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Aneesha Flashcards BRS 2 > management of specific fractures > Flashcards

management of specific fractures Flashcards

1
Q

What is the difference trauma vs orthopaedics?

A

Orthopaedics- look, feel, move, Xray
Trauma- Reduce, hold (plaster, internal fixation, external fixation), rehabilitate (usually 6 weeks later

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2
Q

What are the main principles of assessing and managing trauma?

A

Fracture is usually the least important bit

Keep the patient alive first- ATLS
Airway
Breathing
Circulation
Disability

Fracture is sometimes treated as part of C or in secondary survey (Reduce, hold, rehabilitate)

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3
Q

What are the clinical signs of a fracture?

A

Pain
Swelling
Crepitus
Deformity
Collateral damage- nerves, vessels, tendons, ligaments

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4
Q

How do we investigate a fracture

A

Xray (in most cases)
CT is sometimes indicated- to make diagnosis/ to assess pattern
MRI if unsure
Bone scan

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5
Q

What features of a fracture do we discuss when describing a radiograph?

A

Location- which bone and where in that bone is the fracture located
Pieces- simple, multi fragmentary
Pattern- transverse/ oblique/ spiral
Displacement- displaced/ undisplaced/ minimally displaced
Translated/ angulated
X/Y/Z plane

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6
Q

What are translations in fractures?

A

Straight line movements

Anterior or posterior
lateral or medial
proximal or distal

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7
Q

What are angulations in fractures

A

varus/ valgus- coronal plane (away from midline)
dorsal/ volar -sagittal plane
internal rotation/ external rotation

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8
Q

What are the two ways in which a fracture can heal

A

Direct fracture healing- there is anatomical reduction, absolute compression and stability, no callus forms

Indirect fracture healing- sufficient reduction, micro movement, callus forms

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9
Q

What are the broad steps in healing?

A

Bleeding
Inflammation
Repair
Remodelling

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10
Q

What happens during the inflammation stage of healing?

A

Haematoma formation
Cytokine release
Granulation tissue and new blood vessel formation

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11
Q

What happens during the repair stage of healing?

A

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

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12
Q

What happens during the remodelling stage of healing?

A

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

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13
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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14
Q

How long does it take bone to heal?

A

6 weeks
3-12 weeks depending on the patient

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15
Q

When are signs of healing visible on Xray?

A

7-10 days

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16
Q

How long does it take for the following fractures to heal: phalanges, metacarpals, distal radius, forearm, tibia, femur?

A

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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17
Q

What are the 2 methods of fracture reduction? Give examples.

A
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18
Q

Name 3 methods of holding a fracture

A

Plaster/ splint
Internal fixation- intramedullary, extramedullary
External fixation- monoplanar, multiplanar

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19
Q

What are general complications of fractures?

A

Fat embolus (hours)
DVT (days- weeks)
PE
Infection
Prolonged immobility- UTI, chest infection, bed sores

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20
Q

Name some specific complications of fractures

A

Neurovascular injury
Muscle/ tendon injury
Non-union/ Mal-union
Local infection
Degenerative changes (intraarticular)
Reflex sympathetic dystrophy

21
Q

What factors affect fracture healing?

A

Mechanical environment- movement, forces
Biological environment- blood supply, nutrition, infection, immune function

22
Q

What causes NoF fractures?

A

Osteoporosis (older)
Trauma (younger)
Combination

23
Q

What would you want to know from the history of a person with a NoF fracture?

A

Age
Comorbidities (cardiovascular, respiratory, diabetes, cancer)
Preinjury mobility (were they independent? shopping? walking? sports?)
Social hx (relatives? stairs at home? EtOH?)

24
Q

Look at this picture of NoF anatomy son.

A

red dotted line is the attachment of the capsule along the intertrochanteric line on the front line
- On the back of the femur the capsule goes halfway up NOF
- Anything above dotted line is intracapsular and everything below it is extracapsular (there’s a half zone on the back where it’s extracapsular there but around the front it’s intracapsular)

25
Q

What types of NoF fractures are there by location?

A

Supcapital (intracapsular)
Transcervical (extra capsular)
Basicervical (extra capsular)
Subtrochanteric
Intratrochanteric

26
Q

What complications can arise from intracapsular fractures?

A
  1. Avascular necrosis- due to interruption of blood supply
    Blood supply to femoral head (mainly from medial and lateral circumflex branches of profunda femoris) goes through capsule, so neck fracture can lead to head necrosis (avascular necrosis)
  2. non-union
27
Q

What factors decide whether to fix or replace NoF fracture?

A

Location/ displacement
Age

28
Q

Management of extra capsular NoF

A

Internal fixation (with plate and screws/ nails)

29
Q

Management of intra capsular undisplaced NoF

A

Fixation with screws

30
Q

Management of intra capsular displaced NoF where patient is <55 years old

A

Reduction and fixation with screws

31
Q

Management of intra capsular displaced NoF where patient is >65 years old and fit and mobile

A

total hip replacement

32
Q

Management of intra capsular displaced NoF where patient is >65 years old and less fit

A

hemiarthroplasty

33
Q

Dislocated shoulder radiograph

A
34
Q

How would a dislocated shoulder present?

A

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

35
Q

What is an important clinical examination performed for patients present with a dislocated shoulder?

A

Assess neuromuscular status- axillary nerve

36
Q

What investigations are carried out for shoulder dislocation?

A

Xray prior to any manipulation: identify fracture (e.g. humoral neck, greater trochanter avulsion fracture, glenoid)
Scapular Y-view/ modified axillary in addition to AP

37
Q

Management for shoulder dislocations

A

There are numerous techniques for reducing a dislocated shoulder
Vigorous manipulation/ twisting manipulation should be avoided to avoid fractures
The safest method is to use traction-counter traction +/- gentle internal rotation to disimpact humeral head
If alone, could use Stimson method (using hanging weights)
ensure adequate patient relaxation e.g. entonox, benzodiazepines
Undertake in a safe environment, especially if elderly e.g. resus, ask for senior/ anaesthetic support early on if necessary.

38
Q

Name a complication of shoulder dislocation and what can this lead to?

A

Hill-Sachs defect (as humerus comes out, it bangs on glenoid and a fleck of bone comes off, called a Bankart lesion)
can lead to recurrent shoulder dislocation

39
Q

What are the three ways in which a distal radius fracture is managed?

A

Cast and splint- temporary treatment for any distal radius fracture: fracture is reduced and fixed within cast until definitive treatment. this is definitive treatment for minimally displaced, extra-articular fractures

MUA and K-wire- for fractures that are extra-articular but have instability, particularly in children. Wires can be removed in clinic post-op.

ORIF- any fracture that is displaced, unstable and unsuitable for K-wires or with intra-articular involvement can be treated with open reduction and internal fixation with plate and screws

40
Q

describe how a tibial plateau fracture can occur

A

The proximal tibia is a key weight-bearing surface and forms part of the knee joint articulating with the distal femur
The tibial surface is mostly flat, with medial and distal tibial plateaus and a central tibial spine for ligament attachment.
Any excessive varus/ valves force or axial loading across the knee can cause a tibial plateau fracture, with the impaction of the femoral condyles causing the relatively soft tissue of the tibial plateau to depress/ split
concomitant ligament/ meniscus injury is not uncommon

41
Q

Non-operative management for tibial plateau fracture

A

only done for truly undisplayed fractures with good joint line congruency assessed on CT or high fidelity imageing

reduce, hold, rehabilitate

42
Q

operative management for tibial plateau fracture

A

Predominant treatment
Articular surface is restored using a combination of plates and screws
Bone graft or cement may be necessary to prevent further depression after fixation

43
Q

What fractures make up a trimalleolar fracture?

A

Oblique (lateral) malleolus fracture- fibula
Medial malleolus fracture- tibia
Posterior malleolus fracture- tibia

44
Q

What is the most frequently fractured ankle bone

A

fibula

45
Q

Non-operative ankle fracture management

A

Non-weightbearing below knee cast for 6-8 weeks, can transfer into walking boot and then physio to improve range of motion/stiffness from joint isolation

Weber A and Weber B if no evidence of instability (no posterior/ medial malleolus fracture and no talar shift)

46
Q

Operative ankle fracture management

A

Soft-tissue dependent- patients need strict elevation as injuries often swell considerably

ORIF +/- 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 needed

Unstable Weber B and Weber C fractures

47
Q

What is a Weber A fracture

A

simple fracture to bottom part of fibula (below syndesmosis)

48
Q

What is a Weber B fracture

A

Fracture of fibula at level where it ligamentally joins to the tibia (syndesmosis)

49
Q

What is a Weber C fracture

A

Fibular fracture above level of syndersmosis (where tibia and fibula join ligamentously) therefore unstable

Aneesha Flashcards BRS 2 (47 decks)

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