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Y2 MSK > Management Of Specific Fractures > Flashcards

Management Of Specific Fractures Flashcards

1
Q

Define fracture

A

Discontinuity of bone

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2
Q

What four factors can a fracture be described based off?

A

Orientation, location, displacement and skin penetration

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3
Q

What are the four orientations of a fracture?

A

Transverse, oblique, spiral, comminuted

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4
Q

Outline the process of primary bone healing

A

Intramembranous healing, occurs with Haversian remodelling
Little or no gap
Slow process
Cutter cone concept - like bone remodelling

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5
Q

Outline the process of Secondary (indirect) bone healing?

A

Endochondral healing involves responses in the periosteum and external soft tissues
Fast process resulting in callus formation - fibrocartilage

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6
Q

What is involved in assessing a fracture?

A

Pain
Swelling
Crepitus
Deformity
Collateral damage - nerve, vessel

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7
Q

What investigations can be made into assessing a fracture?

A

X-ray, CT, MRI

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8
Q

How is a fracture radiograph described?

A

Location: which bone and which part
Pieces: simple/ multi-fragmentary
Pattern: transverse/ oblique/ spiral
Displaced/undisplaced
Translated/ angulated
X/Y/Z plane

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9
Q

What pre-requisites are required for fracture healing?

A

• Minimal fracture gap• No movement if direct (primary) bony healing or some movement if indirect (secondary) bone healing• Patient physiological state - nutrients, growth factors, age, diabetic, smoker

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10
Q

What does Wolffs law state regarding bone adaptation?

A

Bone adapts to forces placed upon it by remodelling and growing in response to external stimuli

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11
Q

What are the three main types of complication of fracture healing?

A

Non-union
Malunion
Pseudoarthrosis

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12
Q

Regarding complications of fracture healing what does non-union describe?

A

Failure of bone healing within an expected time frame

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13
Q

What are the two types of non-union complications of fracture healing?

A

Atrophic - healing completely stopped with no X-RAY changes, often physiological (diabetic, smoker)
Hypertrophic - too much movement, causing callus healing

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14
Q

Regarding complications of fracture healing what does Malunion describe?

A

Bone healing occurs but outside of the normal parameters of alignment

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15
Q

Regarding complications of fracture healing what does pseudoarthrosis describe?

A

Fibrous callus formation
Forms like a joint and becomes mobile
Not stable as it is gummed up with fibrocartilage

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16
Q

What are the four key steps to fracture management?

A
  1. Resuscitate - save the patients life, then worry about the fracture!!2. Reduce - bring the bone back together in an acceptable alignment3. Rest - hold the fracture in position to prevent distortion or movement4. Rehabilitate - get function back and avoid stiffness
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17
Q

When considering how to manage a fracture why does period of immobility need to be thought about?

A

*Think about period of immobility:• functional limitations and support needed• wider MDT (physio, occi health)• VTE prophylaxis

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18
Q

What are the two different forms of fracture management?

A

Conservative
Surgical

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19
Q

What are the fundamentals of conservative fracture management? (RIE)

A

Rest, ice, elevation

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20
Q

What is used in the conservative management of a fracture>?

A

Plaster/fibreglass cast or splint

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21
Q

When is a backslab used and what does this prevent?

A

Used in an acute setting to allow for swelling
Avoids compartment syndrome

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22
Q

In the conservative management of a fracture, what difference is their in the management if the fracture is at the joint compared to the mid shaft?

A

Joint - Only the joint needs immobilising
Midshaft - join above and below need immobilising

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23
Q

What are the four types of surgical management of a fracture?

A

External fixation
Internal fixation
Athroplasty
MUA + K-wire

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24
Q

What are the two types of internal surgical fixations for fracture management?

A

ORIF and IM nail
ORIF - open reduction internal fixation (extramedullary)
IM nail - useful for long bone fracture (intramedullary)

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25
Q

What are the two types of arthroplasty for surgical fracture management?

A

Hemiarthroplasty and total joint replacement

26
Q

what are the signs on osteoarthritis that can be seen on an x-ray?

A

LOSS- Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

27
Q

On histology, osteoclasts are ________

A

Multinucleated

28
Q

What are the six steps to approaching an orthopaedic x-ray?

A

1.projection - need 2 views
2. Patient details
3. Technical adequacy - entire area in question included? Adequate exposure? Rotation?
4. Obvious abnormality
5. Systemically review - edges of bones, medulla (licence/sclerosis), soft tissue swelling, joint effusion, bone density, dislocation
6. Summarise

29
Q

How does a shoulder dislocation normally present?

A

Variable Hx but often direct trauma
Pain
Restricted movement
Loss of normal shoulder contour

30
Q

What is done in the clinical examination of a patient with suspected shoulder dislocation?

A

Assess neuro vascular status - axillary nerve
Test over regimental patch area for any sensory deficit

31
Q

How do we investigate s suspected shoulder dislocation?

A

X-ray prior to any manipulation - identify fracture e.g humoral neck, greater tuberosity avulsion or Glenoid
Scapular Y-view/ modified axillary in addition to AP

32
Q

What is often the cause of a fractured neck of femur?

A

Osteoporosis or trauma

33
Q

What are the 4 types of neck of femur fractures by location?

A

Subcapital - intracapsular
Transcervical - extracapsular
Basicervical - extracapsular
Subtrochanteric/ 3 part intertrochanteric

34
Q

What are the main types of shoulder dislocation and which is most common?

A

Anterior - most common
Posterior
Interior

35
Q

What is an anterior shoulder dislocation?

A

Humoral head not overlying glenoid

36
Q

What is a posterior shoulder dislocation?

A

Rare (6%)
Associated with seizures/ shocks
Light bulb sign on X-RAY

37
Q

What is an inferior shoulder dislocation?

A

Humoral head not articulating correctly when arm held abducted above head

38
Q

What is the safest method in the management of a shoulder dislocation?

A

Traction-counter traction with gentle internal rotation to disimpact humoral head
Ensure adequate patient relaxation - entonox; benzos
If alone use Stimson method

39
Q

What neuro vascular complications are often associated with a shoulder dislocation?

A

Axillary nerve injury
Iatrogenic as a result of reduction manoeuvre
Delayed onset due to an evolving haemotoma post injury/ manipulation

40
Q

What is a Hill-Sachs defect?
What is a Bankart lesion?

A

Hill-Sachs defects = posterolateral humoral head depression fracture resulting from impact with anterior glenoid rim - indicative on an anterior glenohumeral dislocation
Bankart lesion = injury of labrum and associated glenohumeral capsule

41
Q

What is then typical presentation of a proximal humerus fracture?

A

Fall onto outstretched hand
Typically in the elderly or those with osteoporosis

42
Q

What investigations are conducted in a patient with a suspected proximal humerus fracture?

A

Plain x-rays
CT if concern over articular involvement or high degrees of communication

43
Q

What are the three classifications (described by Neer) of proximal humerus fracture?

A

Surgical neck fractures - 2 parts
Avulsion fractures of Greater tuberosity - 2 parts
Comminuted fractures - >3 parts

44
Q

In the management of a proximal humerus fracture, when is a collar and cuff used?

A

2-part fracture with minimal displacement
Those with high surgical risk/ comorbidities
Is compliant with post-operative care

45
Q

In the management of a proximal humerus fracture, when is an ORIF - plate and screws, used?

A

Any fracture with displacement i.e. 2parts + but not highly comminuted
Previous unsuccessful shoulder replacement
Complex fracture/ chronic shoulder dislocation

46
Q

In a humeral head fracture with large displacement and thus high-risk of non-union reverse arthroplasty, what is used in management?

A

ORIF-plate and screws

47
Q

What is the typical presentation of a distal radius fracture?

A

Very common
Often present with clear mechanism of falling onto affected area, swelling and visible deformity
Most common presentation is dorsal displacement due to fall on outstretched hand

48
Q

What investigations should be made into a patient with a suspected distal radius fracture?

A

Plain radiographs - PA/lateral views to assess fracture type
Thorough clinical examination to avoid concomitant injuries

49
Q

What is a reverse total arthroplasty?

A

Surgeon removes the damaged parts of the shoulder and replaces them with artificial parts

50
Q

What are the different classifications of distal radius fracture?

A

Extra or intra articular
Angular ion
Dorsal or volar (palmar)
Based on the more distal fragment

51
Q

in what conditions would a cast/ splint be used for a distal radius fracture?

A

Temporary treatment for any distal radius fracture - reduction of fracture and placement into cast until definitive fixation
Is definitive if minimally displaced, extra-articular fracture

52
Q

In what conditions would a MUA and K-wire be used to manage a distal radius fracture?

A

Fractures that are extra-articular but have instability - particularly in children

53
Q

In what conditions would an ORIF be used in the management of a distal radius fracture?

A

Any displaced, unstable fractures not suitable for K-wires or with intra-articular involvement may benefit from open reduction internal fixation with plate and screws

54
Q

What are the goals of operative management of distal radius fracture?

A

Articular surface congruency
Radial inclination
Radial height
Volar tilt

55
Q

What is the typical presentation of a scaphoid fracture?

A

Commonest carpal bone injury
Typically a fall backwards onto their hand

56
Q

Who should have a clinical examination for a scaphoid fracture and what does this involve?

A

Anyone with FOOSH (fall onto outstretched hand) or distal radius fracture
Palpation of anatomical snuffbox, scaphoid tubercle or telescoping of the thumb

57
Q

What investigations are conducted for a patient with a suspected scaphoid fracture?

A

Plain radiographs difficult to access- request scaphoid views
Delayed radiographs if normal but clinical suspicion
Consider MRI/CT if still concerned

58
Q

What is the management plan for displaced scaphoid fractures?

A

Retrograde blood supply means high risk of non-union/ AVN of proximal pole
Most displaced fractures disrupt this and therefore ORIF I usually undertaken

59
Q

what is the management plan for an undisplaced scaphoid fracture?

A

Can be treated conservatively in a scaphoid cast
Length of time to heal can be long so some surgeons opt for fixation as a result

60
Q

What are the different lunate dislocations?

A

Radius, lunate and capitate should all align, lunate dislocation named on misalignment:
Perilunate dislocation (capitate out of line)
Lunate dislocation (lunate out of line)

61
Q

Outline the typical presentation of a pelvic fracture?

A

Usually a result of high energy trauma
Patients can become very unstable - a lot of visceral organs and vasculature are adherent to the pelvis

62
Q

What are the three classifications of pelvic fractures?

A

lateral compression
Anterior-posterior compression
Vertical shear

Y2 MSK (5 decks)

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