MSK FRACTURES - IMAGES AND QUESTIONS Flashcards
What is the management and diagnosis
Femoral shaft fracture- management through IM nails or plates and screws.
What is it and management
Distal femoral shaft fracture- extra articular. Manage using plate and screws (internal fixation) ORIF
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Proximal tibial fracture- intra articular. Managed through plate and screws.
What are tibial shaft fractures at a high risk of after initial management?
Compartment syndrome.
What is the diagnosis and how is it managed?
Tibial shaft fracture. Management through plates and screws or an intra-medullary rod.
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Ankle (lateral malleolus fracture)- no tallus shift. Management plate and screws.
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Surgical neck of humerus fracture. Shaft tends to be displaced medially due to pull of pec major. Can be left to heal conservatively if patient has low work load for arm. If not- plate and screws.
What is the risk of operating on the shaft of the humerus?
Compression/damage to the radial nerve as it sits in the radial groove.
Diagnosis and management
Distal humerus fracture- fixed using ORIF.
Diagnosis and management.
Olecranon fracture- fix using plate and screws. Could leave if patient has low demand.
What is the function of the radial head?
Allows supination and pronation.
Why are you likely to get two fractures or a fracture and a dislocation in the forearm?
Forearm is a ringed structure- therefore when one bit breaks- likely to be pathology elsewhere.
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Radius is fractured- ulna is dislocated. This is a galeazzi fracture
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Ulna is fractured- radius has been dislocated. This is Monteggia fracture. ORIF is needed.
Galaezzi Fracture vs Monteggia Fracture Treatent of both?
Fracture of radius with dislocation of distal RU joint - galeazzi fracture dislocation Facture of ulna with dislocation of radius at elbow. - monteggia fracture dislocation Both treatments require ORIF
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Colles fracture- fracture of the distal radius (extra-articular) displacing anteriorly with anterior angulation. Management- reduce in patients who need their hands for a living.
Complications of a Colles fracture
Median nerve compression. and extensor pollicis longus ruputre - late complication
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Smiths fracture- fracture of the distal radius with volar (anterior) displacement and angulation. Needs ORIF.
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Bartons fracture-intra-articular distal radius fracture with subluxation of carpal bones.
Define the regions in which you can get hip fractures
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What is the blood supply to the femoral head?
Retinacular arteries and foveolar artery.
What is Shentons line?
The medial cortex of the femur should form a smooth line with the inferior aspect of the pubic ramus.
What is the risk of intracapsular fractures?
Avascular necrosis.
Is there a risk of AVN in extra capsular hip fractures?
NOPE.
What treatment would you provide for an extra capsular hip fracture?
Usually heal with sliding hip screw. Can also fix with IM nail.
How would a pubic rami fracture present?
Tender groin and some pain on rotation (but less than you would get with a hip fracture)
How would you manage fractures of the greater trochanter?
Conservative management generally fine. If it transverses the femoral neck then needs internal fixation.
How would you manage a suspected cervical spine fracture?
C-spine needs to be clinically cleared in a conscious patient- -No history of loss of consciousness -GCS 15 with no alcohol intoxication -No significant distracting injury -No neurological symptoms in the upper and lower limbs -No midline tenderness or pain in the C spine -No pain on gentle active movement.
If the patient doesn’t meet the criteria to clinically clear the C spine, what must happen?
Collar needs to remain inplace. Full trauma assessment and neurological exam needs to be carried out.
What is the pattern of osteoporotic lumbar fractures?
They tend to be wedged shaped.
When would an injury to the lumbar spine have indications for surgery?
Presence of neurological defecit Unstable injury pattern with substantial loss of vertebral height, displacement or involvement of the posterior ligament structures.
What is central cord syndrome?
Usually occurs as a hyperextension injury in the cervical spine with OA. Paralysis of the arms more than the legs occurs due to the motor fibres of the arms being more central in the cord and the legs being more peripheral.
What is anterior cord syndrome?
Loss of motor function as well as loss of coarse touch, pain and temperature sensation whilst proprioception, vibration sense and light touch are preserved.
What is Brown- Sequard syndrome?
Hemisection of the cord- results in ipsilateral paralysis and loss of sensation with contralateral loss of pain, temperature and coarse touch sensation
Name the three patterns of injury associated with pelvic fractures
A lateral compression fracture A vertical shear fracture An anterior posterior compression injury.