Management of specific fractures Flashcards by Sharon Adeniran

Fracture assessment

Pain
Swelling
Crepitus
Deformity
“Collateral damage”
- Nerve
- Vessel

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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

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What are two types of displacement?

Translation - displaced bone moves in a plane
Angulation - displaced bone moves at an angle

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Describe translation in the X Y and Z planes

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

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Describe angulation in the X Y and Z planes

X - varus/vulgus // Y - internal/external rotation // Z - dorsal/volar

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Direct fracture healing

Anatomical reduction
absolute stability/compression
no callus

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Indirect fracture healing

Sufficent reduction
Micromovement
Callus

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What is a callus?

Connective tissue that forms around a fracture, will eventually solidify into bone

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What is Wolff’s Law?

Bone grows and remodels in response to forces placed around it

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What are the three stages of indirect fracture healing?

Inflammation (haematoma formation),
Repair (callus formation),
Remodelling (from external forces)

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How long do fractures take to heal

Typically 6 weeks

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What are the three stages of managing fractures?

Reduce,
Hold,
Rehabilitate

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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)

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What is the other term for open/closed reduction?

Internal (open) / External (closed) fixation

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What are some general fracture complications?

Fat embolus, DVT, infection,
Prolonged immobility can lead to utis and sores

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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)