Other fractures Flashcards
The pelvic ring is formed by:
- Two innominate bones (ilium, ischium and pubis)
- Sacrum
- Supporting ligaments
What is the most common cause of pelvic injury?
High energy blunt trauma, such as road traffic accidents or falls from height
Clinical features of a pelvic fracture
- Significant pain and swelling around the pelvis
- Full neurovascular assessment is required, including checking anal tone
Pelvic fracture investigations
- 3 plain film radiographs are required to completely assess the pelvic ring
- However in a trauma setting, often a CT scan is performed as part of the patient assessment, which usually negated the need for plain films
Initial management of pelvic fracture
- Initial management of a patient with high energy trauma follows the ATLS guidelines and should always begin with a primary survey to identify life threatening injuries
- Pelvic binder to give skeletal stabilisation (required for clot formation)
What is the syndesmosis is of the ankle?
The tibia and fibula are joined at the syndesmosis, a very strong fibrous structure comprised of the anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament and the intra-osseous membrane.
How can ankle fractures be classified anatomically?
- Isolated lateral maleolar fractures
- Isolated medial malleolar fractures
- Bimalleolar fractures (medial + lateral malleolar fracture)
- Trimalleolar fractures (medial + lateral + posterior malleolar fracture)
How are lateral malleolus fractures classified?
- Type A = below the syndesmosis
- Type B = at the level of the syndesmosis
- Type C = above the level of the syndesmosis
(The more proximal the injury, the higher the likelihood of ankle instability)
Clinical features of ankle fracture
- Ankle pain following traumatic injury
- May be associated deformity
Investigations for ankle fracture
A plain radiograph should be obtained in all suspected cases, with both AP and lateral views. (Ensure ankle is in full dorsiflexion.)
Check joint space for uniformity ensuring there is no talar shift.
Management of ankle fracture
- Immediate fracture reduction
- Once reduced, ankle should be placed in a below knee back slab
- Repeat neurovascular examination
- Repeat plain film radiography
Which ankle fractures will require surgical management?
Open reduction and internal fixation
- Displace bimalleolar or trimalleolar fractures
- Weber C fractures
- Weber B fractures with Talar shift
- Open fractures
What percentage of all fractures do distal radius fractures represent?
What is the most common type of radius fracture?
25% of all fractures seen clinically
Colles’ fracture account for 90% of distal radius fractures
Describe a Colles’ fracture
An extra-articular fracture of the distal radius with dorsal angulation and dorsal displacement, within 2cm of the articular surface.
How does a Colles’ fracture occur?
It occurs when a person falls forwards and plants their outstretched hand in front of them. The transfer of load as their body fall forces the wrist into supination.
This type of fracture typically occurs as a “fragility fracture” in osteoporotic bone.
Clinical features of a distal radius fracture
Examination
- Episode of trauma
- Immediate pain +/- deformity
- Sudden swelling around fracture site
On examination:
- Check for neurovascular compromise
Investigations for distal radius fracture
Plain film radiograph
Which nerve is at high risk of being damaged in a humeral shaft fracture?
If this nerve is involved what features would this produce?
Prognosis of nerve injury
Radial nerve (10%)
If the radial nerve is involved, the patient may complain of reduced sensation over the dorsal 1st webspace and weakness in wrist extension.
90% will improve within 3 months without any intervention.
Clinical features of humeral shaft fracture
- Pain and deformity
- May occur from a fall directly onto the outstretched limb or falling laterally onto an adducted limb
In which part of the humerus do the majority of humeral shaft fracture occur?
Middle third of the humerus
Humeral shaft fracture investigations
- Plain film radiograph
- AP and lateral views
- Elbow and shoulder should be visible
The majority of humeral fractures can be managed conservatively. What is the conservative management of a humeral fracture?
- Realignment of the limb
- Fuctional humeral brace
Clinical features of a fractured scaphoid
- High energy trauma
- Sudden onset wrist pain
Examination:
- Tenderness on floor of anatomical snuffbox
- Pain on palpating the scaphoid tubercle
- Pain on telescoping of the thumb
Investigations for scaphoid fracture
- Initial plain radiographs: a scaphoid series
- If initial imaging negative but there is significant clinical suspicion, the patient should have wrist immobilisation in a thumb splint and repeat plain radiographs in 10-14 days for further evaluation
- If repeat radiograph imagin is negative, but there remains clinical suspicion, an MRI scan is indicated
Complications of scaphoid fracture
- Avascular necrosis
- Mal-union (the bone failing to heal properly)
