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!!!!! BRS YR2 !!!!! > MSK - Management of Specific Fractures > Flashcards

MSK - Management of Specific Fractures Flashcards

1
Q

What are the main clinical signs of a fracture?

A
  • Pain
  • Swelling
  • Crepitus
  • Deformity
  • Adjacent structural injury: Nerves/vessels/ligament/tendons
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2
Q

What is crepitus?

A

A grating or crackling sound due to the friction between bone + bone or bone + cartilage

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3
Q

What are the different ways of imaging a fracture?

A

Radiograph (X-ray)
Bone scan
CT scan
MRI scan

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4
Q

Name the modality of this imaging.

A

Radiograph (X-ray)

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5
Q

Name the modality of this imaging.

A

Radiograph (X-ray)

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6
Q

Name the modality of this imaging.

A

CT scan

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7
Q

Name the modality of this imaging.

A

MRI scan

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8
Q

Name the modality of this imaging.

A

Bone scan

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9
Q

How do you describe a fracture on a radiograph? What are you looking for?

A
  • Location: which bone and which part of bone?
  • Pieces: simple/multifragmentary?
  • Pattern: transverse/oblique/spiral
  • Displaced/undisplaced?
  • Translated/angulated?
  • X/Y/Zplane
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10
Q

What are the main patterns of fractures?

A
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11
Q

What are the 2 types of displacement?

A

Translated

Angulated

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12
Q

What are the different planes of translation?

A
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13
Q

What are the different planes of angulation?

A
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14
Q

What are the 2 main types of bone healing?

A

Intermembranous healing

Endochondral healing

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15
Q

What are the general principles of tissue healing? What cells are involved?

A

Bleeding (blood)
Inflammation (neutrophils, macrophages)
New tissue formation (fibroblasts, osteoblasts, chondroblasts)
Remodelling (macrophages, osteoclasts, osteoblasts)

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16
Q

What are the 3 main steps of fracture healing?

A

Inflammation
Repair
Remodelling

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17
Q

What is involved in the inflammation stage of fracture healing?

A

Haematoma formation
Release of cytokines
Granulation tissue and blood vessel formation

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18
Q

What is involved in the repair phase of fracture healing?

A

Soft callus formation (Type II Collagen - Cartilage)

Converted to Hard callus (Type I Collagen - Bone)

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19
Q

What is involved in the remodelling phase of fracture healing?

A

Callus responds to activity, external forces, functional demands and growth
Excess bone is removed

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20
Q

What is Wolff’s law?

A

Bone grows and remodels in response to the forces that are placed upon it

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21
Q

What is primary bone healing?

A

Intramembranous healing

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22
Q

What is secondary bone healing?

A

Endochondral healing

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23
Q

What are the features of intramembranous healing?

A

Absolute stability

Direct to woven bone

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24
Q

What are the features of endochondral healing

A

Involves responses in the periosteum and external soft tissue
Relative stability
More callus

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25
Q

What is the average fracture healing time for the phalanges?

A

3 weeks

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26
Q

What is the average fracture healing time for metacarpals?

A

4-6 weeks

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27
Q

What is the average healing time for distal radius?

A

4-6 weeks

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28
Q

What is the average healing time for a fracture in the forearm?

A

8-10 weeks

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29
Q

What is the average fracture healing time for tibia?

A

10 weeks

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30
Q

What is the average fracture healing time for the femur?

A

12 weeks

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31
Q

What are the general steps to managing a fracture?

A

Reduce
Hold
Rehabilitate

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32
Q

What are the different options and pathways possible in reduction?

A
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33
Q

What are the different options and pathways involved in the ‘hold’?

A
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34
Q

What are the different options and pathways involved in fixation?

A
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35
Q

What are the different options and pathways in rehabilitation?

A
36
Q

What type of fixation is this?

A

Internal Extramedullary

37
Q

What type of fixation is this?

A

Plaster (external fixation)

38
Q

What type of fixation is this?

A

External monoplanar

39
Q

What type of fixation is this?

A

External multiplanar

40
Q

What type of fixation is this?

A

Internal intramedullary

41
Q

What are some general fracture complications?

A

Fat embolus
DVT
Infection
Prolonged immobility (UTI, chest infections, sores)

42
Q

What are the specific fracture complications at the site of fracture?

A 
Neurovascular injury
Muscle / tendon injury
Non-union / mal-union
Local infection
Degenerative change (intra-articular)
Reflex sympathetic dystrophy
43
Q

What factors in the mechanical environment affect tissue healing?

A

Movement

Forces

44
Q

What factors in the biological environment affect tissue healing?

A

Blood supply
Immune function
Infection
Nutrition

45
Q

What are common causes of fractured neck of femur?

A

Osteoporosis (older)
Trauma (younger)
Combination of both

46
Q

What do you look for in the history in a neck of femur fracture?

A

Age
Comorbidities (resp, cvd, diabetes, cancer)
Pre-injury mobility independent, shopping, walking, sports
Social history (relatives, stairs, alcohol history)

47
Q

Name these parts of the femur.

A 
A = head of femur
B = neck of femur
C = lesser trochanter
D = greater trochanter
48
Q

Name the structures here.

A
49
Q

Identify whether these fractures are intracapsular or extra capsular.

A
50
Q

Which of these fractures is displaced?

A

Radiograph 2

51
Q

What is the risk of compromised blood supply and AVN with extracapsular fractures?

A

Minimal risk to blood supply and AVN

52
Q

How do you treat an extracapsular NoF fracture?

A

Fix with plate and screws (dynamic hip screw)

Usually doesn’t need replacement

53
Q

What is the risk of compromising blood supply and AVN with intracapsular fractures?

A

Undisplaced = less risk to blood supply

If displaced = higher risk of compromising blood supply, 25-30% risk of AVN

54
Q

How do you treat a displaced intracapsular fracture?

A

Replace in older patients (age > 55)

Fix in young

55
Q

How do you treat an undisplaced intracapsular NoF fracture?

A

Fix with screws

56
Q

What are the 2 ways in which you can do a hip replacement?

A

Total hip replacement

Hemiarthroplasty

57
Q

What is a total hip replacement?

A

Replace the femoral head and the acetabulum with prostheses

58
Q

What is a hemiarthroplasty?

A

Replace just the femoral head (however metal head will rub against the socket)

59
Q

When is a total hip replacement preferred over a hemiarthroplasty?

A

Patients walk more than a mile a day
Independent
Minimal comorbidities

60
Q

When is a hemiarthroplasty preferred over a total hip replacement?

A

Patients with :
Low mobility
Multiple comorbidities

61
Q

What is the general blueprint to treating any patient that has a NoF fracture?

A
62
Q

What does this X-ray show?

A
63
Q

How do those with a shoulder dislocation normally present?

A

Variable history but often direct trauma
Pain
Restricted movement
Loss of normal shoulder contour

64
Q

What should be clinically examined in a shoulder dislocation?

A

Assess neurovascular status - axillary nerve

65
Q

What investigations can be done for a shoulder dislocation?

A

X-ray prior to any manipulation
Identify the fracture
Take scapular Y-view / modified axillary in addition to AP

66
Q

How do you manage a shoulder dislocation?

A
67
Q

What are the possible complications of a shoulder dislocation?

A

Hill-Sachs defect = humeral head ‘collides’ with the anterior part of the glenoid, causing a lesion
Bankart lesion = some of the glenoid bone is broken off with the anterior labrum

68
Q

What do these x-rays show?

A
69
Q

What are the 3 ways in which you manage a distal radius fracture?

A

Cast/splint
MUA + K-wire
ORIF

70
Q

When is a cast / splint used to manage a distal radius fracture? What is this method?

A

Temporary treatment for any distal radius fracture
Reduction of fracture and placement into cast until definitive fixation
Used if minimally displaced, extra-articular fracture

71
Q

What is the MUA + K-wire method and when is it used to manage a distal radius fracture?

A

MUA in theatre with K-wire fixation, wires are removed in clinic post-op
Used when fractures are extra-articulated but have instability, particularly in children

72
Q

What is ORIF and when is it used to manage a distal radius fracture?

A

ORIF = open reduction + internal fixation with plate and screws
Used for any displaced, unstable fractures not suitable for K-wires, or with any intra-articular involvement

73
Q

What does this x-ray show?

A
74
Q

What does this x-ray show?

A
75
Q

What is the pathophysiology of a tibial plateau fracture?

A
76
Q

What other injuries are common with tibial plateau fracture?

A

Concomitant ligamentous or meniscal injury

77
Q

When do you manage a tibial plateau fracture non-operatively?

A

Only truly undisplaced fractures with good joint line congruency assed on CT or high fidelity imaging

78
Q

How do you manage a tibial plateau fracture operatively?

A

Restoration of articular surface using combination of plate + screws
Bone graft or cement may be necessary to prevent further depression after fixation

79
Q

What does this x-ray show?

A
80
Q

What are the Weber classifications of ankle fractures?

A

Weber A
Weber B
Weber C

81
Q

What is a Weber A ankle fracture?

A

describes a fracture of the lateral malleolus distal to the syndesmosis (the connection between the distal ends of the tibia and fibula)

  • Below the level of the tibial plafond (syndesmosis)
  • Tibiofibular syndesmosis intact
  • Deltoid ligament intact
  • Occasional oblique or vertical medial malleolus fracture
82
Q

What is a Weber B ankle fracture?

A

fracture at the level of the tibial plafond (syndesmosis). Fracture of the fibula at the level of the syndesmosis.

  • At the level of the ankle joint, extending proximally in an oblique fashion up the fibula
  • Tibiofibular syndesmosis intact or only partially torn, but no widening of the distal tibiofibular articulation
  • Medial malleolus may be fractured or deltoid ligament may be torn
83
Q

What is a Weber C fracture?

A

fracture proximal to the level of the tibial plafond and often have an associated syndesmotic injury

  • Above the level of the ankle joint
  • Tibiofibular syndesmosis injured with widening of the distal tibiofibular articulation
  • Medial malleolus fracture or deltoid ligament injury may be present.
84
Q

What is the non-operative manage t for ankle fracture?

A

Non-weight bearing, below the knew cast for 6-8 weeks

Can transfer to walking boot and then physiotherapy to improve range of motion and stiffness from joint isolation

85
Q

When is the non-operative management for an ankle fracture used?

A

Weber A i.e. below syndesmosis and therefore thought to be stable
Weber B is no evidence of instability (no medial / posterior malleolus fracture and talar shift)

86
Q

What is the operative management for an ankle fracture?

A

Soft tissue dependent - patients need strict elevation as injuries often swell considerably
ORIF +/- syndesmosis repair using screw or tightrope technique
Syndesmosis screws can be left in situ but may break after some time so therefore can be removed at a later date if necessary

87
Q

When is the operative management for ankle fracture used?

A 
Weber B (unstable fracture - talar shift/medial or posterior malleoli fractures)
Weber C (very unstable so necessary )

!!!!! BRS YR2 !!!!! (72 decks)

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