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Year 2(B2) - Musculoskeletal > MSK FRACTURES - IMAGES AND QUESTIONS > Flashcards

MSK FRACTURES - IMAGES AND QUESTIONS Flashcards

1
Q

What is the management and diagnosis

A

Femoral shaft fracture- management through IM nails or plates and screws.

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2
Q

What is it and management

A

Distal femoral shaft fracture- extra articular. Manage using plate and screws (internal fixation) ORIF

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3
Q

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A

Proximal tibial fracture- intra articular. Managed through plate and screws.

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4
Q

What are tibial shaft fractures at a high risk of after initial management?

A

Compartment syndrome.

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5
Q

What is the diagnosis and how is it managed?

A

Tibial shaft fracture. Management through plates and screws or an intra-medullary rod.

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6
Q

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A

Ankle (lateral malleolus fracture)- no tallus shift. Management plate and screws.

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7
Q

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A

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.

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8
Q

What is the risk of operating on the shaft of the humerus?

A

Compression/damage to the radial nerve as it sits in the radial groove.

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9
Q

Diagnosis and management

A

Distal humerus fracture- fixed using ORIF.

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10
Q

Diagnosis and management.

A

Olecranon fracture- fix using plate and screws. Could leave if patient has low demand.

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11
Q

What is the function of the radial head?

A

Allows supination and pronation.

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12
Q

Why are you likely to get two fractures or a fracture and a dislocation in the forearm?

A

Forearm is a ringed structure- therefore when one bit breaks- likely to be pathology elsewhere.

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13
Q

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A

Radius is fractured- ulna is dislocated. This is a galeazzi fracture

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14
Q

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A

Ulna is fractured- radius has been dislocated. This is Monteggia fracture. ORIF is needed.

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15
Q

Galaezzi Fracture vs Monteggia Fracture Treatent of both?

A

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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16
Q

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A

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.

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17
Q

Complications of a Colles fracture

A

Median nerve compression. and extensor pollicis longus ruputre - late complication

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18
Q

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A

Smiths fracture- fracture of the distal radius with volar (anterior) displacement and angulation. Needs ORIF.

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19
Q

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A

Bartons fracture-intra-articular distal radius fracture with subluxation of carpal bones.

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20
Q

Define the regions in which you can get hip fractures

A

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21
Q

What is the blood supply to the femoral head?

A

Retinacular arteries and foveolar artery.

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22
Q

What is Shentons line?

A

The medial cortex of the femur should form a smooth line with the inferior aspect of the pubic ramus.

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23
Q

What is the risk of intracapsular fractures?

A

Avascular necrosis.

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24
Q

Is there a risk of AVN in extra capsular hip fractures?

A

NOPE.

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25
What treatment would you provide for an extra capsular hip fracture?
Usually heal with sliding hip screw. Can also fix with IM nail.
26
How would a pubic rami fracture present?
Tender groin and some pain on rotation (but less than you would get with a hip fracture)
27
How would you manage fractures of the greater trochanter?
Conservative management generally fine. If it transverses the femoral neck then needs internal fixation.
28
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.
29
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.
30
What is the pattern of osteoporotic lumbar fractures?
They tend to be wedged shaped.
31
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.
32
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.
33
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.
34
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
35
Name the three patterns of injury associated with pelvic fractures
A lateral compression fracture A vertical shear fracture An anterior posterior compression injury.
36
What is a lateral compression fracture of the hip?
Occurs with side impact where one half of the pelvis is displaced medially. Fractures through the pubic rami or ischium are accompanied by a sacral compression fracture or SI joint disruption.
37
What is a vertical shear fracture?
Axial force on one hemipelvis (half pelvis) is displaced superiorly. The sacral nerve roots and lumbrosacral plexus are at high risk of injury and the leg on the affected side will appear shorter.
38
What is an anteroposterior compression fracture?
A wide distribution of the pubic symphysis. Pelvis opens up like a book. Substantial bleeding occurs and the pelvis can contain litres of blood in its new expanded form.
39
In any pelvic fracture, what examination is mandatory and what are you assessing?
PR exam mandatory- to assess sacral nerve function and look for presence of blood.
40
What does the presence of blood PR after a hip fracture indicate?
A rectal tear rendering the injury an open fracture (higher risk of infection ect).
41
What is more common- an anterior shoulder dislocation or a posterior shoulder dislocation?
Anterior.
42
Colles fracture can also be known as:
Dinner fork fracture
43
Smiths fracture is a reverse ...... fracture
Colles
44
What is chondromalacea patellae?
Cartilage on the underside of the knee cap deteriorates and softens. Common in young female athletes.
45
Who do scaphoid fractures usually present in? What is the treatment?
Males falling on an outstretched hand. Treatment is usually in a cast but operative intervention may be necessary.
46
What are the risks of fracturing your scaphoid?
Blood supply to the scaphoid is tenuous and runs from distal to proximal therefore it makes the patient more likely to develop post fracture necrosis.
47
Hallmarks of a deep infection
High CRP and ESR, fever, oozing from the wound.
48
What signs are suggestive of a haematoma after a THR?
Bruising and swelling.
49
How would a leg sit if the hip had been posteriorly dislocated?
Internally rotated, abducted and flexed.
50
How would the leg sit in an anterior dislocation of the hip?
The leg is extended and externally rotated.
51
Long term use of corticosteroids is a risk factor for ...
Osteoporosis.
52
Orthopedic management of an intratrochanteric femur fracture
Dynamic hip screws
53
Orthopedic management of a pubic ramus fracture
Rarely require operative intervention unless there is pelvic instability or damage to the acetabulum. Patients should be given analgesia and active mobilisation.
54
What might a subcapital fracture of the femoral head be associated with?
Damage to the joint capsule resulting in impairment of the blood supply to the femoral head.
55
How would you repair a ruptured achilles?
Suture repair.
56
POP immobilisation is? and is good for?
Plaster of Paris. Used to treat undisplayed ankle fractures (e.g. calcaneal fractures)
57
What does chronic acidosis do to your bones?
Causes defective bone mineralisation
58
Where is hip flexion controlled from?
L2/L3
59
What is the difference between hypertrophic non union and atrophic non union?
Hypertrophic- too much movement at fracture site meaning abundant callus formed but no union. Atrophic- poor blood supply or fracture gap too big.
60
Management of intracapsular hip fractures
THR or hemiarthroplasty (if the patient has poorer function)
61
Management of extra capsular hip fractures
Dynamic hip screw.
62
Management of subtrochanteric hip fractures
Thomas splint but IM nail is superior.
63
Management of pubic rami fractures
Conservative- advise early mobility.
64
How would the presentation of someone with a pubic rami fracture differ from someone with a hip fracture?
Tender groin however less pain on external rotation than hip fractures.
65
Management of greater trochanteric fractures
Conservative.
66
Management of femoral shaft fractures
Unstable- IM nailing Stable-Possibly use Thomas splint
67
Management of intra-articular distal femur fractures
Plate and screws
68
Management of extra-articular distal femoral fractures
Very distal-plating Not too distal- nails.
69
Management of proximal tibial fractures
If high energy with substantial soft tissue damage- external fixation until soft tissues have settled then rigid fixation. Intra-articular- plate and screws
70
Management of tibial shaft fractures
Low energy- conservative High energy- IM nailing, plates and screws.
71
What is an intra-articular ankle fracture also known as?
Pilon fracture
72
Management of intra-articular ankle fractures
If significant soft tissue injury- urgent external fixation then internal fixation once soft tissues have settled.
73
Management of isolated distal fibular fractures
Conservative
74
Management of minimally displaced medial malleolus fractures
Conservative
75
Management of bimalleolar fractures
If unstable- ORIF
76
Management of taller shift
ORIF
77
Management of a proximal humeral fracture in the elderly
conservative
78
Management of a proximal humeral fracture with head splitting?
Arthroplasty
79
Management of a proximal humeral fracture in younger patients
Internal fixation
80
Management of humeral shaft fractures
Conservative unless non-union- then internal fixation
81
Management of distal humeral fractures
ORIF
82
Management of olecranon fractures
Internal fixation with wires or a plate and screws.
83
Management of radial head fractures
Minimally displaced- conservative Comminuted- replacement
84
Management of radial and ulna fractures
ORIF
85
Management of Monteggia and Galeazzi fractures
ORIF
86
Management of ulna fracture
Conservative
87
Management of Colles fracture
Stable- Reduce and splint Displaced- MUA and plaster cast Displaced and comminution- ORIF and K-wiring
88
Management of Smiths fracture
ORIF
89
Management of Bartons fracture
ORIF

Year 2(B2) - Musculoskeletal (58 decks)

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