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Year 2 > Long bone fractures > Flashcards

Long bone fractures Flashcards

1
Q

Define the terms diaphysis, metaphysis, epiphysis and physis

A

Diaphysis - shaft of long bone
Metaphysis - between the diaphysis and epiphysis
Epiphysis - end of long bone
Physis - growth plate

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2
Q

List the main long bones of the body

A 
Tibia & fibula
Femur
Radius & ulna
Humerus 
Metatarsals, metacarpals and phalanges
Clavicle
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3
Q

What is primary bone healing?

A

Healing where the gap between two ends of bone is minimal

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4
Q

What type of fracture will heal by primary bone healing?

A

Hairline (after fixation with plate and screws)

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5
Q

What is secondary bone healing?

A

There is a gap between the two ends of the bone which fills with granulation tissue > soft callus > hard callus/bone

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6
Q

Which is more common primary or secondary bone healing?

A

Secondary

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7
Q

What is the sequence of fracture healing?

A 
Haematoma >
Soft callus >
Chondral ossification >
Hard callus >
Bone remodelling
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8
Q

What are the important steps in an assessment of a fracture?

A

Closed vs open
Neurovascular status
Soft tissue injury
Compartment syndrome

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9
Q

What can and should be immediately given for a fracture?

A

Analgesia

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10
Q

What is a comminuted fracture?

A

A fracture with more than two segments

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11
Q

When do comminuted fractures tend to happen?

A

High energy injuries

Poor quality bone

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12
Q

How can fractures be managed non-operatively?

A

Cast (plaster of paris, lightweight)
Functional bracing
Traction

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13
Q

Which age groups typically get traction?

A

Young

Elderly

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14
Q

What are the different types of internal fixation?

A

K-wires
Cerclage wires
Onlay devices (plates & screws)
Inlay devices (intramedullary nail)

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15
Q

What are the different types of external fixation

A

Monolateral

Circular

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16
Q

What does ORIF stand for?

A

Open reduction internal fixation

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17
Q

How might certain intra/periarticular fractures be managed?

A

Joint replacement

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18
Q

High energy fractures +/- soft tissue swelling should be treated with ORIF. T/F

A

False - healing poor and non-union rates high, either way until soft tissues settle or use other techniques

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19
Q

How should a stable, minimally displaced, extra-articular fracture be managed?

A

Conservatively - splint

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20
Q

When is reduction used?

A

When fracture position is unacceptable

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21
Q

An unstable fracture should be operatively managed under which circumstance?

A

When the patient is fit and able to undergo operation

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22
Q

When might intra-articular fractures be managed non-operatively?

A

When they are stable and non-displaced

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23
Q

How should displaced intra-articular fractures be managed? Why?

A

Operatively with internal fixation

Prevent post-traumatic osteoarthritis

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24
Q

When might joint replacement be used in a peri-articular fracture?

A

When non-union risk or avascular necrosis risk is high

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25
Q

How should open fractures be managed?

A

Antibiotics
Tetanus Ig if not vaccinated
Debridement
Operative stabilisation

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26
Q

How should compartment syndrome be managed?

A

Fasciotomy and operative stabilisation

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27
Q

How should vascular injury be managed?

A

Reduction, stabilisation, reassess +/- revascularisation

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28
Q

How should nerve injury be managed?

A

Open - explore

Closed - reduce, stabilise, reassess and monitor

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29
Q

When should metronidazole be given (in addition to other antibiotics) with an open fracture?

A

If it has visible dirt in the fracture wound

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30
Q

Which antibiotics should be prescribed for an open fracture?

A

Gentamicin and flucloxacillin/co-trimoxazole

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31
Q

Is a femoral shaft fracture usually low or high energy? What is the exception to this?

A

High. Pathological fracture

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32
Q

What are the risks with femoral shaft fracture?

A

Hypovolaemia (fluid replacement, blood transfusion)
Fat embolism
Acute respiratory distress syndrome

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33
Q

What type of analgesia is given in a femoral shaft fracture?

A

Femoral nerve block

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34
Q

How is a femoral shaft fracture treated?

A

Stable - Thomas splint

Unstable - Intramedullary nailing

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35
Q

Are extra-articular distal femur fractures stable or unstable? Why?

A

Unstable. The muscles cause flexion

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36
Q

How is an extra-articular distal femur fracture managed?

A

Thomas splint
Intermedullary nail if more proximal
Plate and screw if very distal

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37
Q

How are intra-articular distal femur fractures managed?

A

Reduction and rigid fixation with plate and screws

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38
Q

Is a proximal tibial fracture high or low energy?

A

High energy in the young

Low energy in the old

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39
Q

What kind of force is usually responsible for proximal tibial fractures? What pattern of fracture does this cause?

A

Valgus

Lateral tibial plateau fracture with articular disruption

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40
Q

How is a proximal tibial fracture managed?

A

Temporary external fixation if high energy with substantial swelling
Anatomical reduction with rigid fixation +/- bone graft

41
Q

What is a common complication of proximal tibial fractures?

A

Post traumatic osteoarthritis

42
Q

How is a proximal tibial fracture assessed?

A

CT scan

43
Q

Are tibial shaft fractures high or low energy?

A

Either

44
Q

What is a common complication that tibial shaft fractures must be monitored for?

A

Compartment syndrome

45
Q

How well is 1) angulation and 2) internal rotation tolerated in a tibial shaft fracture?

A

1 - well tolerated within 5 degrees

2 - poorly tolerated

46
Q

How long does a tibial shaft fracture take to heal and over which time frame indicates non-union?

A

4 months. 1 year

47
Q

How is a tibial shaft fracture managed?

A

Conservative - plaster

Surgical - intermedullary nailing, plate, ex-fix

48
Q

How is compartment syndrome diagnosed?

A

Clinically

49
Q

What is an intra-articular distal tibial fracture called?

A

Pilon fracture

50
Q

Is an intra-articular tibial fracture high or low energy?

A

High

51
Q

What are the associated injuries of a distal tibial fracture?

A

Spine, pelvis, calcaneous

52
Q

How is a distal tibial fracture managed?

A

Urgent external fixation +/- limited internal fixation >
Soft tissues settle >
Internal fixation

53
Q

How are distal tibial fractures assessed?

A

CT scan

54
Q

When may ankle fractures be treated conservatively?

A

Isolated distal fibular fracture

Minimally displaced medial malleolus

55
Q

What are the two causes of talar shift?

A 
Bimalleolar fractures (unstable)
Distal fibular fracture with ruptured deltoid ligament
56
Q

How at risk of post-traumatic OA are ankle fractures?

A

Most are high risk

57
Q

How is talar shift managed? Why?

A

ORIF. Change in joint force causes massive increase in OA risk

58
Q

What is the main cause of proximal humerus fractures and in which type of patient?

A

Osteoporosis. Elderly

59
Q

What are the risks of proximal humerus fractures?

A

Brachial plexus injury

Axillary artery injury

60
Q

What are the risk in comminuted proximal humerus fractures?

A

Avascular necrosis

Non-union

61
Q

How are proximal humerus fractures managed?

A

Elderly - conservative
Head splitting/comminuted fracture - arthroplasty
Young and displaced - internal fixation

62
Q

What are the benefits of arthroplasty in proximal humerus fractures? The drawbacks?

A

Pain relief. Poor range of movement

63
Q

Why is surgery not chosen for proximal humerus fractures in the elderly?

A

Stiffness and rotator cuff dysfunction causes poor healing

64
Q

What is the risk with humeral shaft injuries?

A

Radial nerve injury (neurapraxia)

65
Q

Can angulation be tolerated with humeral shaft injuries?

A

Yes

66
Q

How is humeral shaft fracture managed?

A

Bracing

67
Q

When might humeral shaft fractures be managed surgically?

A 
Non-union
Pathological
Polytrauma
Open fracture
High energy 
Not tolerating brace
68
Q

How is a distal humerus fracture managed?

A

Intra-articular - ORIF

Elderly - arthroplasty

69
Q

Most olcranon fractures are avulsion. T/F

A

True - due to quadriceps contraction

70
Q

How are olcranon fractures managed?

A

Internal fixation unless elderly with low demand

71
Q

Which fracture often occurs in conjunction with an elbow dislocation?

A

Radial head fracture

72
Q

How are radial head fractures managed?

A

Minimally displaced - conservative
Fragment blocking movement/displaced with large fragments - fixation
Comminuted - excise +/- replacement

73
Q

What is a Galeazzi fracture dislocation?

A

Isolated radial fracture and distal radio-ulnar joint disocation

74
Q

What is a Monteggia fracture dislocation?

A

Isolated ulnar fracture and dislocation of radial head

75
Q

How is a forearm fracture of both the radius and ulna managed?

A

ORIF

76
Q

How is a Galeazzi or Monteggia fracture managed?

A

ORIF (dislocation should reduce)

77
Q

What is a nightstick fracture? How is it managed?

A

Isolated fracture of the ulna. Conservatively

78
Q

How does a nightstick fracture occur?

A

Direct blow to the ulna

79
Q

What is a Colle’s fracture?

A

Extra-articular, dorsal angulation and dorsal displacement of the distal radius

80
Q

How is a Colle’s fracture managed?

A

Stabled/minimally displaced - Plaster of paris
Simple displacement - manipulation under anaesthetic
Displaced comminution - manipulation under anaesthetic & k-wires or ORIF

81
Q

What are the complications of Colle’s fracture?

A

Median nerve compression
EPL rupture
Chronic regional pain syndrome
Loss of grip strength

82
Q

What is the typical mechanism by which a Colle’s fracture occurs?

A

Fall onto an outstretched hand

83
Q

What type of fracture can result in a dinner fork deformity?

A

Colle’s fracture

84
Q

What is the typical mechanism by which a Smiths fracture occurs?

A

Fall onto the back of the hand

85
Q

What is a Smith’s fracture?

A

Extra-articular, volar displacement and angulation of the distal radius

86
Q

How is a Smith’s fracture managed?

A

ORIF

87
Q

What is a Barton’s fracture?

A

Intra-articular, volar or dorsal on lateral +/- carpal subluxation of the distal radius

88
Q

How is a Barton’s fracture managed?

A

ORIF

89
Q

How is a comminuted intra-articular fracture of the distal radius managed?

A

External fixation +/- k-wires

90
Q

How many x-ray views does a scaphoid fracture required? What else must be done?

A
  1. Must be x-rayed a number of days after to confirm
91
Q

How is a perilunate dislocation of the wrist managed?

A

Urgent reduction

92
Q

How is polytrauma defined?

A

More than one major fracture (long bones/pelvis)

93
Q

What are the two worst fractures in terms of blood loss/fat embolism?

A

Pelvic and femoral shaft fracture

94
Q

What is the risk in terms of inflammatory cascades during polytrauma?

A

Systemic inflammatory response syndrome
Adult respiratory distress syndrome
Multiple organ dysfunction syndrome

95
Q

What is the lethal triad in relation to blood loss and polytrauma?

A

Hypothermia, acidosis and coagulopathy

96
Q

How is a pelvic fracture managed?

A

Pelvic binder

97
Q

What is consumption coagulopathy?

A

Bleeding uses up all clotting factors

98
Q

What are the most pressing injuries to treat in polytrauma?

A

Pelvic, tibial or femoral fracture
Vascular compromise
Open fractures
Compartment syndrome

Year 2 (72 decks)

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