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Block 12 > Principles Of Diagnosis And Management Of Fractures And Soft Tissue Injuries > Flashcards

Principles Of Diagnosis And Management Of Fractures And Soft Tissue Injuries Flashcards

1
Q

what is a pathological fracture

A

occurs through abnormal bone in which disease causes structural weakness thus predisposing the individual to injury

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2
Q

what is a stress fracture

A

repeated low stress forces cause bone weakness which increases likelihood of a fracture when injury occurs

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3
Q

injuries can be predicted by knowing what 4 factors

A

chief complaint

age of the patient

mechanism of the injury

estimation of the amount of energy delivered

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4
Q

what is a fracture

A

break in the continuity of bone or cartilage

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5
Q

what are the clinical presentations of a fracture

A

loss of function
pain
tenderness
swelling
abnormal motion
deformity

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6
Q

what does it mean when a fracture is closed or open

A

closed fracture = the skin and soft tissues overlying the fracture sites are intact

open = if fracture site is exposed to outside environment in any manner

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7
Q

how should all fractures be identified and classified

A

open vs closed

exact anatomical position

direction of fracture line

simple or comminuted

position ( displacement, alignment)

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8
Q

how can direction of fracture line be described

A

this is comparison to the long axis of the bone in question

transverse = occurs at a right angle to the long axis of the bone

spiral fracture = results from rotational force and encircles shaft of a long bone in a spiral fashion

Oblique = runs oblique to long axis of bone

comminuted = fracture with more than 2 fragments

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9
Q

what is displacement

A

fracture fragments that have deviated from their normal position

can in mm or as a % of bone width

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10
Q

what is alignment

A

relationship of the longitudinal axis of one fragment to another

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11
Q

what is angulation

A

deviation from normal alignment

The direction of angulation is
determined by the direction of the
apex of an angle formed by the two
fracture fragments

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12
Q

what is a complete fracture

A

if it interrupts both cortices of the bone and incomplete if it only involves one

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13
Q

what is avulsion

A

bone fragment is pulled away from normal position either by

  • forceful contraction of a muscle
    or
  • resistance of a ligament to a force in the opposite direction
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14
Q

what is impaction

A

forceful collapse of one fragment of bone into or onto another

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15
Q

examples of diseases that cause structural weakness thus predisposing to injury are…

A

primary or metastatic malignancies
cysts
cysts
osteomalacia
ostogenesis imperfecta
scurvy
rickets
pagets disease

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16
Q

repeated low intensity forces may lead to…

A

resorption of normal bone resulting in a stress fracture

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16
Q

what occurs in the inflammaoty phase of healing

A

granulation tissue forms on the fracture surfaces. Resorption of the hematoma provides the first continuity between the fragments; however, this procallus provides no structural rigidity.

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16
Q

what occurs in the haematoma phase of healing

A

haematoma is caused by the rupture of vessels crossing the fracture line. the haematoma bridges the fragments

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17
Q

what occurs in the remodelling phase of healing

A

callus is formed on the periosteal and endosteal surfaces of the bone acting as a biologic splint

area becomes mineralised by deposition of calcium phosphate and then undergoes osseous metaplasia?

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17
Q

malunion meaning

A

occurs when a
residual deformity exists.

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18
Q

what occurs in the final stage of healing

A

callus is resorbed, development of firm bony union

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19
Q

rate of fracture healing is affected by which factors

A

type of bone
degree of fracture
opposition and systemic states such as hyperthyroidism or
excess corticosteroidism.
exercise = speeds healing
chronic hypoxia = slows repair

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20
Q

nonunion meaning

A

is a failure of a
fracture to unite.

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21
Q

pseudoarthrosis

A

when nonunion results in a false joint

22
23
What happens radiographically to a fracture site in the first 3 weeks of fracture healing
In the first 10 days the bone surrounding the fracture becomes less dense due to resorption and bone remodelling. Fascia becomes easier to detect on X ray After 2-3 weeks the swelling of soft tissue will regress and callus becomes visible - will be mottled and starts to become dense
24
What are green stick fractures
Mostly occur in children Are incomplete angulated fractures of long bone Bowing of the bone present
25
What is a torus fracture
In children Incomplete fracture characterised by a wrinkling or buckling of cortex due to impact ion
26
What can mimic fractures of x rays
Epiphysis and epiphyseal growth plates
27
What does a type I fracture in children indicate
Injuries involve only a slip of the zone of provisional classification
28
What do type II fractures in children indicate
Fracture extends into the metaphysis = most common fracture in children
29
What does a type III fracture in children indicate
Injuries are composed of a slip of the growth plate plus a fracture through the epiphysis involving the articular surface
30
What does a type IV fracture in children indicate
Like type III but extends into the metaphyssis
31
What does a type V fracture in children indicate
Crushing injuries of the epiphyseal plate usually due to compressive forces
32
What diagnostic modalities are used for fractures
Plain X rays (at least two views which are perpendicular to each other required. Oblique view also used) Radionucleotide bone scanning = helpful in detecting stress fractures + occult fractures. Inject small amount of radioactive material Computed tomography = CT used to confirm or define better displacements, alignment, fragmentation or fracture MRI = expensive and time consuming. Should only be used when there is doubt in diagnosis
33
What is the primary complication of fractures especially open fractures
Infections such as osteomyelitis or septic arthritis Treated with vigorous irrigation and debridgement of wound. Use of antibiotics if needed
34
What is another complication of a fracture
Haemorrhage - large amounts of blood loss, shock and death can occur ( exsanguination)
35
Apart from bone which other structure can be damaged during a fracture
Vascular injuries such as to the popliteal artery in knee injuries
36
What are the 5 Ps
Pulseless Paralysis Paraesthesia Pain Pallor/pale
37
What is neuropraxia (complication)
Contusion of a nerve which disrupts ability of nerve to transmit impulses but function regains after a few weeks to months
38
What is axonotmesis (complication)
Severe crush injury to nerve. Spontaneous healing possible but very slow
39
What is neurotmesis (complication)
Severing of a nerve usually requiring surgical repair. All functions are absent if severed ( touch, pain and temperature etc)
40
What is compartment syndrome (complication)
Raised blood pressure within a muscle that leads to reduced blood flow and pain. serious acute emergency complication that should be considered whenever pain and paraesthesia occur in an extremity after a fracture within an enclosed space.
41
What is the treatment for compartment syndrome
Complete fasciotomy
42
What is fat embolism syndrome ( complication)
Fat globules in the lung parenchyma and peripheral circulation after a long bone fracture or major trauma Occurring most commonly after long bone fractures in young adults and after hip fractures in elderly patients. ARDS ( acute respiratory distress syndrome) and hypoxaemia are the earliest manifestations.
43
What are fracture blisters ( complication)
Tense blisters that accompany high energy injuries in areas of little skin coverage such as ankle, elbow, foot and knee
44
What is subluxation
Partial loss of continuity between two articulating surfaces
45
What is dislocation
Complete loss of continuity between two articulating surfaces Presents as sev pain especially on movement of joint
46
Before attempting reduction the patient should be given..
Analgesia Sedation Nerve block
47
What are sprains
Classified as a soft tissue injury in which ligaments are damaged resulting from an abnormal motion of a joint Injury to the fibres of a supporting ligament of a joint
48
How should sprains be treated and managed
Apply ice Elevation Analgesia NSAIDS Physical therapy and rehabilitative exercises Immobilisation techniques such as splints, braces, air casts, elastic bandages
49
What is tendinitis
Inflammatory condition = pain at tendinous insertions into bone occuring in the setting of overuse Presents as pain with motion and limited function, may be tender
50
Common sites for tendinitis
Rotator cuff of shoulder Achilles tendon Radial aspect of the wrist and elbow joint
51
What is bursitis
Painful inflammation of a bursa
52
Causes of bursitis
Trauma Infection Systemic illness
53
Where does bursitis usually occur
Olecranon Subacromial Greater trochanter of femur Prepatellar bursa
54
How to treat tendinitis
Use of rest ICE NSAIDS Rehabilitation and training
55
Orthopaedic injuries are part of the secondary survey unless…
There is profuse bleeding or ischaemia of limb

Block 12 (11 decks)

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