specific fracture management Flashcards
assessing a fracture- 5 signs to look out for
-pain
-swelling
-crepitus
-deformity
-collateral damage- nerve/vessel
order to describe fracture radiograph
demographic
Adequacy
Bone-young/old
Cartilage-joint space
which bone and location
type of fracture
-Pattern: transverse/oblique/spiral
-Displacement: undisplaced/Translated/angulated?
-X/Y/Z plane
orthopaedic management/trauma - 4Rs
ortho-
look
feel
move
x-ray
trauma
resuscitate
reduce
restrict
rehabilitate
4 types of displacement
translation (medial/lateral)
angulation (valgus/varus)
rotation (internal/external)
impaction
3 points of direct fracture healing
anatomical reduction
absolute stability
no callus
3 points of indirect fracture healing
-sufficient reduction
-micromovement
-callus
what is Wolff’s Law:
bone grows and remodels in response to force placed on it
process of indirect fracture healing
[Inflammation, repair, remodel ]
inflammation-form haematoma +release cytokines
repair-soft callus formation (t2 collagen-cartilage) convert to hard callus (t1 collagen-bone)
remodelling-callus respond to external forces
fracture complications general vs specific
general - FID
fat embolus
infection
DVT
Specific
neurovascular injury
muscle/tendon injury
what affects fracture healing in the biological environemnt - 4 points
BIIN
-blood supply
-immune function
-infection
-nutrition
risk of intracapsular fracture in NoF
blood supply more likely to be compromised- AVN/Non-union
management of extracapsular NoF fracture
fix-
internal fixation-plates/screws/nails
management of NoF fracture- intracapsular displaced less than 55y/o
reduce and fixation with screws
management of NoF fracture -intracapsular, displaced, 65 y.o+
replace-
fit and mobile=THR
less fit=hemiarthroplasty
management of NoF fracture, intracapsular undisplaced
fixation with screws
shoulder dislocation management
2 different methods and relaxation med name
traction-counter traction +/- gentle internal rotation
stimson method if alone
relaxation med- benzodiazepine
what is hill-sachs defect and bankart leison
hill-sachs defect=humorous head breaks a piece of bone
bankart leison=separated piece of glenoid
what risks recurrent shoulder disocation
Hill-sachs defect and bankart leison
distal radius fracture management- 3 types
cast/splint
MUA + k-wire
ORIF
when are these used and what they are
cast/splint
MUA + k-wire
ORIF
cast/splint
-temporary or
-minimally displaced extra-articular fracture
MUA + k-wire
-unstable extra-articular fracture
-esp children
ORIF
-displaced unstable fracture unsuitable for K-wires
-intra-articular involvement
tibial plateau fracture causes
-extreme varus/valgus force
-extreme axial loading of knee
tibial plateau fracture management: when to use non-operative
undisplaced fractures with congruent joint line on CT/MRI
tibial plateau fracture management: operative
-restore articular surface with plate+screws
-bone graft to prevent further depression
ankle fracture management- operative vs non-operative. Treatment and which weber class for each
non-operative
-weber A/ stable weber B
-non-weighbearing below knee cast for 6-8 weeks. Transfer into walking boot then physio
operative
-unstable weber B/weber C
-soft tissue dependent- strict elevation due to swelling
-ORIF +/- Syndesmosis repair with screw
weber classification
a- below syndesmosis fracture (lateral malleolus)- stable
b-fibula fracture at level of syndesmosis. variable stability
c- fibular fracture above syndesmosis level- unstable
what is Barton’s fracture
intra-articular fracture (wrist)
