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BRS YR2 > Management of Specific Fractures > Flashcards

Management of Specific Fractures Flashcards

1
Q

What are the main principles of Trauma?

A
  • advanced trauma life support
  • reduce the fracture
  • hold the fracture
  • rehabilitate after healing
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2
Q

What are the main principles of Orthopaedics?

A

(LT, chronic issues)

  • history
  • examinations
  • look/feel/move
  • investigations
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3
Q

What are the clinical signs of a fracture?

A
  • pain
  • swelling
  • crepitus
  • deformity
  • adjacent structural injury (nerves/vessels/ligaments/tendons)
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4
Q

What investigations can be done if a fracture is suspected?

A
  • radiograph
  • CT
  • MRI
  • Bone
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5
Q

How do you describe a fracture?

A
  • location
  • pieces
  • pattern
  • displaced/undisplaced
  • translated/angulated
  • X/Y/Z plane
  • epiphysis present?
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6
Q

What are the different fracture patterns?

A
  • open
  • simple
  • transverse
  • comminuted
  • spiral
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7
Q

What are the different forms of displacement?

A
  • translation

- angulation

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8
Q

How would you describe translation with the X/Y/Z planes?

A

X - medial/lateral
Y - proximal/distal
Z - anterior/posterior

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9
Q

How would you describe angulation with the X/Y/Z planes?

A

X - dorsal/volar
Y - internal/external
Z - varus/valgus

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10
Q

What do the X/Y/Z planes mean with translation?

A

X - in reference to the midline (facing on)
Y - foot up from the femur
Z - from the side

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11
Q

What do the X/Y/Z planes mean with translation?

A

X - coronal plane (away from midline)
Y - axial plane
Z - sagittal plane

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12
Q

How do fractures heal?

A
  • bleeding
  • inflammation
  • new tissue formation
  • modelling
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13
Q

What happens in inflammation when a fracture is healing?

A
  • haematoma formation
  • cytokine release
  • granulation tissue and blood vessel formation
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14
Q

What happens during new tissue formation when a fracture is healing?

A
  • Soft Callus formation (T2 collagen - cartilage)

- Converted to Hard Callus (T1 collagen - bone)

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15
Q

What is involved in remodelling when a fracture is healing?

A

macrophages
osteoclasts
- BLASTS

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16
Q

What are the different types of ossification?

A
  • endochondral ossification

- intramembranous ossification

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17
Q

What happens once the bone is formed?

A

callus that will remodel according to the stressors put onto it

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18
Q

What is involved in inflammation when a fracture is healing?

A
  • neutrophils

- macrophages

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19
Q

What is involved during new tissue formation when a fracture is healing?

A 
-BLASTS
fibro - 
osteo - 
chondro - 
(forming collagen)
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20
Q

What happens in remodelling when a fracture is healing?

A
  • Callus responds to activity, external forces, functional demand and growth
  • excess bone is removed
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21
Q

What is Wolff’s law?

A

bone grows and remodels in response to the forces that it is placed under

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22
Q

What stability is provided with intramembranous healing?

A

absolute

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23
Q

What stability is provided with endochondral healing?

A

relative

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24
Q

What is primary bone healing?

A
  • intramembranous healing
  • absolute stability
  • direct to woven bone
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25
Q

What is secondary bone healing?

A
  • endochondral healing
  • involves responses in the periosteum and external soft tissues
  • relative stability
  • endochondral ossification: more callus
26
Q

When are the signs of healing visible on a XR?

A

7-10 days

27
Q

What are the general principles of fracture management?

A
  • reduce
  • hold
  • rehabilitate
28
Q

What are the different types of reduction?

A
  • open

- closed

29
Q

What are the different types of closed reduction?

A
  • manipulation

- traction (skin, skeletal (pins in the bone)

30
Q

What are the different types of open reduction?

A
  • mini-incision

- full exposure

31
Q

What are the different types of hold?

A
  • closed

- fixation

32
Q

What are the different types of closed hold?

A
  • plaster

- traction (skin, skeletal)

33
Q

What are the different types of fixation?

A
  • internal

- external

34
Q

What are the different types of internal fixation?

A
  • intramedullary (pins, nails)

- extramedullary (plates/screws, pins)

35
Q

What are the different types of external fixation?

A
  • monoplanar

- multiplanar

36
Q

What are the different types of rehabilitation?

A
  • use (pain relief, retrain)
  • move
  • strengthen
  • weight bear
37
Q

What are the different classes of complications?

A
  • general

- specifc

38
Q

What are some examples of general complications?

A
  • fat embolus
  • DVT
  • infection
  • prolonged immobility (UTI, chest infections, sores)
39
Q

What are some examples of specific complications?

A
  • neurovascular injury
  • muscle/tendon injury
  • non-union/mal-union
  • local infection
  • degenerative change (intraarticular)
  • reflex sympathetic dystrophy
40
Q

What factors in the mechanical environment affect tissue healing?

A
  • movement

- forces

41
Q

What factors in the biological environment affect tissue healing?

A
  • blood supply
  • immune function
  • infection
  • nutrition
42
Q

What are the possible causes of a fractured neck of femur?

A
  • osteoporosis
  • trauma
  • combination
43
Q

What Hx should be taken when the patient has a fractured neck of femur?

A
  • age
  • co-morbidities
  • preinjury mobility (?independent)
  • social Hx (?stairs)
44
Q

What is a concern when there is an intra-capsular neck of femur fracture?

A
  • blood supply is more likely to be compromised
45
Q

What determines whether a neck of the femur fracture should be fixed or displaced?

A
  • location (intra- or extracapsular)
  • displacement
  • age of patient
46
Q

What would be the options in a displaced, intracapsular neck of the femur fracture in a patient above 55 years old?

A

if fit and mobile:
- total hip replacement
less fit:
- hemiarthroplasty

47
Q

What is the management of an extracapsular neck of femur fracture?

A

internal fixation (plates and screws, nails)

48
Q

What would be the management in a displaced, intracapsular neck of the femur fracture in a patient less than 55 years old?

A
  • reduce

- fixation with screws

49
Q

What would be the management in an undisplaced, intracapsular neck of the femur fracture?

A

fixation with screws

50
Q

How do shoulder dislocations present?

A
  • variable Hx but often direct trauma
  • pain
  • restricted movement
  • loss of normal shoulder controur
51
Q

What clinical examinations should be done for a suspected shoulder dislocation?

A

assess neurovascular status, axillary nerve

52
Q

What investigations should be done for a suspected shoulder dislocation?

A
  • XR prior to manipulation

- scapular Y view/modified axillary in addition to AP

53
Q

What management is done for a shoulder dislocation?

A
  • reduce the dislocation
  • avoid vigorous/twisting manipulation
  • traction-counter traction recommended
54
Q

What are the possible complications associated with a shoulder dislocation?

A

Hill-Sachs defect with a Bankart lesion (improper or rough reduction)

55
Q

When is a cast/split used in a distal radius fracture?

A
  • temporary treatment for any distal radius fracture
  • reduction of fracture and placed into a cast until definitive fixation
  • definitive if minimally displaced, extra articular fracture
56
Q

When is a MUA and k-wire used in a distal radius fracture?

A

for fractures that are extra-articular but are instable (esp in children)

57
Q

When is an open reduction with internal fixation used in a distal radius fracture?

A
  • in displaced, unstable fractures not suitable for K wires or with intra-articular involvement
58
Q

What are common complications associated with a tibial plateau fracture?

A

concomitant ligamentous or meniscal injury

59
Q

When is non-operative management of a tibial plateau fracture considered?

A

undisplaced fractures with a good joint line

60
Q

What. is the operative management of a tibial plateau fracture?

A
  • restoration of articular surface using combination of plate and screws
  • bone graft or cement may be necessary to prevent further depression after fixation
61
Q

What is the non-operative management of an ankle fracture?

A
  • non-weight bearing knee cast for 6-8 weeks
  • transfer to a walking boot
  • physiotherapy to improve ROM/stiffness
62
Q

What is the operative management of an ankle fracture?

A
  • soft tissue dependent (elevation necessary)

- open reduction internal fixation +/- syndesmosis repair using either screw or tightrope technique

BRS YR2 (70 decks)

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