Orthopaedics & Rheumatology \ Fractures and Dislocations Flashcards
What symptoms are suggestive of a fracture in a patient?
- Swelling
- pain with movement
- deformity
- functional impairment
- focal bony tenderness
If a person has a laceration of the skin over or near the fracture site, what type of fracture is it?
Open fracture
Fracture perpendicular to the shaft of bone
Transverse
Fracture line at an angle to the shaft
Oblique
A fracture with more than two fragments
Comminuted
Fracture line crosses the articular cartilage into the joint
Intra-articular
One cortex of the bone buckles without breaking, usually distal radius of ulna, often in kids
Torus
Fracture fragments are out of their usual alignment
Displaced
A gap exists between the proximal and distal segments of the fracture
Distracted
Angular deformity of a bone without a complete fracture
Greenstick
The day after a new femur fracture, a patient is found to be confused and short of breath. On examination, the patient is dyspneic and has a scattered pin-point rash. What is the most likely diagnosis?
Fat embolism syndrome
How are growth plate fractures in children classified?
- Salter-Harris fractures.
- I: physis (growth plate)
- II: metaphysis and physis
- III: epiphysis and physis
- IV: all three
- V: crush injury to physis
What Salter-Harris fractures require surgical repair to prevent future complications?
Types III, IV, and V
What are the risk factors for fracture nonunion?
- Smoking
- infection, malnutrition
- NSAID overuse
- poor immobilization
- fracture location with poor blood supply
What are the four Rs for treatment of fractures?
- Recognition
- Reduction
- Retention of reduction with a splint, cast, or fixation
- Rehabilitation
What is the risk of casting a patient directly following an acute fracture?
Affected site can swell, making the cast too tight and risking a vascular or nerve injury or compartment syndrome
What are considerations in the radiographic evaluation of a long bone fracture?
- Image joints above and below fracture site to look for dislocation
- obtain images in at least two planes at 90° to each other (AP and lateral)
What additional images should you consider in children with an extremity fracture?
Views of asymptomatic limb, since open physes can make it difficult to identify fracture
What orthopedic injuries require immediate consultation?
- Fracture with vascular injury and pelvic ring injuries
What injuries require orthopedic care within 6 hours of the initial injury?
- Hip dislocation
- open fracture
- penetrating joint injury
- compartment syndromes
What is the name for a bony projection without a secondary ossification center, where a muscle attaches?
Apophysis
What is the most commonly fractured long bone in children?
Clavicle
What is the major risk for an infant with a clavicle fracture at birth?
Brachial nerve palsy
What type of fracture is most typically associated with the following scenarios?
A child falls on an outstretched hand
- Distal radius fracture
- scaphoid fracture in older children and adolescents
Type of fracture
A 3-year-old girl refused to bend her elbow after being lifted by her hand
Radial head subluxation (Nursemaid elbow)
Type of fracture
A 24-year-old male punches a wall and fractures his right fifth metacarpal neck
Boxer fracture
A female raises her arms in self-defense, and her left arm absorbs the blow of a blunt object
Ulnar shaft fracture (Nightstick fracture)
Name the risks and/or complications associated with the Supracondylar fracture of the humerus
- Volkmann ischemic contracture
- brachial artery at risk
Risks/complications associated with mid-shaft humerus fracture
- Risk of injury to radial nerve
- —> resulting wrist drop and loss of thumb abduction
Risks/complications associated with Proximal third scaphoid fracture in hand
Avascular necrosis (AVN)/nonunion due to disruption of blood supply
Risks/complications associates with a Boxer’s fracture with skin laceration from punching someone in the jaw
- Infection with oral pathogens, such as Eikenella.
- Treat with surgical irrigation, debridement, and IV antibiotics.
Risks/complications associated with a nonpathologic fracture of proximal humerus
- Frozen shoulder (early ROM exercises when pain improves, out of sling early)
Risks/complications associate with Fifth metatarsal stress fracture
Nonunion of bone fragments
Risks/complications associated with Tibial fracture
Acute compartment syndrome
