spiral
6) type of displacement if any: shortened, rotated, translated
7) stable/ unstable
what is the 3 main step process of treating fractures
reduce - external with manoeuvres (painful, unlpleasant to du and watch)
or internal with incision- anaesthesia ect
stabilise - internal or external (ext: casts vs int: nails, screws, plates )
rehabillitate - kids can do themselves but adults rl need deliberate
what are some risks you need to be aware of and asses in a distal tibial fracture (Ankle)?
Tom Dick and Nervous Harry
T: Tibialis posterior tendon
D: Flexor digitorum longus tendon
N: Posterior tibial artery, nerve, and vein
H: hallucis longus muscle
how to manage ankle injury (45y0 male with tibial and fibular fracture)
initial reduction and casting
then plan for surgery
what is the classification system used to classify fibular fractures
weber classification: based on how close fracture is to the syndesmosis: fibrous joint linking tibia and fibula (A is on syndesmosis, B is higher up and C even higher up)
why might you see some empty space in bone fracture x rays of older people
bc some bone may crash- smash to pieces and empty space forms
what fracture can you get from fall on flexed wrist
Smith fracture
what fracture can you get from falling on extended hand
colles fracture
what is it called when you get an intra-articular fracture in the distal radius
Barton’s fracture- (can be from both extended or flexed fall - doesnt matter)
what are the structures that need to be assesed when theres a wrist fracture? (colles and smith) + how will you test their integrity?
radial, ulnar and median nerves
make them do ok sign with their hand
what are two tricks you can use on femur fracture xrays to help you tell if theres fracture
1) Shentons Line - line along femur to head and to ischeum - needs to be a nice intact curve
2) “lollipop” draw circle in acetabulum and line femoral neck angle- needs to be like a lollipop not displaced lollipop
how would you manage a neck of femur fracture? why is age important in this injury?
age dependant management:
for younger people in general (No cutoff age but depends on whether they are in good condition aswell ect) you preserve their bone
for older you replace
however: contraindication for dementia: replacement not the best bc theres high risk of them displacing it
classifications of hip fracture
intracapsular: (head and neck) - 1) subcapital - (akrivos kato apo kefali - head), 2) transcervical 3) basicervical
extracapsular:
1) intertrochanteric: cutting the greater trochanter in middle
2) subtrochanteric
what is a dangerous complication you need to asses for in open leg fracture from road traffic collision
Compartment syndrome- sheath between bones- if bone breaks and this sheath fills with blood pressure builds up and starts pushing on bones – if a patient says they are in a lot of pain more thsan youd expect- they prob have this- you need to go into sheath
where and by who would an open leg fracture from road traffic collision be managed?
major trauma centre
MDT: first by trauma team then plastic surgeon ect
what is the classification system for severity/ degree of open fractures
Gustillo- Anderson classification
how would you manage this open fracture trauma
procedures: you need to do washout, then youll do surgery with external fixation and intramedullary nail
guidelines: follow ATLS and BOAST guidelines
meds: antibiotics
smth a bit confusing on young children xray
spaces between bones bc of growth plates- its not broken
what to asses for in 5y Male fall onto right wrist
damage to physis or diaphysis - inhury to growth plate
What is important to respect in this injury?
:5y Male fall onto right wrist
cant do a haematoma block you risk to further injure it. you need to manually sort of fix it
