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Musculoskeletal + Rheumatology > Trauma > Flashcards

Trauma Flashcards

1
Q

What is a fracture?

A

A break in the continuity of the cortex of the bone

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2
Q

What is the difference between a complete and incomplete fracture?

A

Complete means the full cortex is affected (cortex is the hard outside bone)

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3
Q

What is a transverse fracture?

A

Straight cut along axis of bone

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4
Q

What is an oblique fracture?

A

Cut at an angle along axis of bone

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5
Q

What is a spiral fracture?

A

Oblique fracture with twisting along bone axis

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6
Q

What is a communited fracture?

A

Multiple breaks/fragments

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7
Q

What is an impacted fracture?

A

Bone pushes in on itself

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8
Q

What is an avulsion fracture?

A

Ligament pulls off bone

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9
Q

What is a greenstick fracture?

A

Breaks at one side but crumples on the opposite side of the impact, this is only in children

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10
Q

What are buckle fractures

A

Incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex, commonly in children

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11
Q

What is colles fracture?

A

Distal radius fracture with no articular involvement and dorsal displacement of fragmebt

Usually due to fall onto outstretched hand

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12
Q

What is smith fracture?

A

Distal radius fracture with volar angulation of the distal fragment

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13
Q

What system classifies growth plate fractures?

A

Salter- Harris system

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14
Q

Describe the Salter-Harris classification

A

I, fracture through the physis only (x-ray often normal)

II, fracture through the physis and metaphysis

III, fracture through the physis and epiphyisis to include the joint

IV, fracture involving the physis, metaphysis and epiphysis

V, crush injury involving the physis (x-ray may resemble type I, and appear normal)

S = straight through 
A = above 
L = lower 
T = through all 3 (met, growth plate, epi)
R = rammed
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15
Q

How are mid shaft fractures of the radius and ulna managed?

A

Open reduction and internal fixation, if unstable

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16
Q

How are pelvic fractures managed?

A

Trauma call/ATLS

Resuscitation: Blood, Tranexamic acid

Pelvic Binder: Sat at level of GT

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17
Q

How do knee fractures present?

A

Tender along joint line

Lost full flexion

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18
Q

How are knee fractures managed?

A

Total Knee Replacement: Patellar resurfaced

Uni-compartmental

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19
Q

What classification system is used in ankle fractures?

A

Webers

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20
Q

What sex is more likely to be affected by hip fractures?

A

F>M

3:1

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21
Q

What is an extracapsular hip/neck of femur fracture?

A

Affects the femoral head and neck

These can either be trochanteric or subtrochanteric (the lesser trochanter is the dividing line

22
Q

What is an intracapsular hip/neck of femur fracture?

A

Affect the blood supply to the head of the femur

23
Q

How do hip/neck of femur fractures present?

A

Groin pain, sometimes knee pain

Sciatic nerve damage if anterior

Shortened, externally rotated leg

24
Q

What classification system is used for intracapsular neck of femur fractures?

A

Garden

25
Q

Describe Graden type 1

A

Undisplaced incomplete

26
Q

Describe Graden type 2

A

Undisplaced complete

27
Q

Describe Graden type 3

A

Complete partial displacement

28
Q

Describe Garden type 4

A

Complete fully displaced

29
Q

What are the management options for hip/neck of femur fractures?

A

Open repair and internal fixation (ORIF) witth dynamic hip screw

  • Extracapsular (inter and sub-trochanteric)

Open repair and internal fixation (ORIF) with cancellous screws

  • Intracapsular
  • Garden 1/2
  • Garden 3/4 if under 55

Hip hemiarthhroplasty (HEMI), replace the head/neck

  • Intracapsular
  • Garden 3/4 if over 75 or co-morbidities

Total hip replacement, replace socket and head

  • Intracapsular
  • Garden 3/4 ages in between and no co-morbidities
30
Q

What method of analgesia is used in neck of femur fracture?

A

Iliofascial nerve block

31
Q

Give complications of hip fractures

A

The medial femoral circumflex artery is at high risk of compromise in neck of femur fractures

Cementing in surgery can cause a MI (allergic reaction)

Fat embolism

  • Triad of respiratory, neurological and petechial rash
  • Retinal haemorrhages and intra-arterial fat globules
32
Q

Describe the ottawa ankle rules

A

These state that x-rays are only necessary if there is pain in the malleolar zone and

  1. Inability to weight bear for 4 steps
  2. Tenderness over the distal tibia
  3. Bone tenderness over the distal fibula
33
Q

What classification is used for ankle fractures?

A

Weber

34
Q

Describe weber classification

A

Type A, below the syndesmosis

Type B, start at the level of the tibial plafond and may extend proximally to involve the syndesmosis

Type C, above the syndesmosis which may itself be damaged

35
Q

How are ankle fractures managed?

A

Weber A&B

  • Cast/boot and weight bear as tolerated for 6 weeks

Weber C (unstable)

  • Open reduction internal fixation (ORIF)
  • Follow-up in 6-8 weeks
36
Q

Give features of rib fractures

A

Severe acute chest pain, worsening with deep breaths or coughing

Chest wall tenderness over area

Visible bruising

Crackles or reduced breath sounds

Flail chest, in which multiple rib fractures damage underlying lung

37
Q

How are rib fractures managed?

A

CT, diagnostic test

Conservative management with analgesia

Surgical fixation considered if pain is still an issue and the fractures have failed to heal following 12 weeks of conservative management

Flail chest segments are urgently discussed with cardiothoracic surgery for invasive ventilation and surgical fixation

38
Q

Give features of patella fractures

A

Fall onto knee

Pain

Inability to weight bear

Swelling and haemathrosis

Successful straight leg raise

39
Q

How are patella fractures managed?

A

Undisplaced

  • Managed non-operatively in a hinged knee brace for 6 weeks
  • Allowed to fully weight bear

Displaced fractures and those with loss of extensor mechanisms

  • Considered for operative management with either tension band wire, inter-fragmentary screws or cerclage wire
  • Patients are placed in a hinged knee brace for 4 to 6 weeks
  • Allowed to fully weight bear
40
Q

What is an open fracture?

A

Direct communication between the external environment and the fracture, usually through a break in the skin

41
Q

What is the most common open fracture?

A

Fingers and tibial shaft account for >50%

42
Q

What classification system is used for open fractures?

A

Anderson Gustilo Classification

43
Q

Give open fracture complications

A

Immediate

  • Pain
  • Fat embolism
  • Pneumothorax
  • Nerve palsy
  • Arterial damage

Early

  • Compartment Syndrome
  • Immobility
  • Wound infection/Acute osteomyelitis
  • DVT
  • Pulmonary embolism
  • Acute Osteomyelitis

Late

  • Osteoarthritis
  • Avascular Necrosis
  • Chronic Osteomyelitis
44
Q

What is a dislocation?

A

Complete joint disruption

45
Q

What is a subluxation?

A

Partial dislocation, not fully out of joint

46
Q

What is compartment syndrome?

A

Complication of fractures or ischaemia characterised by raised pressure within a closed anatomical space, which will eventually compromise tissue perfusion and result in necrosis

47
Q

How does compartment syndrome present?

A

Severe pain, especially on movement, particulatly passive

Excessive use of breakthrough analgesia should raise suspicion for compartment syndrome

Parasthesia

Pallor

Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise

Paralysis of the muscle group may occur

48
Q

What investigations are used in comaprtment syndrome monitoring?

A

Compartment pressure monitoring

  • Pressures over 20mmHg are abnormal and over 40mmHg is diagnostic

Will typically not show any pathology on xray

49
Q

How is compartment syndrome managed?

A

Prompt fasciotomy to relieve pressure, as muscle groups die within 4-6 hours

IV fluids to prevent myoglobinuria and renal failure

Analgesia

Keep limb level with body

Amputation considered if frank necrosis

50
Q

What fractures are most associated with compartment syndrome?

A

Supracondylar fractures and tibial shaft injuries

51
Q

What can worsen compartment syndrome?

A

Anticoagulation

Musculoskeletal + Rheumatology (16 decks)

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