Lecture 1 - Orthopedic Trauma Flashcards
1
Q
How fractures happen
A
- single traumatic event
- Stress fracture: repetitive stress on normal bone
- Pathological fracture: physiological stress in abnormal bone
- Direct fgorce: bone breaks at point of impact
- Indirect force; bone breaks at a distance from where force is applied
2
Q
Mechanism of injury
A
- spiral = torsion
- butterfly = bending
- short oblique = compression
- Transverse = tension
3
Q
Comminuted fracture
A
More than two fragments
4
Q
Greenstick fracture
A
Bone incompletely divided and periosteum intact
5
Q
How fractures are displaced
A
- translation/shift
- alignment/angulation
- rotation/twist
- length
6
Q
5 steps of bone healing
A
- Hematoma formation
- inflammation/ cellular proliferation
- Callus
- Consolidation
- Remodelling
7
Q
Direct vs indirect healing
A
- indirect hearling - callus forms in response to movement at the fracture site and serves to stabilise the fragments
- Direct healing: if fracture is absolutely immobile- no need for callus - fracture healing occurs directly between fragments
8
Q
Systemic approach to examining a fracture
A
- Examine injured part
- Examine for vascular and neurological injuries at presentation and after any intervention
- Examine the associated injuries in region
- Examine the associated injuries in distal part
9
Q
X ray of fracture - rule of 2s
A
- 2 views: anteroposterior and lateral
- 2 joints: above and below the fracture
- 2 limbs
- 2 injuries
- 2 occasions
10
Q
Advanced imaging for fractures undetectable by Xray
A
- Technetium bone scan: relies on osteoblastic response, may result in false negatives
- CT scan for complex or intra-articular fractures
- MRI scan useful for assessment of associated structures
11
Q
Management principles of fractures
A
- treat the patient not just the fracture
- Reduction/ fixation/ rehabilitation
- preserve normal muscle and joint activity
12
Q
Reduction
A
- complicated by soft tissue swelling
- urgency dictated by presence of neurovascular compromise of joint dislocation
- unecessary if minimal displacement
- two methods: open or closed
13
Q
Closed reduction
A
- performed under appropriate anesthesia and muscle relaxation
- used for most fractures in children, for fractures that are stable after reduction, or for unstable fractures prior to external or internal fixation
14
Q
Open reduction
A
- when closed reduction fails
- articular ractures where anatomical reduction is required
- where internal fixation is required
15
Q
Fracture immobilisation methods
A
- Continuous traction: not commonly used anymore, but still for certain injuries
- cast splintage: plaster of paris. Immobilise joint above and bellow
- functional bracing
- internal fixation: wires, plate and screws, intramedullary nails
- external fixation
16
Q
Cast splintage
A
- use plenty of padding, especially over bony prominences
- as swelling subsides, cast may become loose
- beware tight cast: pain, parasthesia
17
Q
Indications for internal fixation
A
- Failed treatment by closed means
- Inherently unstable fractures
- fractures known to unite poorly and slowly
- pathological fractures
- Multiple injuries
- nursing difficulties
18
Q
Indications for external fixation
A
- Fractures associated with severe soft tissue damage
- Fractures associated with nerve or vessel injury
- Fractures treates with dynamic techniques
- Fractures in the presence of infection
- Rapid stabilisation
19
Q
Principles of treatment for open fractures
A
- wound debridement
- antibiotic prophylaxis
- stabilisation of fracture
- early soft tissue coverage
20
Q
- EarlyFracture complication
A
- vascular injury
- nere injury
- compartment syndrome
- infection
- fracture blisters
21
Q
Late fracture complication
A
Delayed union and non union Malunion Avascular necrosis Growth disturbance Joint impairment Pain syndromes
22
Q
Common nerve injuries
- shoulder dislocation
- humerus shaft fracture
- humerus supracondylar fracture
- hip dislocation
- knee dislocatin
A
- axillary nerve
- radial nerve
- radial or median nerves
- sciatic nerve
- peroneal nerve
23
Q
Compartment syndrome
A
- bleeding, oedema or inflammation can increase pressure in compartment
- can result in muscle ischemia
- vicious circle resultin in necrosis of muscle and nerves
- treatment is urgent fasciotomy
- recognize by: pain out of proportion, pain on passive stretch
24
Q
Physeal injury
A
- 10 % of fractures in children
- most common is type 2: runs through hypertrophic or calcified layer -> little effect on longitudinal growth
25
Q
Delayed union and non union
A
- delayed union: prolonged time to fracture union
- non union - failure of bones to unite
- Caused by: soft tissue interposition, poor blood supply, infection, smoking, nutrition, NSAIDs
- Hypertrophic vs atrophic non union
