Trauma Flashcards
What is a fracture?
A break in the continuity of the cortex of the bone
What is the difference between a complete and incomplete fracture?
Complete means the full cortex is affected (cortex is the hard outside bone)
What is a transverse fracture?
Straight cut along axis of bone
What is an oblique fracture?
Cut at an angle along axis of bone
What is a spiral fracture?
Oblique fracture with twisting along bone axis
What is a communited fracture?
Multiple breaks/fragments
What is an impacted fracture?
Bone pushes in on itself
What is an avulsion fracture?
Ligament pulls off bone
What is a greenstick fracture?
Breaks at one side but crumples on the opposite side of the impact, this is only in children
What are buckle fractures
Incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex, commonly in children
What is colles fracture?
Distal radius fracture with no articular involvement and dorsal displacement of fragmebt
Usually due to fall onto outstretched hand
What is smith fracture?
Distal radius fracture with volar angulation of the distal fragment
What system classifies growth plate fractures?
Salter- Harris system
Describe the Salter-Harris classification
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
How are mid shaft fractures of the radius and ulna managed?
Open reduction and internal fixation, if unstable
How are pelvic fractures managed?
Trauma call/ATLS
Resuscitation: Blood, Tranexamic acid
Pelvic Binder: Sat at level of GT
How do knee fractures present?
Tender along joint line
Lost full flexion
How are knee fractures managed?
Total Knee Replacement: Patellar resurfaced
Uni-compartmental
What classification system is used in ankle fractures?
Webers
What sex is more likely to be affected by hip fractures?
F>M
3:1
What is an extracapsular hip/neck of femur fracture?
Affects the femoral head and neck
These can either be trochanteric or subtrochanteric (the lesser trochanter is the dividing line
What is an intracapsular hip/neck of femur fracture?
Affect the blood supply to the head of the femur
How do hip/neck of femur fractures present?
Groin pain, sometimes knee pain
Sciatic nerve damage if anterior
Shortened, externally rotated leg
What classification system is used for intracapsular neck of femur fractures?
Garden
Describe Graden type 1
Undisplaced incomplete
Describe Graden type 2
Undisplaced complete
Describe Graden type 3
Complete partial displacement
Describe Garden type 4
Complete fully displaced
What are the management options for hip/neck of femur fractures?
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
What method of analgesia is used in neck of femur fracture?
Iliofascial nerve block
Give complications of hip fractures
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
Describe the ottawa ankle rules
These state that x-rays are only necessary if there is pain in the malleolar zone and
- Inability to weight bear for 4 steps
- Tenderness over the distal tibia
- Bone tenderness over the distal fibula
What classification is used for ankle fractures?
Weber
Describe weber classification
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
How are ankle fractures managed?
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
Give features of rib fractures
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
How are rib fractures managed?
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
Give features of patella fractures
Fall onto knee
Pain
Inability to weight bear
Swelling and haemathrosis
Successful straight leg raise
How are patella fractures managed?
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
What is an open fracture?
Direct communication between the external environment and the fracture, usually through a break in the skin
What is the most common open fracture?
Fingers and tibial shaft account for >50%
What classification system is used for open fractures?
Anderson Gustilo Classification
Give open fracture complications
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
What is a dislocation?
Complete joint disruption
What is a subluxation?
Partial dislocation, not fully out of joint
What is compartment syndrome?
Complication of fractures or ischaemia characterised by raised pressure within a closed anatomical space, which will eventually compromise tissue perfusion and result in necrosis
How does compartment syndrome present?
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
What investigations are used in comaprtment syndrome monitoring?
Compartment pressure monitoring
- Pressures over 20mmHg are abnormal and over 40mmHg is diagnostic
Will typically not show any pathology on xray
How is compartment syndrome managed?
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
What fractures are most associated with compartment syndrome?
Supracondylar fractures and tibial shaft injuries
What can worsen compartment syndrome?
Anticoagulation