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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
What are the two types of arthroplasty for surgical fracture management?
Hemiarthroplasty and total joint replacement
26
what are the signs on osteoarthritis that can be seen on an x-ray?
LOSS- Loss of joint space Osteophytes Subchondral sclerosis Subchondral cysts
27
On histology, osteoclasts are ________
Multinucleated
28
What are the six steps to approaching an orthopaedic x-ray?
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
How does a shoulder dislocation normally present?
Variable Hx but often direct trauma Pain Restricted movement Loss of normal shoulder contour
30
What is done in the clinical examination of a patient with suspected shoulder dislocation?
Assess neuro vascular status - axillary nerve Test over regimental patch area for any sensory deficit
31
How do we investigate s suspected shoulder dislocation?
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
What is often the cause of a fractured neck of femur?
Osteoporosis or trauma
33
What are the 4 types of neck of femur fractures by location?
Subcapital - intracapsular Transcervical - extracapsular Basicervical - extracapsular Subtrochanteric/ 3 part intertrochanteric
34
What are the main types of shoulder dislocation and which is most common?
Anterior - most common Posterior Interior
35
What is an anterior shoulder dislocation?
Humoral head not overlying glenoid
36
What is a posterior shoulder dislocation?
Rare (6%) Associated with seizures/ shocks Light bulb sign on X-RAY
37
What is an inferior shoulder dislocation?
Humoral head not articulating correctly when arm held abducted above head
38
What is the safest method in the management of a shoulder dislocation?
Traction-counter traction with gentle internal rotation to disimpact humoral head Ensure adequate patient relaxation - entonox; benzos If alone use Stimson method
39
What neuro vascular complications are often associated with a shoulder dislocation?
Axillary nerve injury Iatrogenic as a result of reduction manoeuvre Delayed onset due to an evolving haemotoma post injury/ manipulation
40
What is a Hill-Sachs defect? What is a Bankart lesion?
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
What is then typical presentation of a proximal humerus fracture?
Fall onto outstretched hand Typically in the elderly or those with osteoporosis
42
What investigations are conducted in a patient with a suspected proximal humerus fracture?
Plain x-rays CT if concern over articular involvement or high degrees of communication
43
What are the three classifications (described by Neer) of proximal humerus fracture?
Surgical neck fractures - 2 parts Avulsion fractures of Greater tuberosity - 2 parts Comminuted fractures - >3 parts
44
In the management of a proximal humerus fracture, when is a collar and cuff used?
2-part fracture with minimal displacement Those with high surgical risk/ comorbidities Is compliant with post-operative care
45
In the management of a proximal humerus fracture, when is an ORIF - plate and screws, used?
Any fracture with displacement i.e. 2parts + but not highly comminuted Previous unsuccessful shoulder replacement Complex fracture/ chronic shoulder dislocation
46
In a humeral head fracture with large displacement and thus high-risk of non-union reverse arthroplasty, what is used in management?
ORIF-plate and screws
47
What is the typical presentation of a distal radius fracture?
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
What investigations should be made into a patient with a suspected distal radius fracture?
Plain radiographs - PA/lateral views to assess fracture type Thorough clinical examination to avoid concomitant injuries
49
What is a reverse total arthroplasty?
Surgeon removes the damaged parts of the shoulder and replaces them with artificial parts
50
What are the different classifications of distal radius fracture?
Extra or intra articular Angular ion Dorsal or volar (palmar) Based on the more distal fragment
51
in what conditions would a cast/ splint be used for a distal radius fracture?
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
In what conditions would a MUA and K-wire be used to manage a distal radius fracture?
Fractures that are extra-articular but have instability - particularly in children
53
In what conditions would an ORIF be used in the management of a distal radius fracture?
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
What are the goals of operative management of distal radius fracture?
Articular surface congruency Radial inclination Radial height Volar tilt
55
What is the typical presentation of a scaphoid fracture?
Commonest carpal bone injury Typically a fall backwards onto their hand
56
Who should have a clinical examination for a scaphoid fracture and what does this involve?
Anyone with FOOSH (fall onto outstretched hand) or distal radius fracture Palpation of anatomical snuffbox, scaphoid tubercle or telescoping of the thumb
57
What investigations are conducted for a patient with a suspected scaphoid fracture?
Plain radiographs difficult to access- request scaphoid views Delayed radiographs if normal but clinical suspicion Consider MRI/CT if still concerned
58
What is the management plan for displaced scaphoid fractures?
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
what is the management plan for an undisplaced scaphoid fracture?
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
What are the different lunate dislocations?
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
Outline the typical presentation of a pelvic fracture?
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
What are the three classifications of pelvic fractures?
lateral compression Anterior-posterior compression Vertical shear

Y2 MSK (5 decks)

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