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BRS Year 2 > Specific fracture management > Flashcards

Specific fracture management Flashcards

1
Q

whats the difference between trauma and orthopaedics (not important)

A

trauma - advanced trauma life support, reduce hold rehabilitate
orthopaedics - history, examination ,look feel move and investigations

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2
Q

presentation of a fracture

A 
pain
swelling
crepitus
deformity
adjacent structural injury - nerves, vessels, ligaments, tendons
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3
Q

investigations for a fracture?

A

gold standard X ray/radiograph
CT scan
bone scan
MRI scan

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4
Q

how to describe a fracture X ray

A 
location - bone and part of bone
pieces - simple/comminuted
pattern - transverse/oblique/spiral
displaced/undisplaced
translated/angulated
XYZ plane - varus valgus
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5
Q

what is fracture translation?

A

lateral movement of bones
proximal/distal
anterior/posterior
medial/lateral

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6
Q

types of angulation of fractures?

A

internal/external rotation
dorsal/volar (Z plane)
varus/valgus (X plane)

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7
Q

when is a fracture classified as varus or valgus?

A

varus - distal part of bone more medial

valgus - distal part of bone more lateral

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8
Q

what is the broad process of healing?

A

bleeding
inflammation
new tissue formation
remodelling

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9
Q

what happens in the inflammatory stage of healing?

A

haematoma formation
release of cytokines
granulation tissue and blood vessel formation

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10
Q

what happens in the repair stage of healing?

A

1 - soft callus formation (type ii collagen - cartilage)

2 - hard callus transformation (type i collagen - bone)

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11
Q

what is wolffs law?

A

bone grows/remodels according to stresses put on it

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12
Q

what is intramembranous ossification for fracture healing? aka primary bone healing

A

mesenchymal cell - osteoblast produces woven bone straight away
results in stable fractures
when bone ends are still together

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13
Q

what is endochondral ossification in fracture healing? aka secondary bone healing

A

chondral precursor then bone cells migrate to location and produce woven bone
therefore means more callus and less stability than intramembranous

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14
Q

when is healing visible on an x ray?

A

7-10 days

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15
Q

what are the concepts of general fracture management?

A

reduce
hold/fixate
rehabilitate

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16
Q

choices for fracture reduction?

A

closed - manipulation or traction (skin/skeletal traction)

open - full exposure or mini incision

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17
Q

choices for fracture holding?

A

closed - plaster, traction (skin/skeletal)

fixation

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18
Q

choices for fracture fixation?

A

internal - intramedullary (pins nails) or extramedullary (plates pins)
external - monoplanar or multiplanar (all way round)

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19
Q

what are the concepts of fracture rehabilitation?

A

use
move
strengthen
weight bear

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20
Q

general complications of fractures

A

fat embolus
deep vein thrombosis
infection
prolonged immobility (UTI, chest infections, sores)

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21
Q

fracture - specific complications

A 
neurovascular injury
muscle/tendon injury
non union/malunion
local infection
degenerative change
reflex sympathetic dystrophy
22
Q

biological factors affecting fracture healing

A

blood supply
immune function
infection
nutrition

23
Q

mechanical factors affecting healing

A

stresse

environment

24
Q

causes of neck of femur fracture NOF#

A

osteoporosis
trauma
combination

25
Q

location of NOF# classification

A 
subcapital(intracapsular)
transcervical (extracapsular)
intertrochanteric (extracapsular)
subtrochanteric
3 part intertrochanteric
26
Q

what type of neck of femur fracture is more likely to cause avascular necrosis?

A

displaced intracapsular fracture

27
Q

management of an extracapsular neck of femur fracture

A

fix with plate and screws (dynamic hip screw)

28
Q

Management of intra-capsular NOF undisplaced

A

Fix with screws

29
Q

Management of intra capsular NOF displaced

A

30% risk of AVN. replace in older patients, fix if young (under 55)

30
Q

Replacement of undisplaced NOF fracture in over-65 year olds

A

fit and mobile - totla hip replacement

less fit - Hemi-arthroplasty

31
Q

Presentation of shoulder dislocation

A

Variable HX - often direct trauma
pain
restricted movement
loss of normal shoulder contour

32
Q

clinical examination for shoulder dislocation

A

assess neurovascular status of auxiliary nerve

33
Q

Investigation for shoulder dislocation

A

X-ray prior to manipulation: scapular Y-view in addition to AP

34
Q

Reducing shoulder dislocation

A

Avoid vigorous manipulation or twisting. Safest methdo is traction / counter-traction and gentle internal rotation
Ensure adequate patient relaxation. Could use Stimson method

35
Q

Complication of shoulder dislocation

A

Hill-Sachs - ball of humerus chipped off (bankart lesion) may lead to re-dislocation

36
Q

Management of distal radius fracture for minimally displaced extra-articular

A

reduction of fracture and placement into cast until definite fixation

37
Q

Distal radius fracture management - extra-articular and unstable

A

MUA in theatre with K-wire fixation (pins)

Wires removed clinic post-op

38
Q

Distal radius fracture management displaced + unstable

A

not suitable for K-wires

Open reduction / internal fixation with plate and screws

39
Q

What is a lipohaemarthrosis

A

Fat moves when sat down, creating a straight line above tibia
tells you that there is a fracture in the joint

40
Q

non-operative management of tibial plateau fracture indications

A

undisplaced fractures with good joint line congruency assessed on CT (rare)

41
Q

Operative management of tibial plateau fracture

A

Restoration of articular surface using plates and screws

maybe bone graft or cement to prevent further depression

42
Q

Mechanism of injury for tibial-plateau fracture

A

Key weight-bearing surface
Any extreme valgus/varus force or axial loading across the knee
Impaction of femoral condyles causing comparatively soft bone of tibial plateau or depress or split
Additional ligumentus or miniscal injury possible

43
Q

Non operative management of ankle fracture (Weber A and B stable)

A

Non-weight bearing below-knee cast 6-8 weeks
then walking boot
then physiotherapy

44
Q

What is Weber A ankle fracture

A

simple fracture to bottom part of fibular (below syndesmosis)

45
Q

What is Weber B ankle fracture

A

Fracture of fibula at level where it ligamentally joins to the tibia (syndesmosis)

46
Q

What is Weber C ankle fracture?

A

Fibular fracture above level of syndersmosis (where tibia and fibula join ligamentously) therefore unstable

47
Q

Operative management of ankle fracture (Weber B unstable or Weber C)

A

Open reduction with internal fixation +/- syndersmosis repair using screw or tightrope technique

48
Q

What is operative ankle fracture management dependent upon?

A

Pateint’s soft tissues

patients need strict elevation as injury swells significantly

49
Q

Broad mechanisms of fracture

A

trauma
stress
pathalogical / insufficiency

50
Q

Causes behind pathological fractures

A 
Osteoporosis
Malignancy - primary / bone mets
Vitamin D deficiency
osteamyelitis
Osteogenesis imperfecta
Pagets
51
Q

Urgent complications of fractures

A 
Local visceral injury
vascular injury
nerve injury
compartment syndrome
Haemarthrosis
Infection
Gas gangrene

BRS Year 2 (67 decks)

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