Orthopaedics Flashcards
what are certain types of fractures?
acc to cause
insufficiency fracture — due to metabolic or genetics
stress fracture
pathological fracture
Fragility fracture
acc to exposure to external environment
open
closed
acc to pattern of fracture
green stick
comminuted
avulsion
transverse
oblique
spiral
acc to anatomy
how would you approach a patient coming in with a fracture?
Start with a Hx & Exam
if it looks like a life or limb threatening injury or if there is major trauma = activate the ATLS protocol
includes putting on a cervical collar if needed; if there’s suspected pelvic fractures, put on a pelvic binder etc
for the Hx i would do a targetted Hx at least — AMPLE
A: allergies
M: Meds
P: PMH, PSH
L: Last meal
E: events leading to injury — mechanism
for Exam
do the relevant physical exam for the joint — look feel move + special tests
neurovascular exam — check for distal pulses, cap refill, motor function & sensation
order x-rays
2 view: AP and lateral
3 joints: affected joint + joint above & below
reduce the fracture if it is displaced
immobilise joint — using a cast or splint (eg. backslab) temporarily
permanent options would be surgery for internal or external fixation if needed
ensure sufficient analgesia — ice and elevate joint as well
if open fracture = Abx & tetanus jab
what is the arterial supply to the hip and why is it important to know?
the dominant supply of the hip is the trochanteric anastomosis lying around the greater trochanter.
there are 2 main arteries, the ascending branch of medial circumflex A and ascending branch of lateral circumflex A
there are 2 other arteries, inferior gluteal A and descending branch of superior gluteal A.
it is important as a NOF# can disrupt the medial & lateral circumflex arteries, such that even if the fracture is fixed, due to disrupted blood supply, avascular necrosis will occur
what are the risk factors for hip fractures
osteoporosis/osteopaenia
DM
recurrent falls
tobacco & alcohol use
caucasian
how do you classify NOF#?
intracapsular vs extracapsular fractures
intracapsular:
(superior most)
subcapital
transcervical
basicervical
(inferior most)
extracapsular:
intertrochanteric
subtrochanteric — within 1st 5cm below lesser trochanter
what classification system is used for intracapsular NOF#?
Garden Classification
Garden Stage I: undisplaced + incomplete
II: complete + undisplaced
III: complete + incompletely displaced
IV: complete + completely displaced
How do you Tx intracapsular NOF# vs extracapsular NOF#
blablabla
for intracapsular NOF#:
surgical tx — acc to garden classification (reflect likelihood of disturbance to blood supply)
if undisplaced (ie stage I or II) = fix bone rather than replace it
cannulation screws or DHS dynamic hip screws + derotation screws
if displaced (ie stage III or IV)
if young = same as undisplaced
if elderly = joint replacement
hemiarthoplasty — if <5 yr expected survival or highly co-morbid patient
total arthroplasty — if 5-15 yr expected survival or highly active & independent
for extracapsular NOF#:
DHS or intramedullary nail +/- recon nail
what are some complications of joint replacement?
intra-op
surgical failure — fracture persists
nerve injury
vascular injury
cement related hypotension
early post-op
anaemia
infection
dislocation
VTE
limb length discrepancy
late post-op!!
osteolysis
aseptic loosening
periprosthetic fracture
heterotropic fracture
what are some complications of NOF#
avascular necrosis
risk factors: displacement (Garden III or IV), surgery delay, non-anatomical reduction
only 30% of AVNs require intervention
non-union
how do you check a pelvic x-ray for a fracture
go along the Shenton’s Line to check for any disruption — from the femur shaft to inferior femoral neck to inferior border superior pubic ramus
if disruption = fracture of femur or pubic rami
what are the ligaments of the knee?
patellar lig
MCL medial collateral lig
ACL anterior cruciate lig — prevents posterior displacement of femur on tibia
PCL posterior cruciate lig — prevents anterior displacement
which meniscus is more commonly torn?
medial meniscus — as it is attached to MCL medial collateral lig
which are the rotator cuff muscles and which muscles attach to the greater tuberosity?
supraspinatus – for 1st 15 degrees of abduction
infraspinatus
teres minor
subscapularis
supraspinatus, infraspinatus, teres minor attach to greater tuberosity
subscapularis attach to lesser tuberosity
