Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

brs (phase 1b) > (msk) management of specific fractures > Flashcards

(msk) management of specific fractures Flashcards

1
Q

what are the general principles of trauma?

A

ATLS (advance trauma life support)

reduce

hold

rehabilitate (move)

e.g. response to emergency broken bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the general principles of orthopaedics?

A

history

examination
(look, feel, move)

investigations

e.g. response to arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the clinical signs of a fracture?

A

pain

swelling

crepitus (crunching bw broken bones)

deformity

adjacent structural injury (nerves, vessels, ligaments, tendons)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

which radiological investigations can be carried out for a fracture?

A

radiograph/X-ray = most common

bone scan

CT scan

MRI scan

(latter 3 are more expensive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how is a fracture radiograph described?

A

1) LOCATION - which bone and which part of bone? (diaphysis, metaphysis, epiphysis)
2) PIECES - simple/multifragmentary?
3) PATTERN - transverse/oblique/spiral
4) EXTENT of movement - displaced/undisplaced?
5) DIRECTION of movement - translated/angulated?
6) X/Y/Z plane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the ways in which a fracture can be translated?

A 
X = medial/lateral
Y = proximal/distal
Z = anterior/posterior
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the ways in which a fracture can be angulated?

A 
X = valgus/varus
Y = internal/external rotation
Z = dorsal/volar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

wich plane of motion does valgus/varus angulation take place?

A

coronal plane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

wich plane of motion does internal/external rotation angulation take place?

A

axial plane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

which plane of motion does dorsal/volar angulation take place?

A

sagittal plane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the four steps to fracture healing?

A

bleeding

inflammation

proliferation (i.e. soft and then hard callus formation)

remodelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

briefly explain the process of fracture healing

A

bone breaks

haematoma formation brings inflammatory mediators, cytokines, neutrophils & macrophages with it

= induce inflammation

fibroblasts, chondroblasts, osteoblasts fill the region and form a soft callus made primarily of cartilage (type II collagen)

cartilage eventually replaced by bone gradually, forming a hard callus (type I collagen)

hard callus responds to activity, external forces, functional demands and growth + excess bone is removed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

why is haematoma formation important in fracture healing?

A

bleeding brings with inflammatory mediators, cytokines, neutrophils and macrophages with it to stimulate inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

which cells are responsible for soft callus formation?

A

mesenchymal stem cells differentiate into the fibroblasts, chondroblasts, and osteoblasts responsible for soft callus formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

differentiate between soft and hard callus

A

soft callus is made up of cartilage primarily (type II collagen)

hard callus is made up of bone primarily (type I collagen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

why don’t displaced fractures heal very well and how can this be overcome?

A

the distance between the fractured portions of bone is much larger and so it is much harder for soft callus to form

= displaced fractures need to be reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how does soft callus become hard callus?

A

when the cartilage of soft callus is replaced by bone via intramembranous or endochondral ossification = hard callus formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how does a fractured bone gradually return to its original shape?

A

when the hard callus formed is placed under environmental stresses and external forces, the bone is remodelled

excess bone is removed and the fracture site is smoothed and sculpted until it looks much more normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how long does each stage of fracture healing take?

A

tissue destruction & haematoma formation

inflammation (1 week)

soft callus formation (week 2-3)

hard callus formation (week 4-12)

remodelling (months to years)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is Wolff’s law?

A

the idea that bone grows and remodels in response to the forces that are placed on it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

in each stage of fracture healing, what type of tissue is present?

A

bleeding = haematoma

inflammation = granulation tissue

soft callus formation = fibrocartilagenous tissue

hard callus = bone tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the two types of bone healing?

A

primary bone healing = intramembranous healing

secondary bone healing = endochondral healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is intramembranous (primary) bone healing?

A

involves a direct attempt by cortex to re-establish itself after a fracture WITHOUT formation of a fracture callus

(response only in the bone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is endochondral (secondary) bone healing?

A

classical stages of injury: bleeding, inflammation, soft & hard callus formation, remodelling

(responses in the periosteum & soft tissue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

when does intramembranous (primary) bone healing take place?

A

when the fracture edges are closely approximated and held there without much motion
e.g. after surgical plating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

when does endochondral (secondary) bone healing take place?

A

when the ends of the fractured bones are near enough to heal but not perfectly opposed, or when there is some motion at the fracture site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

differentiate between primary and secondary bone healing

A

primary intramembranous healing =

  • absolute stability
  • involves a direct attempt by cortex to re-establish itself after interruption WITHOUT formation of a periosteal fracture callus

secondary endochondral healing =

  • relative stability
  • classical stages of injury: bleeding, inflammation, soft & hard callus formation, remodelling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

when are signs of healing visible on an X-ray?

A

approx 7-10 days after fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what happens when the fracture edges are too far apart or if there is too much motion at the fracture site?

A

unless the fracture is reduced, the fracture will not heal at all

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

differentiate between primary and secondary bone healing

A

primary bone healing =

  • absolute stability
  • fracture edges closely approximated
  • little/no movement at the site of fracture
  • no fracture callus formation

secondary bone healing =

  • relative stability
  • fracture edges not as closely approximated
  • some movement at the site of fracture
  • fracture callus formation occurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

how long does fracture healing take?

A

usually 3-12 weeks depending on site of fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

how long do phalanges normally take to heal?

A

approx 3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

how long do metacarpals normally take to heal?

A

approx 4-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

how long does the distal radius normally take to heal?

A

approx 4-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

how long does the forearm normally take to heal?

A

approx 8-10 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

how long does the tibia normally take to heal?

A

approx 10 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

how long does the femur normally take to heal?

A

approx 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what do bone healing times depend on?

A

age, comorbidities etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what heals faster: upper or lower limb?

A

usually the upper limb heals faster than the lower limb

hands > feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what are the three stages of fracture management?

A

reduce (closed/open)

hold (metal/no metal)

rehabilitate (move, use, physiotherapy, strengthen/weight-bear)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what is fracture reduction?

A

realignment of bone to prevent deformities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what are the types of fracture reduction?

A

open reduction

closed reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what are the types of closed reduction?

A

manipulation (pulling on skin)

traction = skin traction OR skeletal traction (using pins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what are the types of open reduction?

A

mini-incision

full exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what is fracture holding?

A

holding the fracture either with or without metal

46
Q

what are the types of fracture holding?

A

fixation = with metal

closed = without metal

47
Q

what are the types of closed fracture holding?

A

plaster

traction = skin, skeletal

48
Q

what is fracture fixation?

A

stabilising the fracture using metal

49
Q

what is internal fixation?

A

stabilising the fracture with metal under the skin

50
Q

what is external fixation?

A

stabilising the fracture with metal outside the skin

51
Q

what are the types of internal fixation?

A

intramedullary fixation

extramedullary fixation

52
Q

what are the types of external fixation?

A

monoplanar

multiplanar

53
Q

define intramedullary fixation

A

stabilising the fracture by placing metal in the canal of the bone

54
Q

define extramedullary fixation

A

stabilising the fracture by placing metal on the cortex/surface of the bone

55
Q

give examples of intramedullary fixation

A

pins, nails

56
Q

give examples of extramedullary fixation

A

plates, screws, pins

57
Q

what does fracture rehabilitation include?

A

use (pain-relief, retrain)

move

physiotherapy

strengthen

weight-bear (especially if lower limb)

58
Q

define general and specific fracture complications

A

general = complications away from the site of fracture

specific = complications at the site of fracture

59
Q

how can fracture complications be classified based on time?

A

immediate = within first 24 hours of fracture

early = within 30 days of fracture

late = after first 30 days of fracture

60
Q

give examples of general fracture complications

A

fat embolus

deep vein thrombosis

infection

prolonged immobility can cause chest infections, sores, UTIs

61
Q

give examples of specific fracture complications

A

neurovascular injury (e.g. avascular necrosis)

muscle/tendon injury (e.g. compartment syndrome)

local infection

non-union/malunion

degenerative changes

reflex sympathetic dystrophy

62
Q

list factors that affect tissue healing

A

mechanical environment:

  • movement
  • surrounding, external forces

biological environment:

  • blood supply
  • immune function
  • infection present?
  • nutrition
63
Q

list factors that affect tissue healing

A

mechanical:

  • movement
  • surrounding, external forces

biological:

  • blood supply
  • immune function
  • infection present?
  • nutrition
64
Q

what are the main causes of a neck of femur fracture?

A

osteoporosis (elderly patients)

trauma (younger patients)

65
Q

what do we want to elicit in a history from a NoF fracture patient?

A

age

comorbidities

pre-injury mobility (independence, walking status)

social history (physical home environment, relatives, drug/alcohol, lifestyle)

66
Q

in NoF fractures, how are the boundaries of intra/extracapsular fractures different anteriorly and posteriorly?

A

anteriorly = line separating the capsules in on the intertrochanteric line so all of the femoral neck anteriorly is intracapsular

posteriorly = line separating the capsules is approx the midpoint of the femoral neck so the upper femoral neck is intracapsular and everything below is extracapsular

(use posterior line more often to determine intra/extracapsular!)

67
Q

why are intracapsular NoF fractures more dangerous?

A

within the capsule
= more significant blood supply that provides blood to the femoral head

so intracapsular fracture can impair blood supply to a greater extent (increased risk of avascular necrosis of femoral head)

68
Q

what is avascular necrosis?

A

bone death due to lack of blood supply

increased risk of this in intracapsular NoF fractures

69
Q

how is an extracapsular NoF fracture managed (fix/replace) and why?

A

internal fixation (w screws/plate/pins) = dynamic hip screw

as fracture is extracapsular, minimal risk to the blood supply to the femoral head + minimal risk of avascular necrosis

70
Q

how is an intracapsular NoF fracture managed (fix/replace) and why?

A

if non-displaced = risk of avascular necrosis still relatively lower as most of the blood supply is intact so = internal fixation

if displaced = risk of avascular necrosis much higher as most of the blood supply is impaired so = hip replacement

(replace in older patients, fix in young)

71
Q

what are the two ways in which a displaced intracapsular fracture is replaced?

A

1) total arthroplasty

2) hemiarthroplasty

72
Q

what determines if you carry out a total arthroplasty or a hemiarthroplasty?

A

level of mobility of a patient + comorbidities

i.e. more mobile + less comorbid the patient is, more likely to do a total arthroplasty

73
Q

what is a total arthroplasty?

A

complete replacement of the acetabulum and the femoral head with a prosthesis

74
Q

what is a hemi-arthroplasty?

A

replacement of only the femoral head with a prosthesis

acetabulum is left as bone

75
Q

in which category of patients is a total arthroplasty indicated?

A

1) more mobile + independent

2) fewer/no comorbidities

76
Q

in which category of patients is a hemiarthroplasty indicated?

A

1) less mobile

2) multiple comorbidities

77
Q

how is an undisplaced intracapsular NoF fracture managed?

A

internal fixation with screws

78
Q

how is a displaced intracapsular NoF fracture managed?

A

if young + fit (<55)
= reduce + internal fixation w screws

if older (>65)
= depending on mobility, total or hemiarthroplasty
79
Q

how do patients with a dislocated shoulder present?

A

pain, swelling

restricted movement

loss of normal shoulder contour

(most commonly caused by trauma)

80
Q

what must you assess when examining a dislocated shoulder?

A

neurovascular status (e.g. axillary nerve)

+ other surrounding structures like the nerve, muscle, tendons, ligaments and vessels

81
Q

what is the primary investigation that is done for a dislocated shoulder?

A

plain X-ray (AP)

can also do a scapular Y-view or a modified axillary X-ray

82
Q

how is a shoulder dislocation managed?

A

1) avoid aggressive/vigorous twisting manipulations as these can risk fractures
2) ensure patient is sufficiently relaxed (administer bendodiazepines, entonox)
3) carry out reduction is a safe environment w adequate support

  • safest method: traction-counter traction method w gentle internal rotation
  • if alone, then Stimson method can be used
83
Q

what three things must you ensure before reducing a dislocated shoulder?

A

1) avoid aggressive/vigorous twisting manipulations as these can risk fractures
2) ensure patient is sufficiently relaxed (administer bendodiazepines, entonox)
3) carry out reduction is a safe environment w adequate support

84
Q

which shoulder reduction techniques are used primarily to manage a shoulder dislocation?

A

safest method: traction-counter traction method w gentle internal rotation
BUT
if alone, then Stimson method can be used

85
Q

what are two possible complications of shoulder dislocations?

A

1) Hill-Sachs defect

2) Bankart lesions

86
Q

what is a Hill-Sachs defect?

A

when the shoulder becomes anteriorly dislocated, the humerus can push onto the glenoid bone, creating an indent/impression on the humoral head = Hill-Sachs defect

87
Q

what is a Bankart lesion?

A

when the shoulder is anteriorly dislocated, the movement of the humerus causes

1) a tear in the glenoid labrum = labral tear/Bankart lesion
2) a portion of the glenoid bone to be smashed off the main segment = bony Bankart lesion

88
Q

differentiate between a Bankart lesion and a bony Bankart lesion

A

a Bankart lesion occurs when the humerus dislocates and tears part of the glenoid labrum

a bony Bankart lesion occurs when the dislocation of the humerus smashes a portion of the glenoid bone off the main segment

89
Q

why are Hill-Sachs defect and Bankart lesions problematic and how can they be addressed?

A

the compromise the stability of the glenohumeral shoulder joint, facilitating shoulder dislocations

= recurrent dislocations occur, which needs to be corrected by surgery

90
Q

differentiate between extra-articular and intra-articular fractures

A

extra-articular = fracture line does NOT extend into the joint

intra-articular = fracture line does extend into the joint; more serious

91
Q

what are the three ways in which a fracture of the distal radius is managed?

A

1) cast/splint
2) K-wire or mUA
3) ORIF

92
Q

when is a plaster indicated for a distal radius fracture?

A

minimally displaced, fairly stable, extra-articular fracture

plaster still used to hold fracture after reduction and before fixation

93
Q

when is K-wire fixation indicated for a distal radius fracture?

A

displaced, unstable, extra-articular fractures

94
Q

what is ORIF?

A

open reduction and internal fixation (with plate/screws)

95
Q

when is ORIF with plate or screws indicated for a distal radius fracture?

A

displaced, unstable intra-articular fractures OR extra-articular where K-wires cannot be used

96
Q

what are K-wires?

A

Kirschner wires

thin wires, which are pushed or drilled into the bone across the break to keep both sides stable while healing goes on

(wires removed in the post-op clinic)

97
Q

what is MUA?

A

manipulation under anaesthetic

e.g. anaesthetic is usually given for K-wire fixation

98
Q

what is a lipohemarthrosis?

A

results from an intra-articular fracture with escape of fat and blood from the bone marrow into the joint

(frequently seen in tibial plateau/distal femoral fractures)

99
Q

what is lipohemarthrosis pathognomonic of?

A

fracture of a joint nearby

100
Q

what can cause a tibial plateau fracture?

A

any extreme valgus/varus force OR axial loading across the knee

101
Q

what can impaction of the femoral condyles cause?

A

can cause the comparatively soft bone of the tibial plateau to depress or split

102
Q

which injuries can occur alongside a tibial plateau fracture?

A

ligamentous or meniscal injury

103
Q

when are tibial plateau fractures managed non-operatively?

A

when the fracture is undisplaced/minimally displaced with a good joint line congruency

104
Q

how are tibial plateau fractures managed operatively?

A

1) internal fixation with screws and plates to restore joint

2) may need bone graft or cement to prevent further depression after fixation

105
Q

why may a bone graft be needed after internal fixation of a tibial plateau fracture?

A

the bone of the tibial plateau is relatively soft

= to prevent further depression of the plateau that can be caused by impaction of the femoral condyles, bone graft is placed

106
Q

what is the non-operative management of an ankle fracture?

A

1) non weight-bearing below the knee for 6-8 weeks in a cast
2) walking boot
3) physiotherapy to improve range of motion/stiffness

107
Q

what are the classifications of ankle fractures?

A

Weber A = below syndesmosis so thought to be stable

Weber B = at the level of the syndesmosis

Weber C = fibular fracture above the level of the syndesmosis therefore unstable

108
Q

which ankle structure is ankle fracture categorisation (Weber system) based on?

A

distal tibiofibular syndesmosis

below = weber A; at the level = weber B; above = weber C

109
Q

what is the operative management of an ankle fracture?

A

1) ankles can swell considerably due to fracture = strict elevation
2) ORIF + syndesmosis repair with screws or tightrope technique

(syndesmosis screws can be left in situ and broken and removed later)

110
Q

how can ankle swelling due to an ankle fracture be addressed?

A

strict elevation

= keeping your foot raised helps decrease pain and swelling

111
Q

how can ankle swelling due to an ankle fracture be addressed?

A

strict elevation

= keeping your foot raised helps decrease pain and swelling

brs (phase 1b) (71 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions