T&O Flashcards
What are the stages of bone healing?
Haematoma formation
Soft (fibrocartilaginous) callus formation
Hard (bony) callus formation
Bone remodelling
What are some risk factors for fractures?
Older age Post menopausal Smoking Prolonged steroid use Vit D deficiency
What are some early complications of fractures?
Damage to surrounding structures
Compartment syndrome
Fat embolism
What are some late complications of fractures?
Non-union, malunion Contractures Osteomyelitis Avascular necrosis Arthritis
How does a scaphoid fracture occur?
FOOSH
How are scaphoid fractures managed?
Undisplaced fracture of distal pole/waist => immobilisation with a cast
Proximal pole fractures may require surgery
What are some complications of a scaphoid fracture?
Avascular necrosis
Non-union
Osteoarthritis
How can avascular necrosis occur in a scaphoid fracture?
Blood supply to scaphoid is retrograde
Proximal pole fractures can disrupt the blood supply => avascular necrosis
What is a Colles’ fracture?
Extra-articular fractures the radius, with dorsal displacement of the distal segment
Can include a fracture of the ulnar styloid process
How should a Colles’ fracture be managed?
Closed reduction, back slab and repeat x-ray
May require surgery (ORIF, external fixation)
Should be immobilised for 6 wks
What are some complications of Colles’ fractures?
Median/ulnar nerve damage - can cause acute carpal tunnel syndrome
Malunion => reduced range of motion of wrist
How does someone with a fractured NOF present?
Pain in outer, upper thigh/groin, can radiate to knee
Inability to weight bear
Affected leg can be shortened and externally rotated
What investigations should be done for a NOF fracture?
AP and lateral hip x-ray FBC - anaemia Cross match - will probs require surgery Renal function - AKI, rhabdomyolysis ECG, CXR, urine dip
How is a displaced intracapsular NOF fracture managed?
Hemiarthroplasty
THR if previously mobile, not cognitively impaired, medically fit for anaesthesia
How is a non-displaced intracapsular NOF fracture managed?
Cannulated hip screws
How is an extracapsular NOF fracture managed?
Intratrochanteric - dynamic hip screw
Subtrochanteric - intramedullary femoral nail
What are some complications of NOF fractures?
Avascular necrosis
High mortality rate
Neurovascular damage
infection
How can a NOF fracture result in avascular necrosis?
Blood supply to femoral head is retrograde from the medial circumflex artery
In an intracapsular fracture this can become disrupted
What is the Weber classification of ankle fractures?
Medial malleolus fractures
A - below level of syndesmosis
B - at the level of the syndesmosis
C - above the syndesmosis
More proximal => more unstable therefore will probs need surgery
How can an ankle fracture present?
Ankle pain after direct blow/twisting injury
Dislocation
Neurovascular compromise
How is an ankle fracture investigated?
AP and lateral x-ray views
Look for talar shift - deltoid ligament damage
What is the initial management of an ankle fracture?
Analgesia
Reduce under sedation, back slab
Repeat neuromuscular exam
Repeat x-ray
When is conservative management required in an ankle fracture?
Non-displaced medial malleolar fracture
Weber A/B with no talar shift
When is surgery required for ankle fractures?
Displaced bimalleolar/trimalleolar fracture
Weber C
Weber B with talar shift
Open fractures
What is an open fracture?
Direct communication between a fracture site and external environment
Can result from bone penetrating skin, or something else penetrating the skin from above
What are common sites for open fractures?
Tibial, phalangeal, forearm, ankle, metacarpal
How can open fractures be classified?
Gustilo-Anderson classification
1 - <1cm, clean
2 - 1-10 cm, clean
3 - >10cm, adequate soft tissue coverage
4 - >10cm, inadequate soft tissue coverage
5 - vascular injury
What is the initial management of an open fracture?
Realignment and splinting of the fracture
Reassess neurovascualr supply
Broad spectrum antibiotic, tetanus vaccination
Dress with saline soaked gauze
What is the definitive management of an open fracture?
Urgent debridement - immediately if contamination from sewage, marine or agricultural debris
Ensure there is adequate soft tissue coverage
Reconstruction and external fixation
What are some complications of open fractures?
Damage to overlying skin
Damaged soft tissue
Neurovascular injury
Infection - reduced vascularity, systemic compromise, need to metalwork for stabilisation
What are some red flag signs for caudal equina?
Saddle paraesthesia Painless retention of urine Recent onset faecal incontinence Loss of anal tone Bilateral sciatica
What are the stages of disc herniation?
Degeneration
Prolapse
Extrusion
Sequestration
What are common levels of disc herniation?
L4/5 - affects L5, lateral leg and sole of foot, big toe extension
L5/S1 - affects S1, lateral foot, plantarflexion
