Management of Specific Fractures Flashcards
What is the difference in healing time for upper vs lower limb fractures?
Lower limb fractures take twice as long to heal as upper limb fractures
What is the difference in healing time for children vs adults?
Paediatric fractures heal twice as fast as adults
What is non union?
Failure of bone healing within an expected time frame
What are the 2 types of non union and how are they different?
Atrophic= healing completely stopped with no x ray changes, often physiological (smokers, diabetics, delayed presentation) Hypertrophic= too much movement causing callus healing
What is malunion?
Bone healing occurs but outside the normal parameters of alignment
What is the main difference between malunion and non union
In non union the bone doesnt heal and the 2 parts are not touching
In maunion the 2 parts touch but they are misalinged and they have healed
What are the 4 steps in management of a fracture?
Resuscitate
Reduce
Rest
Rehabilitation
What are the 2 main methods by which fractures can be managed?
Conservative
Surgical
What does conservative management of fractures involve?
First= rest, ice, elevation
Second=plaster/fibreglass cast or splint
Third= traction via skin or bone
What does surgical management of fractures involve?
MUA and K-wire- extra cortical
ORIF= open reduction internal fixation- extra cortical
IM nail= intermedullary nail intra cortical
External fixation- mono or bi planar (can’t close the defect at the time of the procedure)
When is MUA (manipulation under anaesthesia) and K wire useful in fracture management?
Good in kids as they have very thick periosteum and later the wires can be pulled out
When is IM nail useful in fracture management?
Good for long fractures
When is external fixation useful in fracture management?
If you can’t close the defect at the time of the procedure
What most commonly causes shoulder dislocation?
Trauma
What is important to consider when there is a shoulder dislocation?
Check if there is axillary nerve damage as the brachial plexus near the shoulder
What are the 3 types of shoulder joint dislocation? Which is most common?
Anterior= most common, when the humeral head is not overlying the glenoid fossa Posterior= associated with seizures or shocks, lightbulb sign is seen (humeral head looks like lightbulb on x-ray) Inferior= arm is held above the head and the humeral head is not articulating
What is the main method for treating shoulder dislocation?
Safest method is to use traction-counter traction +/- gentle internal rotation to disimpact humeral head
For pain relief: benzodiazepines and entonox
Could use stimson method- hanging weights off affected arm)
In shoulder dislocation what is Hill Sach’s defect?
Top of humeral head is hit on the glenoid as its dislocated
In shoulder dislocation what is Bankart lesion?
Damage to the labrum and/or glenoid (after hitting it on glenoid) - destabilizes shoulder joint
Can be soft or bony
Typically who gets fracture of the proximal humerus?
Those with osteoporosis or the elderly
How is proximal humerus fracture managed?
Collar and cuff if the fracture is 2 parts
If more can do an ORIF
What physical action commonly causes a fracture of the proximal humerus?
Falling onto an outstretched hand
What are the 2 types of distal radius fracture?
Extra and intra articular
What are the 2 angulations possible in distal radius fractures?
Dorsal
Volar
Why is it important to look out for carpal fractures?
Missing them can result in loss of wrist function as blood supply may become compromised
What results in fractures when blood supply is lost?
Avascular necrosis
What is the commonest carpal bone fracture?
Fracture of the scaphoid bone
When should scaphoid bone fracture be considered?
In any distal radial injury but it commonly occurs because of a fall backwards onto the hand
How are fractures of the scaphoid managed?
If undisplaced conservative management in a cast is sufficient
If displaced ORIF is usually undertaken
How does dislocation of the lunate bone usually arise?
Progressive disruption to the ligament
How does a shoulder dislocation present?
Painful
Restricted movement
Loss of normal shoulder contour
What investigations would you do for a shoulder dislocation?
X-ray before any manipulation- identify the fracture
Scapular -Y (lateral shoulder) view
How is a fracture of the distal radius managed?
Cast/ Splint: temporary treatment until definitive treatment or definite treatment if fracture is minimally displaced extra-articular fracture
MUA and K-WIRE: extra-articular but unstable fractures
ORIF: Displaced and unstable fractures or with extra-articular involvement
What is a pathognomonic sign of.a joint fracture?
Lipohaemarthrosis
Fat and blood from bone marrow goes to surface - shows as a fluid line on x-ray
What can cause a tibial plateau fracture and what is the significance?
Can be caused by extreme vulgaris force or axial loading across the knee
Impaction of the femoral condyles can cause soft bone of tibial plateau to depress or split
What is the importance of the tibial plateau?
A key weight bearing surface as part of your knee joint
What injuries can occur with a tibial plateau fracture?
Concomitant ligamentous or meniscal injury
How is a tibial plateau fracture managed?
Non- operative: if fracture is nondisplaced with good line congruence seen on CT
Operative:
-most treatment will be operative
-Restore articular surface using plates and screws
-Bone graft or cement might need to be used to prevent depression after fixation
How is an ankle fracture managed?
Non-operative:
-Non weight bearing below knee cast for 6-8 weeks -> walking boot -> physiotherapy
For:
Weber A- below syndesmosis so stable
weber B1- no evidence of instability
Operative:
- Soft tissue dependent- strict elevation to prevent swelling
ORIF +/- syndesmosis repair using screw or tightrope technique
For:
Weber B2 and B3
Weber C
