#s Flashcards
2ndry bone healing =
gap fills with __ > ___ (__callus)> __(__ callus = ___)
granulation tissue
cartilage - soft
bone - hard - enchondral ossification
fractures that heal by primary bone healing
fixed, hairline
lateral displacement of distal part of bone = ___ displacement
valgus
if high E/ substantial soft tissue swelling +# = avoid ___
wait until it settles and then ___
avoid ORIF
nail/externally fixate
if intra/peri articular # and displaced Rx
reduce and rigid internally fixate
if intra/ peri art # at risk of AVN/ non union Rx =
replace
Open # Rx -
Abx, tetanus injection, debride
stabilise Sx
risks of femoral shaft # = ++_
Rx =
1l blood loss, fat emboli, ARDs
resusc, analgesia (femoral nerve block), Thomas splint
unstable = IM nail
distal femur # extra articular Rx =
unstable so Thomas splint
can nail but if too distal = plate
intra articular distal femur # Rx =
reduce and internally fixate with plates and screws
prox tibial # mechanism of injury
Ix =
valgus stress => lateral tibial plateau # with articular surface disruption
CT
Rx of proximal tibial # =
reduce and rigid fixate
elevation of depressed articular and bone fragments
tibial shaft fracture complication =
compartment syndrome
in tibial shaft # tolerate __+__ but not ___
5 degree angulation and 50% bony contact
internal rotation
treatment of tibial shaft #
16wks to union
plaster cast
possibly IM nail, plate or ext fixate
intra-articular distal tibial fracture =
ass with ++_
Pilon #
spinal/ pelvis/calcaneal #s
Pilon # Rx =
Sx emergency - externally fixate to settly soft tissues => internally fixate after CT
Rx for isolated distal fibular/minimally displaced medial malleolus # =
conservative
if Bimalleolar/distal fibia # => talar shift Rx =
ORIF
Rx for prox. humeral #
elderly = conservative (arthroplasty for head splitting/3-4 part#)
youth w displacement = internally fixate
humeral shaft # risks ___ in the ___
radial nerve in spiral groove (usually neurapraxia)
humeral shaft # can tolerate substantial ___ without __
angulation
loss of function
Rx of humeral shaft #
conservative
internally fix if non-union, pathological #, open #, high E, not tolerating brace
Rx of distal humeral # =
usually intra art
may => ORIF
nightstick # =
Rx =
isolated ulnar #
conservative
if ulna and radial # together =
ORIF
Rx for Galeazzi and Monteggia #s
ORIF
potential consequences of Colles #
median nerve compression
EPL rupture
CRPS
lose grip strength
stable minimally displaced/angulated Colles # Rx =
POP (cast)
displaced simple Colles # Rx =
MUA
displaced/comminuted Colles # Rx =
MUA and K wire, ORIF
Smiths # =
mechanism of injury =
Rx =
extra articular distal radial #, volarly displaced and angulated
fall on back of hand
ORIF
Barton # =
Rx =
intra-articular dorsal/volar rim of distal radius # => subluxed carpus
ORIF
comminuted intra-art # of distal radius =
externally fixate +/- K-wires
lasts less than 28 days and is temporary localised conduction block/demyelination
neurapraxia / 1st degree nerve injury
axonotmesis / 2nd degree nerve injury =
nerve cell axon dies distally = Wallerian degeneration
endoneural tubes intact
axonotmesis regenerates ___ per day and get ___ recovery may lead to chronic ___
1mm
8/10
weakness
nerve transected =
Rx =
neurotmesis / 3rd degree nerve injury
Sx
If have a nerve injury due to a # wait ___ and if no function then __ => ____/___
4wks
NCS
nerve graft
tendon transfer
Volkmann’s ischaemic contracture is especially ass with ____ but can be caused by any ___
+ necrosis => ____ at wrist
supracondylar #
upper limb #
fdp + fpl necrosis
flexion contracture
most likely sites of AVN =
head of humerus, head of femur
scaphoid
talus
only ___ of __ bones need xray to confirm union
diaphyseal
long
clinical features of hip + prox femur #s
shortening external rotation trochanteric bruising no SLR severe groin pain on rotation
muscles ass with the hip
gluteus medius and minimus
adductors
pectineus
iliopsoas
femoral neck blood supply is from __+__ -> ___ arteries
circumflex medial and lateral
retinacular
hip capsule = +++
iliofemoral, pubofemoral, ischiofemoral ligaments
zona orbicularis
diagnostic xray feature of intracapsular prox femur #
break in shenton’s line
subtrochanteric femur #s are ass with __
Rx =
long term biphosphonates
Analgesia +/- Thomas splint
IM nail fixate
Rx for pubic rami #
conservative
greater trochanter # Rx =
conservative
fragility fracture sites
NOF neck of humerus wrist vertebrae pelvic
all hip #s admitted to ___ ward within __hrs of presentation
acute orthopaedic
4hrs
all hip #s who are medically fit should have Sx in ___ from admission in normal working hours
<=48hrs
all hip #s should be assessed and cared for in a way to decrease the risk of getting a _____
P ulcer
all fragility hip #s should be managed on ___ ward with routine access to ___ support
acute ortho
acute orthogeriatric medical support
all fragility hip #s should be assessed to see if need ___
antiresorptive therapy
all fragility hip #s after a fall should be assessed ___ to prevent ___
multidisciplinarily
prevent future falls
If have clinical suspicion/confirmed hip # before leaving A+E should have big 6 interventions =
analgesia (esp for xrays) early warning score pressure area inspection blood tests fluid therapy delirium screening
P sores can develop in ___ if on a hard surface
30 mins
mobilisation within __ of hip Sx
1 day
Pelvic injuries ooze blood from ___ and can hold __ of circulating volume
Rx of this =
venous plexus
1/2
Sam sling - pelvic binder = tamponade
in brain haemmorhage get __+__ on same/ opposite side?
weakness
pupil dilatation
contralateral side
torus fracture =
looks like a __
a buckle # (is seen in paeds)
looks like a never ending ring
plastic deformity (specific paed #) =
that cant be manipulated back into place usually due to splint of adjacent bone
how to test for reduced sweating (in nerve damage)
can run pen over skin smoothly
fingers wrinkling in water only occurs if __
nerves intact
movements to assess median, radial and ulnar nerve function
median = OK sign radial = hitchhiker thumb ulnar = starfish
immobilise ___ for diaphyseal #s and ___ for metaphyseal #s
dia = joint above and below meta = adjacent joint
exceptions to conservative management of #s in paeds =
displaced intra articular / growth plate #s
open #s
usual Rx for paed #s
plaster
traction
less invasive fixation
