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BMSc Orthopaedic medicine > Unit 5 - common fractures > Flashcards

Unit 5 - common fractures Flashcards

1
Q

What are the clinical signs of a fracture?

A 
Pain 
Deformity
Swelling
Discolouration/bruising
Loss of function
Crepitus
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2
Q

What methods can be used to investigate fractures?

A

Xrays - mainstay for investigating. Usually 2 angles are needed

Tomograms (CAT) - a view of a slice through a body part. Useful if there are many overlapping structures

Ultrasound - can be useful to show accumulation of fluid (esp blood) in a fracture

Radioisotope scanning - more metabolically active sites (eg #) can be detected therefore can show hard to detect #s

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3
Q

What is an open fracture?

A

One that has broken the skin

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4
Q

Name 4 fracture shapes

A

Spiral
Oblique
Transverse
Linear

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5
Q

What is a comminuted fracture?

A

When the bone is broken into many fragments

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6
Q

What features are described when talking about a fractures postion?

A

Displacement (anterior, posterior, medial, lateral)

Angulation (anterior, posterior, varus, valgus)

Rotation (internal, external)

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7
Q

What is a pathological fracture?

A

One in which the fracture seems out of proportion to the severity (energy involved in) of the injury

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8
Q

What is involved in the immediate management of a fracture?

A

Pain relief:

  • pain killers
  • splintage (should encompass joint above & below injury)

Blood loss:

  • in major long bones (particularly femur) & pelvis, # can cause large blood loss
  • should be crossed matched early

Open fractures:

  • clean & remove dead tissue
  • surgical emergency therefore take to theatre asap
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9
Q

What 2 ways may reduction of a fracture be achieved?

A

Closed reduction - traction and relocation of distal fragment onto proximal fragment by manipulation

Open reduction - if closed unsuccessful # site opened and fragments relocated directly under vision

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10
Q

Name 4 ways a fracture may be held in place

A

Casting

External fixation

Internal fixation

Traction

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11
Q

What is the most common form of casting & how doesit work?

A

Plaster of Paris:

  • acts as a splint
  • controls joint movement & position
  • moulded so pressure is exerted at 3 points, holding # on correct position
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12
Q

What are the disadvantages of plaster of Paris?

A

Heavy & immobilises joint

Cannot examine covered part or xray (need to remove)

Immobility results in muscle wasting & joint stiffness

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13
Q

What are functional braces?

A

Casts that involve moulding along with hinges to allow movement at joints

Over come disadvantages of
plaster casts

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14
Q

When may external fixation be used?

A

In high-energy #s with extensive soft tissue damage (often with skin breaching)

Allows soft tissue healing & access to wound

Internal fixation may cause ischaemia and wound contamination

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15
Q

What 4 methods may be used for internal fixation of a #?

A

Apposition - once fracture is realigned is may only need to be held in alignment for healing to proceed (particularly true for children)

Interfragmentary compression - holding 2 bone fragments together with screws

Onlay device - usually metal plate used to buttress weak structures around joints & fix long bones

Inlay device - intramedullary methods correct alignment of broken bones without disrupting natural bone healing

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16
Q

Why may a bone be weaker after an internal fixation device has been used?

A

Plate off-loads the bone and that bone gets thinner than if it were not off-loaded

17
Q

How does traction work as a holding method?

A

Stimulates muscles to contract and is sufficient to hold a broken bone in position achieved at reduction

Traction in this situation is a holding and moulding device as muscles effectively “massage” aligned fracture ends until natural healing takes place

18
Q

What 3 methods of traction may be used for holding a fracture?

A

Static - used for short periods where pull is applied against another part of the body (Thomas splint)

Balanced - pull against the ring is balanced by a weight attached to the whole splint. This takes the pressure off the skin around the ring while maintaining traction

Dynamic - used where joints are still permitted to move but, by means of pulleys, the pull is still maintained along the line of broken bone. In this case weights provide the pull and counter force is achieved by tilting bed (may require a pin to be inserted into bone)

19
Q

What happens at each of the following stages in fracture healing:

  • 1st 2 weeks
  • 2-6 weeks
  • 6-12 weeks
  • 6-12 months
  • 1-2 years
A

Swelling

Callus forming

Bone forming

Bone

Remodelling taken place & bone returns to normal

20
Q

What stimulates bone to heal?

A

Micromovement along the long axis of the bone at right angles to the break

Bones do heal if there is no movement but very slowly

21
Q

Name early complications of a fracture (primary) and/or treatment (secondary)

A 
Blood loss
Infection
Fat embolism 
Renal failure 
Soft tissue injury
Compartment syndrome

Plaster disease
Renal stones
Immobility

22
Q

What is the commonest cause of bone infection in the west?

A

Internal fixation

23
Q

What causes fat embolism?

A

2 hypothesis:

  • trauma cuases breakdown of fats to fatty acids which precipitate inflammation in lungs
  • fat globules from disrupted marrow fat precipitate in lungs
24
Q

Why may a fracture lead to compartment syndrome?

A

Broken bone leads to bleeding & inflammation in adjacent compartment causing increase in pressure that reduces blood flow & leads to ischaemia

25
Q

What is the clinical presentation of compartment syndrome?

A

Pain out of proportion of injury
Loss of function
Paresthesia
Pale

Stretching muscles in that compartment precipitates extreme pain

26
Q

What is plaster disease & what other issues may immobility cause?

A

Muscle wasting, stiffness, skin sores

Osteoporosis 
Renal stones (excess calcium from bone thinning)
27
Q

What are the possible late complications of fractures?

A 
Non-union
Delayed union
Mal-union
Growth arrest
Arthritis
28
Q

How long do fractures take to heal & when would there to be non-union?

A

Upper limb ~ 6 weeks
Lower limbs ~ 12 weeks

Non-union:

  • > 10 weeks for upper limb
  • > 20 weeks for lower
29
Q

What may cause non-union?

A 
Excess movement 
Too little movement
Soft tissue interposition
Poor blood supply
Infection
Excessive traction
Intact adjacent bone
30
Q

What is the treatment for non-union?

A

Remove underlying cause

Stimulate union (bone graft)

31
Q

What is delayed union?

A

Period between expected union & non-union

32
Q

What is malunion?

A

When a fracture has healed in an incorrect position & will not allow normal function

Usually implies failure of treatment or non-attendance at out-patient clinics

33
Q

When may a fracture cause growth arrest?

A

If it breaches germinal layer of epiphyseal growth plate

34
Q

When may a fracture lead to arthritis?

A

If a joint is excessively stressed

If articular surfaces are disrupted causing uneven forces on it

BMSc Orthopaedic medicine (5 decks)

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