orthopedics Flashcards
definition of a fracture
it is a break in the continuity of the bone or cartilage
what will you observe in your physical examination that would make you suspicious of a fracture?
inspection- deformity
palpation - boney tenderness, pain
movement- loss of function, abnormal movement
What is the management of a open fracture
- ABC
- circulation control bleeding with pressure dressing removing any foreign debris
- immobilization of the joint and splinting (without reduction unless there is vascular compromise)
- irrigation with saline
- IV abx prophylaxis third generation cephalosporin (Cefuroxime IV 1.5 g) plus metronidazole
- tetanus vaccination
what is the main surgical management of a fracture?
reduction and internal fixation
What are the stages of bone healing?
- heamatoma
- procallus
- callus
- remineralisation
How long does it take for a small bone to heal?
2months
How long does it take for a long bone to heal?
4 months
What would delay union?
- age elderly
- medications- corticosteroids
- hypoxia states
- hyperthyroidism
What are the complications of a fracture?
1.. infection (open) osetomyelitis
2. heamorhage- most pelvis and femor
3. neuromuscular compromise- sacrum cauda equina
distal radium median N
hip dislocation- sciatic
lateral tibial plateau - perineal
shoulder dislocation- axillary
4. avascular necrosis
5. compartment syndrome
What is a shearing of the nerve called
neurotomesis
needs micro surgical repair
What injuries are prone to avascular necrosis
Leg 1. femoral head foot 2. talus Hand 3. scaphoid 4. lunate 5. capitate
What are the three principles of damage control?
hypothermia
coagulopathy
acidosis
How do you treat complex pain syndrome?
MDT physiotherapy
- education
- modifying risk factors- counseling
- medications- bisphosphonates, gabapentin, TCA
- surgical sympathectomy
What is the treatment for compartment syndrome
fasciotomy
What are the findings on history and examination that point to compartment syndrome?
- severe pain disproportionate to the injury
2. passive stretching of the muscle increases the pain
What can you use to help in the diagnosis of compartment syndrome?
stryker intracompartmental Pressure monitor
greater than 30 mmhg need for urgent fsciotomy less than 12 hours
What are the complications of compartment syndrome?
myonecrosis
nerve damage
hyperkalemia
What criteria do you use for complex pain syndrome?
veldmans criteria
- pain during exercise, temp difference, color, volume
- symptoms increase after limb use
- symptoms in a large area that injury site
What are the terms that you would use to describe a fracture?
- open or closed
- exact anatomical location
- left or right?
- proximal, middle or distal?
- direction of the fracture line- transverse, oblique, spiral, comminuted
- displacement
- angulation
- complete or incomplete
- avulsion
- compression
- subluxation
How long does it take after an injury for the fracture to be seen on plain film?
10- 12 days therefore if clinical evidence than will need to treat as if # and then re x ray in 2 weeks
why is splinting important?
it decreases pain and increases blood flow
What is a Colles’ Fracture?
Fracture of the distal radius with dorsal displacement and volar angulation, with or without an ulnar styloid fracture.
What is the history in a colles fracture?
Falling on an outstretched hand
silver fork deformity
Smith fracture history
extraarticular fracture with volar angulation of the distal segment
fall on an outstretched hand
barton’s #
intrarticular with posterior displacement of the distal fragment
reverse barton’s
intra-articular fracture with anterior displacement of the distal fragment
What are the complications of a colle’s fracture?
malunion
median nerve palsy and carpal tunnel
osetoarthritis
extensor pollicis longus rupture
What is the treatment for colles fracture?
closed reduction with cast immobilization
if unstable open reduction and internal fixation
What are the treatments for a scaphoid fracture?
non-surgical splint for 6 weeks with x ray every two weeks
distal segment short arm cast
proximal short arm or long arm cast
proximal portion of the wrist receives blood supply from the distal retrograde
what are the complication of a scaphoid fracture?
a vascular necrosis
arthritis
nonunion
delayed union
What are the characteristic findings on a x ray for osteoarthritis?
Loss of joint space
Osteophytes
Subarticular sclerosis
Subcondral cysts
what is the treatment for osteoarthritis
- education
- modifying risk factors
weight loss, physiotherapy, gentle exercise - medical: NSAIDS, duloxetine, intraarticular steroid injections
- surgical: total hip or knee replacement (clinical symptoms)
