Management of Specific Fractures Flashcards
What are the main principles of Trauma?
- advanced trauma life support
- reduce the fracture
- hold the fracture
- rehabilitate after healing
What are the main principles of Orthopaedics?
(LT, chronic issues)
- history
- examinations
- look/feel/move
- investigations
What are the clinical signs of a fracture?
- pain
- swelling
- crepitus
- deformity
- adjacent structural injury (nerves/vessels/ligaments/tendons)
What investigations can be done if a fracture is suspected?
- radiograph
- CT
- MRI
- Bone
How do you describe a fracture?
- location
- pieces
- pattern
- displaced/undisplaced
- translated/angulated
- X/Y/Z plane
- epiphysis present?
What are the different fracture patterns?
- open
- simple
- transverse
- comminuted
- spiral
What are the different forms of displacement?
- translation
- angulation
How would you describe translation with the X/Y/Z planes?
X - medial/lateral
Y - proximal/distal
Z - anterior/posterior
How would you describe angulation with the X/Y/Z planes?
X - dorsal/volar
Y - internal/external
Z - varus/valgus
What do the X/Y/Z planes mean with translation?
X - in reference to the midline (facing on)
Y - foot up from the femur
Z - from the side
What do the X/Y/Z planes mean with translation?
X - coronal plane (away from midline)
Y - axial plane
Z - sagittal plane
How do fractures heal?
- bleeding
- inflammation
- new tissue formation
- modelling
What happens in inflammation when a fracture is healing?
- haematoma formation
- cytokine release
- granulation tissue and blood vessel formation
What happens during new tissue formation when a fracture is healing?
- Soft Callus formation (T2 collagen - cartilage)
- Converted to Hard Callus (T1 collagen - bone)
What is involved in remodelling when a fracture is healing?
macrophages
osteoclasts
- BLASTS
What are the different types of ossification?
- endochondral ossification
- intramembranous ossification
What happens once the bone is formed?
callus that will remodel according to the stressors put onto it
What is involved in inflammation when a fracture is healing?
- neutrophils
- macrophages
What is involved during new tissue formation when a fracture is healing?
-BLASTS fibro - osteo - chondro - (forming collagen)
What happens in remodelling when a fracture is healing?
- Callus responds to activity, external forces, functional demand and growth
- excess bone is removed
What is Wolff’s law?
bone grows and remodels in response to the forces that it is placed under
What stability is provided with intramembranous healing?
absolute
What stability is provided with endochondral healing?
relative
What is primary bone healing?
- intramembranous healing
- absolute stability
- direct to woven bone
What is secondary bone healing?
- endochondral healing
- involves responses in the periosteum and external soft tissues
- relative stability
- endochondral ossification: more callus
When are the signs of healing visible on a XR?
7-10 days
What are the general principles of fracture management?
- reduce
- hold
- rehabilitate
What are the different types of reduction?
- open
- closed
What are the different types of closed reduction?
- manipulation
- traction (skin, skeletal (pins in the bone)
What are the different types of open reduction?
- mini-incision
- full exposure
What are the different types of hold?
- closed
- fixation
What are the different types of closed hold?
- plaster
- traction (skin, skeletal)
What are the different types of fixation?
- internal
- external
What are the different types of internal fixation?
- intramedullary (pins, nails)
- extramedullary (plates/screws, pins)
What are the different types of external fixation?
- monoplanar
- multiplanar
What are the different types of rehabilitation?
- use (pain relief, retrain)
- move
- strengthen
- weight bear
What are the different classes of complications?
- general
- specifc
What are some examples of general complications?
- fat embolus
- DVT
- infection
- prolonged immobility (UTI, chest infections, sores)
What are some examples of specific complications?
- neurovascular injury
- muscle/tendon injury
- non-union/mal-union
- local infection
- degenerative change (intraarticular)
- reflex sympathetic dystrophy
What factors in the mechanical environment affect tissue healing?
- movement
- forces
What factors in the biological environment affect tissue healing?
- blood supply
- immune function
- infection
- nutrition
What are the possible causes of a fractured neck of femur?
- osteoporosis
- trauma
- combination
What Hx should be taken when the patient has a fractured neck of femur?
- age
- co-morbidities
- preinjury mobility (?independent)
- social Hx (?stairs)
What is a concern when there is an intra-capsular neck of femur fracture?
- blood supply is more likely to be compromised
What determines whether a neck of the femur fracture should be fixed or displaced?
- location (intra- or extracapsular)
- displacement
- age of patient
What would be the options in a displaced, intracapsular neck of the femur fracture in a patient above 55 years old?
if fit and mobile:
- total hip replacement
less fit:
- hemiarthroplasty
What is the management of an extracapsular neck of femur fracture?
internal fixation (plates and screws, nails)
What would be the management in a displaced, intracapsular neck of the femur fracture in a patient less than 55 years old?
- reduce
- fixation with screws
What would be the management in an undisplaced, intracapsular neck of the femur fracture?
fixation with screws
How do shoulder dislocations present?
- variable Hx but often direct trauma
- pain
- restricted movement
- loss of normal shoulder controur
What clinical examinations should be done for a suspected shoulder dislocation?
assess neurovascular status, axillary nerve
What investigations should be done for a suspected shoulder dislocation?
- XR prior to manipulation
- scapular Y view/modified axillary in addition to AP
What management is done for a shoulder dislocation?
- reduce the dislocation
- avoid vigorous/twisting manipulation
- traction-counter traction recommended
What are the possible complications associated with a shoulder dislocation?
Hill-Sachs defect with a Bankart lesion (improper or rough reduction)
When is a cast/split used in a distal radius fracture?
- 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
When is a MUA and k-wire used in a distal radius fracture?
for fractures that are extra-articular but are instable (esp in children)
When is an open reduction with internal fixation used in a distal radius fracture?
- in displaced, unstable fractures not suitable for K wires or with intra-articular involvement
What are common complications associated with a tibial plateau fracture?
concomitant ligamentous or meniscal injury
When is non-operative management of a tibial plateau fracture considered?
undisplaced fractures with a good joint line
What. is the operative management of a tibial plateau fracture?
- restoration of articular surface using combination of plate and screws
- bone graft or cement may be necessary to prevent further depression after fixation
What is the non-operative management of an ankle fracture?
- non-weight bearing knee cast for 6-8 weeks
- transfer to a walking boot
- physiotherapy to improve ROM/stiffness
What is the operative management of an ankle fracture?
- soft tissue dependent (elevation necessary)
- open reduction internal fixation +/- syndesmosis repair using either screw or tightrope technique
