Management of specific fractures Flashcards
Fracture assessment
Pain
Swelling
Crepitus
Deformity
“Collateral damage”
- Nerve
- Vessel
What are the steps of describing a fracture radiograph?
Name, date, projection
LPPD:
- Location (which bone, side),
- Pieces (simple, multifragment),
- Pattern (transverse/oblique/spiral) - tells how it happened, the amount of energy that went into it
- Displacement
What are two types of displacement?
Translation - displaced bone moves in a plane
Angulation - displaced bone moves at an angle
Describe translation in the X Y and Z planes
X - anterior/posterior // Y - proximal/distal // Z - medial/lateral
Describe angulation in the X Y and Z planes
X - varus/vulgus // Y - internal/external rotation // Z - dorsal/volar
Direct fracture healing
Anatomical reduction
absolute stability/compression
no callus
Indirect fracture healing
Sufficent reduction
Micromovement
Callus
What is a callus?
Connective tissue that forms around a fracture, will eventually solidify into bone
What is Wolff’s Law?
Bone grows and remodels in response to forces placed around it
What are the three stages of indirect fracture healing?
Inflammation (haematoma formation),
Repair (callus formation),
Remodelling (from external forces)
How long do fractures take to heal
Typically 6 weeks
What are the three stages of managing fractures?
Reduce,
Hold,
Rehabilitate
What are the two types of reduction and what is the difference?
Open (reposition bone surgically), using incisions/full exposure
Closed (reposition bone without exposing), via manipulation (brace) or traction (pins)
What is the other term for open/closed reduction?
Internal (open) / External (closed) fixation
What are some general fracture complications?
Fat embolus, DVT, infection,
Prolonged immobility can lead to utis and sores
What are some specific fracture complications?
Neurovascular injury
Muscle/tendon injury
Non union/mal union
Local infection
Degenerative change (intraarticular)
Reflex sympathetic dystrophy
What are factors of the mechanical environment that affect fracture healing?
Movement and Forces
What are factors of the biological environment that affect fracture healing?
Blood supply, immune function, infection, nutrition
What is the most common cause of FNoF in younger and older patients?
Younger - Trauma // Older - Osteoporosis
What is a fractured neck of femur commonly known as?
Hip fracture
History of FNoF px
age
comorbidity
preinjury mobility
social hx
What are the four types of FNoF?
1 - Subcapital (intracapsular)
2 - Transcervical (extracapsular)
3 - Basicervical (extracapsular)
4 - Subtrochanteric/intertrochanteric
Which type of FNoF is most likely to affect blood supply?
Subcapital/Intracapsular
How would you treat FNoF extracapsular?
Internal Fixation - plate or screws
How would you treat undisplaced intracapsular FNoF?
Fixation with screws
How would you treat displaced intracapsular FNoF
under 55s? - Fixation with screws
over 55s? - Total hip replacement if fit OR Hemiarthroplasty (replace head of femur) if less fit
What is the presentation for shoulder dislocation?
Pain, Restricted movement, Loss of contour, Physical displacement
What clinical examination would you do for shoulder dislocation?
Neurovascular status - axillary nerve
How would you treat a shoulder dislocation?
Benzodiazepine to relax // Traction-Counter Traction to push back in
What complication can form from a shoulder dislocation?
Hill-Sachs Defect (dent in shoulder)
What are the signs of distal radius fracture?
Swelling and limited movement of wrist, neurovascularly intact
What are the three managements of a distal radius fracture?
Cast, minimal displacement
Wire Fixation, extra-articular but unstable
Open Reduction Internal Fixation (ORIF), displaced, unstable fractures
What is a trimalleolar fracture also known as commonly?
Ankle fracture
What is the non-operative management of malleolus fracture?
Non-weightbearing below knee cast, walking boot and physiotherapy
For stable fractures
What is an operative management of malleolus fracture?
Open reduction internal fixation, Syndesmosis repair with screws
For unstable fractures that may be above syndesmosis
What is a syndesmosis
(fibrous joint between bones)
