Limb Trauma Flashcards by Alice Norman

What is the mortality associated with #NOF?

10% die within one month

- 25-30% die within one year

How well did you know this?

Not at all

Perfectly

What are the risk factors for #NOF?

age
osteoporosis
osteomalacia
falls
instability
lack of core strength
gait abnormality
sensory impairment

How well did you know this?

Not at all

Perfectly

How are #NOF classified and sub-classified?

Intracapsular
- - sub capital
- - transcervical
- - basal
Extracapsular

How well did you know this?

Not at all

Perfectly

What are the clinical features of #NOF?

hip pain radiating to the knee
inability to weight bear
affected leg appears shortened, adducted and externally rotated
rotation is painful

How well did you know this?

Not at all

Perfectly

How is #NOF diagnosed?

AP pelvic and lateral hip XR
CT to determine determine displacement and comminution
MRI useful in ruling out occult #, e.g. # suspected but not shown on XR

How well did you know this?

Not at all

Perfectly

What is the initial management of #NOF?

ABCDE assessment and intervention
DVT assessment
ECG
adequate analgesia
early assessment for cognitive impairment
catheter

How well did you know this?

Not at all

Perfectly

What are the principles of secondary management of #NOF?

surgery as soon as medically fit

- early mobilisation post-surgery

How well did you know this?

Not at all

Perfectly

What surgeries may be used to manage #NOF and when is each type used?

Hemi- or total arthroplasty for intracapsular #
Dynamic hip screw fixation for extra capsular fracture
Cannulated screw fixation for undisplaced intra- or extra capsular #

How well did you know this?

Not at all

Perfectly

Femoral # is almost always due to _____, e.g. ________

almost always due to high energy trauma

e.g. RTA, gunshot wound, fall from height

How well did you know this?

Not at all

Perfectly

Where do pathological femoral # occur?

metaphyseal/diaphyseal junction

How well did you know this?

Not at all

Perfectly

If the degree of trauma is inconsistent with the # that has been identified, what should you do?

Investigate to r/o pathological #

How well did you know this?

Not at all

Perfectly

What are the clinical features of femoral fracture?

pain
swelling
deformity: complete external rotation
shorting of the affected leg
features of shock due to haemorrhagic hypovolaemia (up to 1.5L loss)

How well did you know this?

Not at all

Perfectly

How is femoral # in children managed?

r/o NAI
gallows traction for children <2y
hip spica
external fixation, plate or elastic nails in older children

How well did you know this?

Not at all

Perfectly

What is a Salter-Harris Type I injury? and what is the prognosis?

Injury straight through the growth plate (physis) - excellent prognosis, managed non-operatively

How well did you know this?

Not at all

Perfectly

What is a Salter-Harris Type II injury? and what is the prognosis?

Injury above the growth plate (involving the physis and metaphysis) - excellent prognosis, managed non-operatively

How well did you know this?

Not at all

Perfectly

What is a Salter-Harris Type III injury? and what is the prognosis?

Injury lower than the growth plate (involving the physis and epiphysis, extending into the joint) - often unstable

How well did you know this?

Not at all

Perfectly

What is a Salter-Harris Type IV injury? and what is the prognosis?

Injury through the growth plate (involving metaphysis, physis, epiphysis and joint surface) - prone to limb length discrepancies

How well did you know this?

Not at all

Perfectly

What is a Salter-Harris Type V injury? and what is the prognosis?

Crush injury resulting in erasure of the growth plate (physis) - prone to limb length discrepancies

How well did you know this?

Not at all

Perfectly

What are the most common acute knee injuries?

acute patellar dislocation
collateral ligament rupture
contusion
meniscus injury
ACL injury

How well did you know this?

Not at all

Perfectly

How is patellar dislocation managed?

brace for 2-4 weeks

- physiotherapy

How well did you know this?

Not at all

Perfectly

How are collateral ligament ruptures managed?

brace if the knee is lax

- physiotherapy

How well did you know this?

Not at all

Perfectly

How do ACL injuries occur?

twisting injuries e.g. changing direction suddenly while running, tackles in football
hyperextension of the knee due to a fixed foot and onward motion of rest of the body e.g. skiing, landing incorrectly from a jump

How well did you know this?

Not at all

Perfectly

What are the most common long bone fractures?

tibia and fibula

How well did you know this?

Not at all

Perfectly

What is the management of knee injuries?

investigate with MRI
rest
ligament repair if indicated
arthroscopic intervention if meniscal injury

How well did you know this?

Not at all

Perfectly

What percentage of tibial fractures are open?

23%

What are the common causes of tibia/fibula #?

- RTA - Sports - Assault - Falls

What are the clinical features of tibia/fibular #?

- pain | - deformity

How are suspected tibia/fibula # investigated?

- acute: AP and lateral view XR | - delayed: AP, lateral and oblique view XR showing knee and ankle joints

What are the indications for managing a tibia/fibular # with closed reduction under GA and a long leg cast?

- closed # - undisplaced or minor-moderate displacement - low energy trauma - young adults

When is ORIF indicated for tibia/fibula #?

- vascular or neural injuries - segmental # - inadequate reduction - displaced intra-articular #

What is a tibial plafond #?

Intra-articular distal tibia #

What is a tibial plateau #?

Intra-articular proximal tibia #

What are the potential complications of tibial #?

- compartment syndrome - delayed union - non-union - malunion - shortening - infection - joint stiffness - refracture - fat embolism

How are ankle fractures classified?

Danis-Weber classification

What is a Weber A #? what is their prognosis?

of the lateral malleolus distal to the syndesmosis usually stable so can be treated in below knee cast or boot for 6 weeks

What is a Weber B #? what is their prognosis?

of the fibula at the level of the syndesmosis variable stability - may be possible to treat with immobilisation or may need surgery

What is a Weber C #? what is their prognosis?

fibula # proximal to the syndesmosis unstable - required ORIF

What is a Pilon #? how do they occur and what is their prognosis?

intra-articular distal tibia # caused by rotational or axial forces often co-morbid with other associated injuries, often produce comminution requires emergency orthopaedic consult, immobilisation and likely surgery

A major complication of displaced talar fractures is _____

avascular necrosis

How are calcaneal # managed?

- non WB immobilisation for 12 weeks | - fixation if articular surface affected (to reduce future arthritis)

How are undisplaced metatarsal # managed?

conservative | BK cast or boot

How are phalangeal # managed?

neighbour strapping

What are the 6 basic steps to describe a #?

1. which bone? 2. where on the bone? (think in thirds) 3. type of fracture? 4. number of fragments? 5. any displacement? 6. intra-articular involvement?

What are the types of fracture displacement?

- translation (post/ant, med/lat, rad/uln) - angulation - distraction - shortening - rotation

What are the types of complete fracture? Describe them

Transverse: fracture at right angles to the shaft Oblique: fracture at an angle to the shaft Spiral: caused by twisting injury Comminuted: 2 or more bone fragments Impacted: fractured bone forced together

Displacement of a # is described in terms of the distal fragment in comparison to the proximal fragment. True or false?

True

What does a DEXA scan measure?

bone mineral density

What does the t score from a DEXA scan represent?

how many SD the individuals BMD is from the ideal BMD

What does the z score from a DEXA scan represent?

how many SD the individuals BMD is from that of comparable individuals (matched for sex and age)

What are the types of incomplete fracture? Describe them

Torus/Buckle: a bulge in the cortex Bowing: associated bend in the bone shaft Greenstick: bending of the shaft with a fracture on the convex surface Salter-Harris: involving the growth plate

Adults are more likely to sustain incomplete fractures than children, due to their greater bone mineral density. True or false?

False - incomplete fractures most commonly occur in children

There is a greater risk of infection with closed fractures. True or false?

False - there is a greater risk of infection with open fractures

What are the components of the ABCS approach to XR interpretation?

Alignment and joint space Bone texture Cortices Soft tissues

How would you interpret a DEXA t score?

T-score of -1.0 or above = normal bone density T-score between -1.0 and -2.5 = low bone density, or osteopenia T-score of -2.5 or lower = osteoporosis

How long do fractures in smaller bones e.g. the clavicle take to heal?

~6weeks

How long to fractures in long bones e.g. the femur take to heal?

12-18weeks

What does it mean if a fracture is "off-ended"?

If the distal fragment is translated further than the width of the bone, it is said to be ‘off-ended’

In a flexor tendon injury to the hand, what will be the impact on passive and active movements?

- passive unaffected (but may be painful) | - active impaired

How do you test whether flexor digitorus profundus is intact?

- Immobilise MCP, PIP and ask patient to flex DIP | - If possible to flex then FDP is at least partially intact and able to pull on the PP

How do you test whether flexor digitorus superficialis is intact?

- Fix all but suspect finger in the extended position to remove the effect of FDP (mass action muscle, no independent action) and ask patient to flex suspect finger - If FDS is not intact then patient cannot flex the finger

What is the "fallout sign"?

Abnormal cascade of digits of the hand due to both flexor tendons being severed

How does the shoulder typically dislocate?

Anteriorly