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Phase 1b - Musculoskeletal & Rheumatology > Management of Specific Fractures > Flashcards

Management of Specific Fractures Flashcards

1
Q

What methods are used to investigate a bone fracture (3)?

A
  • XRay (in most cases)
  • CT sometimes indicated
    • To make diagnosis
    • To assess pattern
  • MRI if unsure
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2
Q

What is used when describing a fracture radiograph (4)?

A
  • Location:
    • Which bone and which part of bone?
  • Pieces:
    • Simple / Multifragmentary
  • Pattern:
    • Transverse / Oblique / Spiral
  • Displaced / Undisplaced:
    • Translated / Angulated
    • X / Y / Z plane
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3
Q

What kind of fracture pattern is this?

A

Transverse

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4
Q

What kind of fracture pattern is this?

A

Oblique

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5
Q

What kind of fracture pattern is this?

A

Spiral

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6
Q

What kind of fracture pattern is this?

A

Comminuted

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7
Q

What kind of displacement is this?

A

Translation

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8
Q

What kind of displacement is this?

A

Angulation

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9
Q

What kind of displacement is this?

A

Rotation

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10
Q

What kind of displacement is this?

A

Impication

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11
Q

What is an impacted fracture?

A
  • One fracture is driven into the other as a result of compression
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12
Q

What is a greenstick fracture?

A
  • Partial fracture in which one side of the bone is broken
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13
Q

What is an open fracture?

A
  • A fracture in which at least one end of the bone penetrates the skin - presenting a potential risk of infection
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14
Q

What is a closed fracture?

A
  • A fracture in which the skin remains intact
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15
Q

What is the universal fracture classification?

A
  • OTA classification

OTA: Orthopaedic Trauma Association

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16
Q

What is primary bone healing?

A
  • Intermembranous healing is associated with absolute stability
    • Osteoblasts move into fracture → In primary bone healing, the bone ends are in contact therefore the osteoblasts can traverse across and bone formation is accelerated, membrane forms
      • Membrane formation behaves as a conduit for osteoblasts to pass
    • Haversian remodelling occurs in circumstances that there is a little or no gap < 500mm
    • Slow process using a cutter cone concept
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17
Q

What are the 3 phases of primary bone healing?

A
  • Inflammatory phase (Neutrophils , Macrophages) (Duration: Hours-Days)
  • Reparative phase (Fibroblasts, Osteoblasts, Chondroblasts) (Duration: Days-weeks)
  • Remodelling phase (Macrophages, Osteoclasts, Osteoblasts) (Duration: Months-years)
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18
Q

What happens during the inflammatory phase?

A
  1. Haematoma formation
  2. Release of cytokines, growth factors & prostaglandins
  3. Fracture haematoma becomes organised & infiltrated by fibrovascular tissues → Forms matrix for bone formation & primary callus
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19
Q

What is the Wolff’s Law?

A
  • States that bone grows and remodels in response to the forces that are exerted onto it
    • Placing stress in specific directions stimulate osteocyte activity
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20
Q

What are the 4 steps to managing a bone fracture?

4 Rs

A
  • Resuscitate
    • ​Save the patients life, then worry about the fracture
  • Reduce
    • Bring the bone back together in an acceptable alignment
  • Rest / Hold
    • Hold the fracture in position to prevent distortion or movement
  • Rehabilitate
    • ​Get function back and avoid stiffness
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21
Q

What are the possible ways to reduce a fracture (3C / 2O)?

A
  • Closed:
    • Manipulation
    • Skin traction
    • Skeletal traction
  • Open:
    • Mini-incision
    • Full explore
22
Q

What are the possible ways to rest a fracture (3C / 4IF / 2EF)?

A
  • Closed:
    • Plaster
    • Skin traction
    • Skeletal traction
  • Fixation:
    • Internal:
      • Intramedullary pins
      • Intramedullary nails
      • Extramedullary plate / screws
      • Extramedullary pins
    • External:
      • Monoplanar
      • Multiplanar
23
Q

What are the possible ways to rehabilitate a fracture (4)?

A
  • Use
  • Move
  • Strengthen
  • Weight bearing
24
Q

What are the possible systemic fracture complications (12)?

A
  • General:
    • Fat embolus
    • DVT
    • Infection​
  • Prolonged immobility:
    • UTI
    • Chest infection
    • Sores
  • Specific:
    • Neurovascular injury
    • Muscle / tendon injury
    • Non union / malunion
    • Local infection
    • Degenerative charge (intraarticular)
    • Reflex sympatheti dystrophy
25
Q

What factors are affecting fracture healing (6)?

26
Q

What is Type 1 NoF Fracture?

Specific fracture: NoF Fracture

A

Subcapital (intracapsular)

27
Q

What is Type 2 NoF Fracture?

Specific fracture: NoF Fracture

A

Transcervical (extracapsular)

28
Q

What is Type 3 NoF Fracture?

Specific fracture: NoF Fracture

A

Basicervical (extracapsular)

29
Q

What is Type 4 NoF Fracture (left & right)?

Specific fracture: NoF Fracture

A

Subtrochanteric (left) / 3 Part intertrochanteric (right)

30
Q

What factors determine the management of an NoF fracture?

Specific fracture: NoF Fracture

A
  • Intracapsular / Extracapsular
  • Displaced / Undisplaced
  • Age
  • Fit and Mobile / Not
31
Q

How does shoulder dislocation present?

Specific fracture: Shoulder dislocation

A
  • Variable hx (mostly direct trauma)
  • Pain
  • Restricted movement
  • Loss of normal shoulder shape / contour
32
Q

What clinical examination is conducted after a shoulder dislocation?

Specific fracture: Shoulder dislocation

A
  • Assess neurovascular status - axillary nerve
33
Q

What investigation is conducted after a shoulder dislocation?

Specific fracture: Shoulder dislocation

A
  • X-Ray prior to manipulation
34
Q

How is shoulder dislocation managed?

Specific fracture: Shoulder dislocation

A
  • Numerous techniques to reduce a dislocated shoulder
    • Vigorous manipulation or twisting manipulation should be avoided to avoid fractures
    • Safest method is to use traction-counter traction +/- gentle internal rotation to disimpact humeral head
  • Ensure adequate patient relaxation - Entonox; benzodiazepines
  • If alone could use Stimson method
  • Undertake in safe environment, especially in elderly e.g. resus, ask for senior/anaesthetic support early on if necessary
35
Q

What are the possible complications of shoulder dislocation (2)?

Specific fracture: Shoulder dislocation

36
Q

How does distal radius fracture present?

Specific fracture: Distal radius fracture

A
  • Variable hx (mostly direct trauma)
  • Pain
  • Restricted movement
  • Gross swelling
37
Q

What investigation is conducted after a distal radius fracture?

Specific fracture: Distal radius fracture

38
Q

When is cast / splint recommended for managing a distal radius fracture?

Specific fracture: Distal radius fracture

A
  • Temporary treatment for any distal radius fracture - reduction of fracture and placement into cast until definitive fixation
  • Definitive if minimally displaced, extra articular fracture
39
Q

When is MUA & K-Wire recommended for managing a distal radius fracture?

Specific fracture: Distal radius fracture

A
  • For fractures that are extra-articular but have instability, particularly in children, MUA in theatre with K-wire fixation can be used. Wires can then be removed in clinic post-op
40
Q

When is ORIF recommended for managing a distal radius fracture?

ORIF: Open Reduction Internal Fixation

Specific fracture: 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
41
Q

How does scaphoid fracture present?

Specific fracture: Scaphoid fracture

A
  • Variabl hx but often direct trauma
  • Chronic pain (>1/7)
42
Q

What investigation is conducted after after a scaphoid fracture?

Specific fracture: Scaphoid fracture

43
Q

When is Cast / Splint recommended for managing a scaphoid fracture?

Specific fracture: Scaphoid fracture

A
  • Conservative treatment for any minimal displaced fracture & placed into cast until definitive fixation
44
Q

When is ORIF recommended for managing a scaphoid fracture?

ORIF: Open Reduction Internal Fixation

Specific fracture: Scaphoid 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
45
Q

How does tibial plateau fracture present?

Specific fracture: Tibial plateau fracture

A
  • Variable hx but often direct trauma
    • Any extreme valgus/varus force or axial loading across the knee can cause a tibial plateau fracture, with impaction of the femoral condyles causing the comparatively soft bone of the tibial plateau to depress or split (Concomitant ligamentous or meniscal injury is not uncommon)
  • Chronic pain (> 4 / 24)
46
Q

What investigation is conducted after after a tibial plateau fracture?

Specific fracture: Tibial plateau fracture

47
Q

When is non-operative recommended for managing a tibial plateau fracture?

Specific fracture: Tibial plateau fracture

A
  • Only truly undisplaced fractures with good joint line congruency assessed on CT or high fidelity imaging
48
Q

When is operative recommended for managing a tibial plateau fracture?

Specific fracture: Tibial plateau fracture

A
  • Predominance of treatment will be operative

  • Restoration of articular surface using combination of plate and screws
    • Bone graft or cement may be necessary to prevent further depression after fixation
49
Q

How does an ankle fracture present?

Specific fracture: Ankle fracture

A
  • Variable hx but often direct trauma
  • Extremelly swollen
  • Dislocated
50
Q

What investigation is conducted after an ankle fracture?

Specific fracture: Ankle fracture

51
Q

What is the non-operative management for an ankle fracture?

Specific fracture: Ankle fracture

A
  • Non-weightbearing below knee cast for 6-8 weeks, can transfer into walking boot and then physiotherapy to improve range of motion/stiffness from joint isolation
    • Weber A i.e. below syndesmosis and therefore thought to be stable
    • Weber B if no evidence of instability (no medial/posterior malleolus fracture and no talar shift)
52
Q

What is the non-operative management for an ankle fracture?

Specific fracture: Ankle fracture

A
  • Soft tissue dependent - patients need strict elevation as iniuries often swell considerably
  • Open reduction internal fixation +/- syndesmosis repair using either screw or tightrope technique
  • Syndesmosis screws can be left in situ but may break after some time so therefore can be removed at a later date if necessary
    • Weber B (unstable fractures - talar shift/medial or posterior malleoli fractures)
    • Weber C i.e. fibular fracture above the level of the syndesmosis therefore unstable

Phase 1b - Musculoskeletal & Rheumatology (11 decks)

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