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BRS Flashcards (Y2) > Management Of Specific Fractures > Flashcards

Management Of Specific Fractures Flashcards

1
Q

Is the fracture usually the main priority?

A

No, keep the patient alive first:
Airway
Breathing
Circulation
Disability
Fracture can be treated as part of ‘C’ if affecting circulation, e.g. blood loss

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2
Q

What is considered when assessing a fracture?

A

Pain
Swelling
Crepitus
Deformity
Collateral damage
- Nerve
- Vessel

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3
Q

What are the investigations for fractures?

A

XRay (in most cases)
CT sometimes indicated to make diagnosis and assess pattern
MRI if unsure

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4
Q

How do you describe a fracture radiograph?

A

Name, date, projection
Location:
Which bone?
Which side?
Which part of bone - is it intra-articular (did it enter the joint)?
Pieces: simple/multifragmentary
Pattern: transverse/oblique/spiral
Displaced/minimally displaced
What plane: translated/angulated/rotated?

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5
Q

What is the difference between varus and valgus?

A

Varus - outward
Valgus - inward

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6
Q

Why do fractures displace?

A

Because of the muscles
Displace towards strongest muscles

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7
Q

What are the differences between direct and indirect fracture healing?

A

Direct:
- Bone ends are joined
- Anatomical reduction allows for natural bone turnover and growth - important for joint health
- Absolute stability/compression
- No callus
Indirect fracture healing
- Sufficient reduction
- Micromovement - some movement at fracture site
- Callus formation
- Not concerned with joint functionality

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8
Q

What steps are involved in the inflammation stage of indirect fracture healing?

A

Haematoma formation
Release of cytokines
Granulation tissue and blood vessel formation

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9
Q

What steps are involved in the repair stage of indirect fracture healing?

A

Soft callus formation (type II collagen - cartilage)
Converted to hard callus (type I collagen - bone)

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10
Q

What steps are involved in the remodelling stage of indirect fracture healing?

A

Callus responds to activity, external forces, functional demands and growth
Excess bone removed

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11
Q

What is Wolff’s Law?

A

Bone grows and remodels in response to the forces that are placed on it

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12
Q

How long does it take for fractures to heal?

A

3-12 weeks depending on site and patient
Healing visible on XR from 7-10 days
Phalanges: 3 weeks
Metacarpals: 4-6 weeks
Distal radius: 4-6 weeks
Forearm: 8-10 weeks
Tibia: 10 weeks
Femur: 12 weeks

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13
Q

How are fractures managed?

A

Reduce:
- Closed
- Open
Hold:
- Plaster/splint
- External fixation
- Internal fixation
Rehabilitation:
- Early/late
- Weight bearing
- Physiotherapy

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14
Q

What are the general complications of fractures?

A

Can be early or late
Fat embolus
DVT
Infection
Prolonged immobility (UTI, chest infections, sores)

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15
Q

What are the specific complications of fractures?

A

Neurovascular injury
Muscle/tendon injury
Non union/mal union
Local infection
Degenerative change (intraarticular)
Reflex sympathetic dystrophy - also known as complex regional pain syndrome (neurological)

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16
Q

What mechanical factors affect fracture healing?

A

Movement
Forces

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17
Q

What biological factors affect fracture healing?

A

Blood supply
Immune function
Infection
Nutrition

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18
Q

What are the causes of fractured neck of femur?

A

Osteoporosis (older)
Trauma (younger)
Combination

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19
Q

What would you ask in a history for a fractured neck of femur?

A

Age
Comorbidity
Preinjury mobility
Social hx: relatives, stairs

20
Q

Describe the different planes of displacement

A
21
Q

What’s the difference between translation, angulation, rotation and impaction?

A
22
Q

Describe the different routes for reduction

A
23
Q

Label this image

A
24
Q

Label this image with the names of the different types of NoF fracture

A
25
Q

What must be considered when managing an intracapsular NoF fracture?

A

Blood supply is more likely to be compromised
Avascular necrosis (AVN)
Non-union

26
Q

How are intra and extracapsular NoF fractures managed?

A

Extracapsular - fix
Intracapsular - fix or replace - depends on displacement and age

27
Q

What do these two images show?

A

Left - hemiarthroplasty
Right - total hip arthroplasty

28
Q

What does this x-ray show?

A

Shoulder dislocation

29
Q

How does shoulder dislocation typically present?

A

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

30
Q

What clinical examinations are done for shoulder dislocation?

A

Assessment of neurovascular status - axillary nerve

31
Q

What investigations are done for suspected shoulder dislocation?

A

X-ray prior to manipulation - identify fracture
Scapular-Y view/modified axillary in addition to AP view

32
Q

What technique should be avoided in shoulder dislocation management?

A

Vigorous manipulation or twisting - may cause fractures

33
Q

What are the safest methods for shoulder dislocation management?

A

Traction-counter traction +/- gentle internal rotation to disimpact humeral head
If alone, could use Stimson method
Ensure adequate patient relaxation - can give Entonox or benzodiazepines
Undertake in a safe environment, esp. with elderly

34
Q

What do these images show?

A

Hills-Sachs defect - posterolateral humeral head depression fracture (dent) resulting from the impaction with the glenoid rim, usually following an anterior glenohumeral dislocation
Bankart lesion - Glenoid labrum tear in the anterior joint

35
Q

What does this radiograph show?

A
36
Q

When is a cast/splint used in distal radius fracture management?

A

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

37
Q

When is a manipulation under anaesthesia (MUA) with K wire used in distal radius fracture management?

A

Fractures that are extra-articular but have instability
Typically used for children
Wires can be removed in clinic post-op

38
Q

When is open reduction internal fixation used in distal radius fracture management?

A

Displaced, unstable fractures not suitable for K-wires or with intra-articular involvement
Involves use of plate and screws

39
Q

What does this x-ray show?

A
40
Q

What does this x-ray show?

A
41
Q

What can cause a tibial plateau fracture?

A

Extreme varus/valgus force or axial loading across knee
Impaction from the femoral condyles can cause the tibial plateau to depress or split

42
Q

What may also accompany a tibial plateau fracture?

A

Concomitant ligamentous or meniscal injury

43
Q

How is a tibial plateau fracture managed?

A

Non-operative:
- Only for truly undisplaced fractures with good joint line congruency assessed on CT or high fidelity imaging
Operative:
- Majority of cases
- Restoration of articular surface using combination of plate and screws
- Bone graft or cement may be necessary to prevent further depression after fixation

44
Q

What does this x-ray show?

A
45
Q

Outline non-operative management of an ankle fracture

A

Non-weight bearing below knee cast -> 6-8 weeks
Transfer to walking boot
Then physio to improve range of motion/stiffness from joint isolation
Weber A -> below syndesmosis and therefore thought to be stable
Weber B if no evidence of instability

46
Q

Outline operative management of an ankle fracture

A

Soft tissue dependent - requires strict elevation as injuries often swell
Open reduction internal fixation +/- syndesmosis repair using either screw or tightrope technique
Weber B - unstable fractures
Weber C - fibular fracture above level of syndesmosis therefore unstable

BRS Flashcards (Y2) (79 decks)

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