specific fractures Flashcards
5 main hip # classification based on treatment
-intracapsular undisplaced= cannulated hip screw
-intracapsular displaced young=cannulated hip screw
-intracapsular displaced old>80=hemiarthroplasty
-intracapsular displaced old<80=THR depending
-extracapsular intertrochanteric=dynamic hip screw
=subtrochanteric=intra-medullary nailing
arteries of the femoral head
- medial circumflex
- lateral circumflex
- ascending transverse arc
- retinacular arteries
- artery of ligamentum teres
fractures most associated to osteoporosis and elderly
femoral head
humeral head
vertebrae
colles wrist
what are neck of femur fractures at risk of and why
-AVN
due to blood supply all comes from below except small amount ligamentum teres
cause of subtrochanteric fractures
pathological or high energy trauma
assessment of nof fracture
- inability to weight bear
- shortened and externally rotated leg
- co-morbidities
- pain
x-rays for hip fracture
AP pelvis and lateral
femoral shaft fracture cause, management and risk
- high energy trauma
- IM nailing or
- risk of fat embolism and ARDS
splint used for femoral fractures
thomas splint
wrist fractures classification based on treatment
- posterior dorsal angualted=MUA and cast
- anterior volar angulated will slip in cast so use ORIF
what is a colles fracture
FOOSH dorsal angulated displaced distal radius -shortened and bayonetting can be low energy in elderly
complications of wrist fractures
- median nerve compression
- mal union
- carpal tunnel syndrome
- can get impingement of ulna
management dru # in children
closed reduction in plaster or internal fixation with percutaneous k wires
surgery for wrist fracture
-plates and screws
distal radius locking plates
can be done under brachial plexus block
what is a smith fracture and treatment
volar displaced ankle fracture
volar buttress plate
weber classification
-A distal to syndesmosis
B=at level of syndesmosis
C=proximal to syndesmosis
fracture of fibula
which weber has greater risk of talar shift and instability and needs orif
weber c
sometimes B
what other factor in ankle fracture determines treatment
bi or uni-malleolus
uni can do conservative probably
-bi usually weber c so orif and risk of talar shift
what is a proximal humerus # associated too
- ostop
- elderly women FOOSH
management of proximal humerus #
-non-op in elderly
use a sling
-orif sometimes in young depending if comminuted
complications of proximal humerus #
- NV
- stiffness
- non union
- 2ndary arthritis
- AVN
humeral # shaft mangement
- heals well due to blood supply
- immobilise in U slab or functional brace 8-12 weeks
nerve commonly trapped at elbow
ulna
distal humerus # 4 types
unicondylar
bicondylar
supracondylar
intercondylar
most common distal humerus #
intercondylar as fall drives coronoid into trochlea so split condyles apart
complications of distal humerus #
ulna nerve
- heterotopic ossification
- arthritis
- stiffness
most common distal humerus # in children
supracondylar due to FOOSH as force transmits up forearm to metaphysis
forearm fractures are common in
children
treatment for forearm fracture
plate or cast in children
complication of forearm fracture
- mal union
- damage to all 3 nerves
- cross union between forearm bones
- compartment syndrome
what is a galeazzi #
radius shaft # with dislocation of DRUJ
what is a monteggia #
displaced ulna # assoc. to radial head dislocation
what is the most commonly # carpal bone
scaphoid bone
what causes a scaphoid # and who most commonly
violent hyperextension of the wrist-fall
seen most commonly in young males
why is the scaphoid at risk of AVN
blood arises from distal end so gets disrupted
most common part of the scaphoid to fracture
80% in mid part
symptoms of a scaphoid fracture
- pain in anatomical snuff box
- weakness of pinch grip
- pain axial compression of the thumb
x-ray views of the scaphoid
AP
lateral and oblique x2
as easy to miss
management of a scaphoid#
- cast if absent clinical signs and inx and repeat view in 2 weeks
- cast for 6-8 weeks if minimmaly displaced or undis
- for displacement >1mm then ORIF
pelvic ring fracture complications
retroperitoneal and abdo haemorrhage risk
management of pelvic ring #
-ATLS
resuscitation
AP for radiograph
pelvic cast
what is the most common cause for compartment syndrome
tibia shaft #
what are tibia plateau # associated too
meniscal tears
collateral/ cruciate rupture
NV and compartment syndrome
management of tibia shaft #
- cast if closed
- if open need debridement and IM nailing or ex fix
name for distal tibia # from a heigh
pilon #
3 areas on a 5th metatarsal #
prox to distal
- avulsion #
- Jones #either stress or acute break
- proximal diaphyseal #
management of Jones #
risk of watershed injury due to blood supply so may need ORIF
OTTAWA rules for deciding whether to x-ray an ankle
If ankle pain is present and there is tenderness over the posterior lateral malleolus 6cm
If midfoot pain is present and there is tenderness over the navicular or the base of the 5th metatarsal then x-ray foot
If there is ankle or midfoot pain and the patient is unable to take 4 steps
