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Orthopedics 2 > Tx of Fx > Flashcards

Tx of Fx Flashcards

1
Q

What are the three phases of fracture healing?

A

Reactive phase: fracture and inflammation, granulation tissue formation

Reparative phase: cartilage callus formation

Remodeling phase: trabecular bone is replaced with compact bone

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2
Q

WHAT ARE SOME COMMON CONDITION THAT IMPAIR HEALING?

A

DM, arteriovascular disease, anemia, vitamin deficiencies, tobacco use, chronic alcohol abuse, Meds: NSAIDs, glucocorticoids, cipro

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3
Q

Evaluation of the Fx
-what should you check/think?

What are some complications of fractures?

A
  • where is the deformity?
  • open or closed injury?
  • check joints above and below the fracture
  • Minimum 2 x-ray views of the injured part (“one view is no view”)

Complications

  • pelvic and femoral fx can have significant blood loss
  • injuries to other structures (nerves, vessels)
  • acute compartment syndrome
  • increased risk of venous thrombosis with major trauma
  • fat embolism syndrome
  • complex regional pain syndrome
  • late: osteomyelitis, non/mal union, post traumatic arthritis
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4
Q

Common injury patterns (what gets broken)

  • Outstretched hand
  • fall off a roof
A
  • Outstretched hand: scaphoid, radial head, wrist, proximal humerus
  • fall off a roof: os calcis (calcaneus), tibial plateau, TL compression Fx
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5
Q

How do you acutely stabilize a fracture?

Definitive treatment?

A

Acute stabilization

  • evaluate the patient
  • immobilize the fracture (splint)
  • provide analgesia: ice, elevation, immobilization, pain meds

Definitive treatment
-create conditions in which the body will heal the fracture while the pt is a s functional as possible

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6
Q

Fractures:

-treatment options

A

Treatment

  • minimal treatment: rib fractures, torus fractures, metacarpal fractures, toe fractures
  • immobilization with cast, splint, brace
  • traction…not used much anymore
  • fracture reduction (open or closed)
  • surgical fixation
  • -pins and wires
  • -plates and screws
  • -external fixators (for unstable injuries and contaminated fractures)
  • -intramedullary devices (gamma nails)
  • -replacements (hip, shoulder, radial head)
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7
Q

What is the treatment of choice for undisplaced, stable, and some reduced fractures?

What is the treatment for diaphyseal fractures?

A

Casting

Casting but include the joint above and below the fracture

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8
Q

What is the growth plate fracture classification used for children?

A

Salter Harris Classification!

1: undisplaced
2: physis and metaphysis
3: physis and epiphysis
4: across the physis
5: crush injury

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9
Q

Clavicular fractures

  • MC site on the clavicle
  • tx of stable
  • tx of displaced, angulated, over riding
A

MC site is mid shaft (middle third)

Tx of stable: sling or figure 8 splint

Tx of displaced: may need surgery

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10
Q

Adult shoulder fractures

  • often due to what MOI?
  • tx of impacted or non-displaced
  • when to refer
A

Often due to
-falling from STANDING height

Tx
-conservative (sling, limit activities, pain meds)

Refer if
-anatomic neck, complex fracture, dislocations

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11
Q

Distal Forearm Fractures in Children

  • When do they need ortho referral?
  • tx of stable fractures
  • tx of colles fracture
A

Refer if

  • neurovascular compromise
  • open fracture
  • gross deformity
  • displaced Satler Fx

Stable fractures tx
-casts and braces

Colles fractures tx
-ranges from splint to pinning to plating

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12
Q

Metacarpal fractures

  • usually due to what MOI
  • tx

Base of thumb fractures
-tx

A

Usually due to direct trauma (punching a wall)

tx

  • depends on displacement, angulation, rotation
  • shelf brace or taping of fingers

Base of thumb
-tx depends on stability, test stability`

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13
Q

Vertebral compression fractures

  • what is Dowager’s hump?
  • tx
A

Dowager’s hump
-osteoporotic vertebral compression fractures

tx

  • pain relief and correction of osteoporosis
  • bracing for pain relief and increased activity
  • surgery for neuro compromise or unresponsive pain
  • -vertebroplasty
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14
Q

Pelvic Fractures

  • concerns about this type of fracture
  • who is this commonly seen in?

Hip fractures

  • t/f, significant source of morbidity and mortality
  • tx of choice
A

Pelvic Fractures
Concerns
-beware of blood loss and injuries to other organs

Can see pubic rami or sacral fractures with minimal trauma in the osteoporotic

Hip fractures
-True, 1/3 die within 6 months

tx
-surgery (it decreased morbidity, relieves pain, allows for function)

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15
Q

Femoral neck fx
-tx

Intertrochanteric Hip Fractures
-tx

Subtrochanteric hip fx
-tx

A

Femoral neck fractures
tx
-replacement is better than pinning because the fracture/pin can interrupt blood supply and has a high complication rate

Intertrochanteric Hip Fx
tx
-plate and screws, but can lose significant blood (type and screen pre op)

Subtrochanteric hip fx
tx
-unstable injury: intramedullary device (rod type thing), can have significant blood loss

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16
Q

Tibial Shaft Fx

  • distal metaphysis fx MC MOI
  • mid shaft fx MC MOI
  • spiral, oblique, or distal fxs MC MOI
  • tx

Ankle Fractures

  • Dx
  • tx of stable injury, unstable
A

Distal metaphysis
-usually low energy fx

Mid shaft fx
-high energy injury (MVA)

Spiral, oblique, distal fx
-rotational injury

Tx

  • need referral to ortho
  • many will require surgery, may be able to splint until then

Ankle Fx

  • Dx: AP, lateral, and oblique Xrays
    tx:
  • stable can treated conservatively
  • unstable: surgery
  • -surgery is mandatory if there is ankle joint separation (look at mortice)
17
Q

Foot fracture

  • dx
  • tx
A

Dx

  • palpate for occult injuries!
  • AP, lateral, oblique xrays

Tx

  • conservatively
  • -short leg walking cast or boot, stable toe fx can be taped
18
Q

Metastatic Fractures

-tx

A

tx

  • stabilize fracture, remove tumor
  • -bone cement
  • early lesion (pre fracture) may respond to radiotherapy
19
Q

Stress fracture

  • cause
  • dx
  • tx
A

Cause

  • repetitive stresses applied to a bone (rate of absorption exceeds that of a deposition)
  • -can start as a dull ache and build to sharp pain

Dx
-often not seen on xray… MRI or bone scan id suspicious

Tx
-most respond to decreased activity and immobilization

20
Q

What are some fractures that suggest child abuse?

A
  • metaphyseal corner fractures
  • fractures of the ribs, sternum, scapula, spinus process
  • multiple fracture in various stages of healing
  • bilateral acute long bone fractures
  • skull fractures in children younger than 18 months
21
Q

When to refer…

A
  • any open injury
  • neurovascular compromise
  • high energy injuries
  • excessive pain… possible compartment syndrome
  • fracture that is significantly angulated or displaced
  • fractures with known bad outcomes like hip, scaphoid, displaced long bone fxs
  • whenever a parent or pt has concern!

Orthopedics 2 (14 decks)

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