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Year 2 MSK > Specific fracture management > Flashcards

Specific fracture management Flashcards

1
Q

Function of bones

A

See BRS I

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2
Q

What are the different types of bones?

A 
Flat bones
Long bones
Irregular bones
Short bones
See BRS I
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3
Q

What are the three parts of the bone?

A

Epiphysis
Metaphysis
Diaphysis

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4
Q

What is the role of the periosteum?

A

Provides blood supply and nutrition to the bone

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5
Q

What are the two types of bone?

A

Woven

Lamellar

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6
Q

What comprises the extracellular matrix of bone?

A

Collagen (90% Type I) (Type V)

Mineral salts

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7
Q

What comprised the cellular components of bone?

A

Osteoblasts
Osteocytes
Osteoblasts

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8
Q

What are osteocytes?

A

As osteoid mineralises

Osteoblasts are entombed between lamellae

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9
Q

What is special about osteocytes?

A

The are multinucleated

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10
Q

What happens once bones are formed?

A

Constant state of remodlling

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11
Q

What do osteoblasts have receptors for?

A

PTH
Prostaglandins
Vitamin D
Cytokines

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12
Q

What is a fracture?

A

Discontinuity of the bone

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13
Q

How do you describe fractures?

A

Orientation
Location
Displacement
Skin penetration

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14
Q

What is the AO/OTA classification?

A

Number for a specific bone e.g. humerus 1

Number for location e.g. proximal end 11

Subgroup relating to type of fracture

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15
Q

What are the features of primary bone healing?

A

Direct bone healing
Generally intermembraneous healing
Small gap and no movement
Key is that this is a very slow process and that achieving no movement is very difficult

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16
Q

What are the features of secondary bone healing?

A

Stage III

Neovascularisation

Calcified matrix is deposit as osteoblasts is brought in by the new blood vessels

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17
Q

What is an expected timeline of healing for a fracture?

A

6 months
6 weeks for callus formation
1 year for full remodelling

Lower limb twice as long as upper limb
Children half as long adults

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18
Q

Give an example of Wolff’s law

A

If the femur heals bent
Bone will remodel so new cells are formed on the concave side
Reabsorption on the other side
Straightens the bone out

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19
Q

What are the two categories of fracture healing complications?

A

Non-union

Union

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20
Q

What is Malunion?

A

Bone healing occurs outside of the normal parameters of alignment

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21
Q

What is non-union?

A

Failure of bone healing within an expected time frame

Atrophic- healing completely stopped with no XR changes often physiological

Hypertrophic - too much movement causing too much callus healing. Bone does not unite and form a callus

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22
Q

What are examples of hypertrophic non-union?

A

Elephant’s foot

Horse’s foot

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23
Q

What is pseudoarthritis?

A

fibrous callous formation that forms like a joint

becomes mobile at that site but is not stable

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24
Q

What are the steps of fracture management?

A

Resuscitate

Reduce - bring the bone back together in an acceptable alignment, can allow for pain relief and prevent any further blood loss.

Rest- hold the fracture in a position to prevent distortion or movement

Rehabilitate- get function back and avoid stiffness

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25
Q

What must you think about with regards to a period of immobility?

A

Functional limitations and support needed
wider MDT (catherisation, nutrition etc.)
VTE prophylaxis
Physio
Occupational therapist

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26
Q

What is the conservative approach to fracture management?

A

Try in this order until happy with managment

Rest
Ice
Elevation

Plaster/Fibreglass cast or Splint

Traction - skin/bone
Pulls on the leg until the bone ends are reconstituted - provides almost immediate relief
Hummerus - tend to use collar and shaft which utlises gravity

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27
Q

Why is a backslap cast used in A&E as opposed to a circumferential cast?

A

Acute injuries - tendency to swell

If a circumferetial cast is used the blood flow will be limited

Can create compartment syndrome?

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28
Q

What is an example of internal fixation?

A

K wire - reduces with patient under anaesthetic, useful for children as they have thick periosteum’s that prevent the fracture from holding in position

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29
Q

What os ORIF?

A

Open reduction

Internal Fixation

30
Q

What are IM nails?

A

Intramedullary nails
Useful for long bone fractures - insufficient soft tissue coverage for extramedullary methods

Can be very dangerous since you can disrupt the physiology of a patient

31
Q

What are examples of external fixators?

A

Mono/biplanar

Sits within one or two planes

Goes in from outside the skin - apply rods on the outside and build a construct that allows for stability of the fracture pattern

Used often in open fractures where there is poor soft tissue coverage

32
Q

What are examples of external fixators?

A

Mono/biplanar

Sits within one or two planes

Goes in from outside the skin - apply rods on the outside and build a construct that allows for stability of the fracture pattern

Used often in open fractures where there is poor soft tissue coverage

After the soft tissue injury has been dealt with other internal fixation methods can be used

Quick an easy

33
Q

When would you used a ring fixator?

A

When other methods have been used and there is still non-union

Patient is non-compliant with intramedullary methods

Use computer tomography to say where to place the pins

Multiplanar construct thats more stable

34
Q

How do approach orthopaedic X-rays?

A 
Projection
Patient details
Technical adequacy
Obvious abnormality 
Systematic review of X-ray
Summarise
35
Q

What is projection?

A

At least two views

36
Q

What is important when checking patient details?

A

NHS number

2 people may have the same name

37
Q

How might shoulder dislocation present?

A

Variable Hx but often direct trauma
Pain
Restricted movement
Loss of normal shoulder contour

38
Q

What must be assessed prior to internvention?

A

Assess neurovascular status
Axillary nerve
Sensation of regimental patch

39
Q

What are the types of shoulder dislocation?

A

Anterior
Posterior
Inferior

40
Q

What are the features of anterior shoulder dislocation?

A

Commonest type 90%
Bimodal distribution
Humeral head not overlying glenoid

41
Q

What are the features of posterior shoulder dislocation?

A

Rare (around 6%)
Associated with seizures/shock

Lightbulb sign on Xray

42
Q

What is the safest method of shoulder dislocation management?

A

Traction-counter traction

Gentle internal rotation

43
Q

What is Hills-Sachs defect?

A

During injury or reduction

Catch humeral head on glenoid or other bony strucure

44
Q

What is a Bankart lesion?

A

During injury or reduction

Lesion to the glenoid

45
Q

What is the consequences of Hills-Sachs or Bankart defects?

A

Can cause instability or impingement

46
Q

What is a typical presentation of proximal humerus fracture?

A

Fall onto outstretched hand

Typically in the elderly or those with osteoporosis

47
Q

How can proximal humerus fractures be classified?

A

Neer classification

48
Q

When would you opt for conservative management for proximal humerus fracture?

A

Collar and Cuff
2-part fracture, minimally displaced
High surgical risk

49
Q

What is a Colles fracture?

A

Distal radius fracture
Dorsal angulation
Extra articular

50
Q

What is Smith fracture?

A

Distal radius fracture
Volar angualtion
Extra articular

51
Q

What is a Barton fracture?

A

Distal radius fracture
Dorsal angualtion
Intra articular

52
Q

What is a Reverse barton fracture?

A

Distal radius fracture
Volar angualtion
Intra articular

53
Q

How to scaphoid fractures present typically?

A

Commonest carpal bone injury, usually in young patients

Typically a fall backwards onto their hand

54
Q

How is a scaphoid fracture examined?

A

Anyone with FOOSH or with distal radius fracture should have a scaphoid exam

Palpation of anatomical snuffbox

55
Q

What is Perilunate instability?

A

Spectrum of disorders around the lunate

56
Q

What is a perilunate dislocation?

A

Remainder of your carpal bones do not line up and not articulate with the radius

But the lunate does

57
Q

What is lunate dislocation?

A

All carpal bones BUT Lunate articulate

58
Q

How do pelvic fractures typically present?

A

Usually as as result of high energy trauma

Patients can become very unstable - lots of visceral organs and vasculature are adherent to the pelvis

59
Q

How to manage pelvic fractures?

A

ABCDE principles
Hypovolaemia is common
Pelvic binders are used as a tamponade device but need to placed accurately
Ongoing instability should suggest surgical intervention

60
Q

What line indicates disruption to the femoral head?

A

Shenton’s line

61
Q

What are the features of neck of femur fractures?

A

Makes up 25% of all fractures seen in hospital

Pathological fracture, often as a result of osteoporosis and minimal trauma in the elderly

62
Q

What is common signs of neck of femur fracture in the history?

A

Minor fall
May report groin, thigh or buttock pain
Want to ask about preceding symptoms

63
Q

What is the clinical examination for neck of femur fracture?

A

Look
Feel
Move
Thorough secondary survey to look for other injuries

64
Q

What is the protocol for neck of femur fracture management?

A

Rule out other pathology that could cause fall

Involve orthogeriatricians/medical team early

Pain relief

Catheterise

Blood tests

ECGs/CXR

Pre-op optimisation

65
Q

How do you classify neck of femur fractures?

A

Intracapsular:
Subcapital
Transcervical Basicervical

Extracapsular:
Intertrochanteric Subtrochanteric
Reverse Oblique

66
Q

What are the mangement option for intracapsular NOF fractures?

A

Total hip arthroplasty
Hemiarthroplasty
Cannulate screws

67
Q

What is the criteria for total hip arthroplasty?

A 
Mobile with <1 walking
stick outdoors
No cognitive
impairment
Medically suitable for
procedure and
anaesthetic
68
Q

What are the management options for extracapsular NOF fracture?

A

Dynamic hip screws

Intramedullary nails

69
Q

What is the criteria for hemiarthroplasty?

A 
Mobile with >1
walking stick
outdoors
Reduced AMTS
Comorbidities or
reduced baseline not
benefiting from THR
70
Q

What is key in post-op management?

A

Prevent leading causes of death – hospital acquired infections, DVTs/PEs by early
mobilisation

Year 2 MSK (9 decks)

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