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BRS YR2 > Management of Specific Fractures > Flashcards

Management of Specific Fractures Flashcards

1
Q

What are the main principles of Trauma management?

A
  • advanced trauma life support
  • reduce the fracture
  • hold the fracture
  • rehabilitate after healing
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2
Q

What are the main principles of Orthopaedics?

A

(LT, chronic issues)

  • history
  • examinations
  • look/feel/move
  • investigations
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3
Q

What are the clinical signs of a fracture?

A
  • pain
  • swelling
  • crepitus (clicking/cracking joints)
  • deformity
  • adjacent structural injury (nerves/vessels/ligaments/tendons)
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4
Q

What investigations can be done if a fracture is suspected?

A
  • radiograph
  • CT (to make diagnosis and assess pattern)
  • MRI
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5
Q

How do you describe a fracture?

A
  • location
  • pieces
  • pattern
  • displaced/undisplaced
  • translated/angulated
  • X/Y/Z plane
  • epiphysis present?
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6
Q

What are the different fracture patterns?

A
  • open
  • simple
  • transverse
  • comminuted
  • spiral
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7
Q

What are the different forms of displacement?

A
  • translation
  • angulation
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8
Q

How would you describe translation with the X/Y/Z planes?

A

X - medial/lateral
Y - proximal/distal
Z - anterior/posterior

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9
Q

How would you describe angulation with the X/Y/Z planes?

A

X - varus/valgus (outward/inward rotation)
Y - internal/external
Z - dorsal/volar (front/back)

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10
Q

What do the X/Y/Z planes mean with translation?

A

X - in reference to the midline (facing on)
Y - foot up from the femur
Z - from the side

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11
Q

How do fractures heal?

A

Direct or indirect fracture healing

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12
Q

What happens in the inflammation stage of indirect fracture healing?

A
  • haematoma formation
  • cytokine release
  • granulation tissue and blood vessel formation
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13
Q

What happens during the repair phase of indirect fracture healing?

A
  • Soft Callus formation (T2 collagen - cartilage)
  • Converted to Hard Callus (T1 collagen - bone)
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14
Q

What happens in the remodelling phase of indirect fracture healing?

A
  • callus responds to activity, external forces, functional demands and growth
  • excess bone is removed
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15
Q

What are the different types of ossification?

A
  • endochondral ossification
  • intramembranous ossification
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16
Q

What is Wolff’s law?

A

bone grows and remodels in response to the forces that it is placed under

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17
Q

When are the signs of healing visible on a XR?

A

7-10 days

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18
Q

What are the different types of reduction?

A
  • open
  • closed
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19
Q

What are the different types of closed reduction?

A
  • manipulation
  • traction (skin, skeletal (pins in the bone))
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20
Q

What are the different types of open reduction?

A
  • mini-incision
  • full exposure
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21
Q

What are the different types of hold?

A
  • plaster/splint
  • internal fixation
  • external fixation
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22
Q

What are the different types of internal fixation?

A
  • intramedullary (pins, nails)
  • extramedullary (plates/screws, pins)
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23
Q

What are the different types of external fixation?

A
  • monoplanar
  • multiplanar
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24
Q

What are the different types of rehabilitation?

A
  • early/late
  • weight bearing
  • physiotherapy
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25
Q

What are the different classes of fracture complications?

A
  • general
  • specifc
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26
Q

What are some examples of general complications?

A
  • fat embolus
  • DVT
  • infection
  • prolonged immobility (UTI, chest infections, sores)
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27
Q

What are some examples of specific complications?

A
  • neurovascular injury
  • muscle/tendon injury
  • non-union/mal-union
  • local infection
  • degenerative change (intraarticular)
  • reflex sympathetic dystrophy
28
Q

What factors in the mechanical environment affect tissue healing?

A
  • movement
  • forces
29
Q

What factors in the biological environment affect tissue healing?

A
  • blood supply
  • immune function
  • infection
  • nutrition
30
Q

What are the possible causes of a fractured neck of femur?

A
  • osteoporosis
  • trauma
  • combination
31
Q

What Hx should be taken when the patient has a fractured neck of femur?

A
  • age
  • co-morbidities (resp/cardio/diabetes/cancer)
  • preinjury mobility (?independent)
  • social Hx (?stairs)
32
Q

What is a concern when there is an intra-capsular neck of femur fracture?

A
  • blood supply is more likely to be compromised
33
Q

What determines whether a neck of the femur fracture should be fixed or displaced?

A
  • location (intra- or extracapsular)
  • displacement
  • age of patient
34
Q

What would be the options in a displaced, intracapsular neck of the femur fracture in a patient above 55 years old?

A

if fit and mobile:
- total hip replacement
less fit:
- hemiarthroplasty

35
Q

What is the management of an extracapsular neck of femur fracture?

A

internal fixation (plates and screws, nails)

36
Q

What would be the management in a displaced, intracapsular neck of the femur fracture in a patient less than 55 years old?

A
  • reduce
  • fixation with screws
37
Q

What would be the management in an undisplaced, intracapsular neck of the femur fracture?

A

fixation with screws

38
Q

How do shoulder dislocations present?

A
  • variable Hx but often direct trauma
  • pain
  • restricted movement
  • loss of normal shoulder controur
39
Q

What clinical examinations should be done for a suspected shoulder dislocation?

A

assess neurovascular status, axillary nerve

40
Q

What investigations should be done for a suspected shoulder dislocation?

A
  • XR prior to manipulation
  • scapular Y view/modified axillary in addition to AP
41
Q

What management is done for a shoulder dislocation?

A
  • reduce the dislocation
  • avoid vigorous/twisting manipulation
  • traction-counter traction recommended
  • etonox/benzodiazepines to keep patient relaxed
42
Q

What are the possible complications associated with a shoulder dislocation?

A

Hill-Sachs defect with a Bankart lesion (improper or rough reduction)

43
Q

When is a cast/split used in a distal radius fracture?

A
  • temporary treatment for any distal radius fracture
  • reduction of fracture and placed into a cast until definitive fixation
  • definitive if minimally displaced, extra articular fracture
44
Q

When is a MUA and k-wire used in a distal radius fracture?

A

for fractures that are extra-articular but are instable (esp in children)

45
Q

When is an open reduction with internal fixation used in a distal radius fracture?

A
  • in displaced, unstable fractures not suitable for K wires or with intra-articular involvement
46
Q

What are common complications associated with a tibial plateau fracture?

A

concomitant ligamentous or meniscal injury

47
Q

When is non-operative management of a tibial plateau fracture considered?

A

undisplaced fractures with a good joint line

48
Q

What is the operative management of a tibial plateau fracture?

A
  • 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

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

A
  • non-weight bearing knee cast for 6-8 weeks
  • transfer to a walking boot
  • physiotherapy to improve ROM/stiffness
50
Q

What is the operative management of an ankle fracture?

A
  • soft tissue dependent (elevation necessary)
  • open reduction internal fixation +/- syndesmosis repair using either screw or tightrope technique
51
Q

How do you assess and manage trauma?

A
  • keep patient alive first - ABCD
  • airway, breathing, circulation, disability
52
Q

What are the features of direct fracture healing?

A
  • anatomical reduction
  • absolute stability/compression
  • no callus
53
Q

What are the features of indirect fracture healing?

A
  • sufficient reduction
  • micromovement
  • callus
54
Q

What is the normal time for bone healing?

A

6 weeks

55
Q

What is the range in bone healing time?

A

3-12 weeks

56
Q

How long do the phalanges take to heal?

A

3 weeks

57
Q

How long do the metacarpals and distal radius take to heal?

A

4-6 weeks

58
Q

How long does the forearm take to heal?

A

8-10 weeks

59
Q

How long does the tibia take to heal?

A

10 weeks

60
Q

How long does the femur take to heal?

A

12 weeks

61
Q

What is this fracture called?

A

Subcapital (intracapsular)

62
Q

What is this fracture called?

A

Transcervicular (extracapsular)

63
Q

What is this fracture called?

A

Basicervical (extracapsular)

64
Q

What are these fractures called?

A

Subtrochanteric and intertrochanteric

65
Q

Label this diagram

A
  1. Coracoid
  2. Glenoid
  3. Acromion
  4. Humerus (normal position)
  5. Displaced humerus
  6. Scapula
  7. Clavicle
66
Q

What are the three stages of indirect fracture healing?

A
  1. inflammation
  2. repair
  3. remodelling

BRS YR2 (67 decks)

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