T&O Flashcards
What is the classifcation for Intracapsular NOF fractures?
Garden classification:
Garden I: incomplete and undisplaced fracture
Garden II: Complete but undisplaced fracture
Garden III: Complete fracture with partial displacement
Garden IV: Complete fracture with 100% displacement
What is the classification system for open fractures and explain the types
Gustilo-Anderson classification
Type 1: <1cm wound and clean
Type 2: 1-10cm wound and clean
Type 3A: >10cm wound and high-energy, but with adequate soft tissue coverage
Type 3B: >10cm wound and high-energy, but with inadequate soft tissue coverage
Type 3C: All injuries with vascular injury
3A can be managed by orthopaedics alone, 3B requires plastics input, and 3C requires vascular input
What are the common sites for open fracture?
Tibial
Phalangeal
Forearm
Ankle
Metacarpal
Name the different classifications of fracture based on how they appear
What are the 3 most common sites for avascular necorosis?
Neck of Femur (intracapsular)
Scaphoid (Carpal bones)
Talus (most superior of tarsal bones)
If a scaphoid fracture of a broken wrist was missed and led to avascular necrosis. What might the patient complain of?
Pain
Stiffness
Reduced function
Which 5 organ cancers most commonly metastasies to bones?
Breast
Prostate
Kidney
Lungs
Thyroid
Where do injuries to the Talus most often occur / how do they occur?
50 % occur in the neck (can occur in head, neck, lateral body)
Neck fractures: high energy fracture causing ++ dorsiflexion. Talus pushed agaisnt Tibia. Blood supply disturbed - avascular necrosis
Body fractures : jumping from height
How do calcaneal fractures often occur?
What type of fracture is common?
What are some long term complications of calcaneus fracture?
Occur due to axial loading e.g. falling from a height like a ladder
Comminuted fracture is common. Xray - calcaneus shorter and wider
Can lead to arthritis in sub-talar joint. Inversion and eversion are painful making walking on unever ground painful.
What type of joint is the ankle joint?
What 2 movements does this allow and which is more stable?
Hinge joint
Dorsiflexion and Plantarflexion of the foot
Dorsiflexion is more stable as the anterior part of talus is wider and is held in the mortise (In plantarflexion the narrower posterior part is)
At the ankle joint the Tibia and Fibia are held together by ____(1)____
This results in a bracket shaped socket called ____(2)_____ which the _____(3)_____bone fits snugly into
(1) Tibiofibular ligaments
(2) Mortise
(3) Talus
60 yr old pt presents with a knee that is swollen, stiff, ++ painful and hot. Says he thinks its happened before but can’t remember when. Pt temp is 38
You get follwing Xray, what is the diagnosis?
Calcium pyrophosphate deposition disease - CPPD (Pseudo Gout)
Rhombioid shaped calcium pyrophosphate crystals can be seen on xray in menisci
Distinguish between Gout and Pseudo-Gout
Gout: uric acid crystals
Pseudo -Gout: calcium pyrophosphate crystals (rhomboid)
What are some differencials for a patient presenting with an acutely swollen joint?
Septic Arthritis (*** exlude! ***especially if 1 joint)
Trauma - Haemarthrosis
Crystal arthropathies - Gout & Pseudo-Gout
Rheumatological - RA
Spondyloarthropathies - Psoriatic Arthritis, ankylosing spondylisits, Reactive Arthritis
Osteoarthritis
MSK injuries (brusitis, ligament / tendon injury)
How does pseudo gout mimic RA and OA over time?
Worse in the morning - stiffness / fatigue
knobbly, deformed joint e.g. knee, elbow, wrist etc
Low grade fever
Reduced joint movement
Pain
What investigations would you do to diagnose pseudo gout?
Xray - see calcium pyrophosphate crystals and exclude other cause
Aspirate knee - find crystals (exclude gout crystals)
Full blood count - exclude other diseases
What are some risk factors for psudeo - gout?
Advanced age
Injury or previous joint surgery
Hyperparathyroidism
Hypophosphataemia
Haemochromatosis
Hypomagnesaemia
What are some treatments for Pseudo - Gout
NSAIDS (- pain / inflammation )
Colchicine if NSAIDs contraindicated
Corticosteroid interarticular injection / short course oral steroids if above contraindicated
Ice / rest etc
Open Fracture in A& E descibre immediate stesps
1) Look for polytrauma (often found with OF)
2) A- E assessment including Hx / contamination
3) Neurovascular exam
Treatment depends on location of fracture but generally requires immediate IV antibiotics (broad spec) and urgent irrigation and debridement followed by surgical fixation as needed.
What complications are associated with open fractures? (Orthobullets)
Surgical site infection
Compartment syndrome
Osteomyelitis
Neurovascular injury
What 4 ways can the outcome of an open fracture be thought of?
Skin - large wound will need plastics input for cover e.g. grafting
Soft Tissue - damage to ligaments /tendons may need reconstructive surgery
Neurovascular - nerves and blood vessesls may be compressed by deformity- arteriospasm, intimal transection or fully transected
Infection - High risk due to systemic compromise (trauma), contamination, reduced vasculaity and insertion of metal work when reducing.
What initial (non surgical) and surgical management would you do for a pt with an open fracture?
Non surgical
IV broad spectrum AB (immeidate if contaminated e.g. farm)
Tetanus injection if out of date
Photograph (to avoid excessive undressings)
Remove large debris form wound
Resusitation and stablisation- realign and splint with saline covered gauze- assess neurovascular after re-aligning
Surgical
Surgical debridement and theatre saline wash
Definitive reconstruction and fracture fixation
Soft tissue cover (plastics) / neurovascular input (vascular)
What investigations for an open fracture ?
Xray
Blood test - Group & Save (so transfusion blood is ready)
What are the 2 most common injuries for NOF fracture?
Low energy trauma - osteoperiotic frail older pt -falls
High energy trauma - road traffic accident, fall from height
