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Week 118 - Fractured Hip Flashcards

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1
Q

Week 118 - Fractured Hip: Give a definition of fracture.

A

The loss of continuity of a bone due to physical stress.

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2
Q

Week 118 - Fractured Hip: Give a definition of dislocation.

A

The complete loss of contact between articulating surfaces of a joint.

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3
Q

Week 118 - Fractured Hip: What are the five types of fractures of long bones? Give a brief description of each.

A
  • Transverse - Across the bone.
  • Spiral - As it says on the tin.
  • Oblique - diagonally down the bone.
  • Comminuted - The bone breaks into several pieces. (close together).
  • Segmental - The bone breaks into more than 2 pieces but the breaks are quite far apart.
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4
Q

Week 118 - Fractured Hip: What are the two types of fractures for cancellous bones. Give a brief description of each.

A
  • Impacted - A fracture when bone fragments are driven into each other.
  • Crush / Compression - Mostly associated with spinal.
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5
Q

Week 118 - Fractured Hip: What is an avulsion fracture?

A

• This is when a bit of bone is pulled off the rest of a bone by a tendon/ligament.

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6
Q

Week 118 - Fractured Hip: What are the four types of deformity that can occur?

A
  • Displacement (shift)
  • Angling (Tilt)
  • Rotation
  • Shortening
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7
Q

Week 118 - Fractured Hip: What are the four stages of fracture healing?

A
  • Inflammation
  • Soft callus
  • Hard callus
  • Remodelling
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8
Q

Week 118 - Fractured Hip: What is present in a fracture haematoma?

A
  • Fibrin clot
  • Platelets
  • Monocytes
  • Polymorphs
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9
Q

Week 118 - Fractured Hip: What marks the start and end of the soft callus stage of fracture healing?

A
  • Begins when pain and swelling subsides.
  • Ends with bony fragments being united by fibrous or cartilaginous tissue.

• Bone ends are no longer freely moveable but angulation is still possible.

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10
Q

Week 118 - Fractured Hip: What occurs during the hard callus stage of fracture healing?

A
  • Mineralisation of cartilage.
  • Osteoblasts convert cartilaginous tissue into woven bone.
  • Increasing fracture stiffness.
  • External callus.
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11
Q

Week 118 - Fractured Hip: What occurs during the remodelling stage of fracture healing?

A
  • Woven bone is converted into lamellar bone.
  • Excessive callus removed.
  • Medullary canal reconstructed.
  • May not be completed for years.
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12
Q

Week 118 - Fractured Hip: Which type of fixing methods give relative stability?

A
  • Plaster cast
  • IM nails
  • External fixation
  • Traction
  • Circular frames
  • Internal fixation with relative stability.
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13
Q

Week 118 - Fractured Hip: Which fixing method gives absolute stability?

A

• Internal fixation with absolute stability.

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14
Q

Week 118 - Fractured Hip: What are the rules of two for radiographs?

A
  • Two views (90º)
  • Two joints
  • Two limbs
  • Two occasions
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15
Q

Week 118 - Fractured Hip: What are the non-operative options for retention of a fracture?

A
  • Strapping
  • Plaster slab/cast
  • Traction
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16
Q

Week 118 - Fractured Hip: What are the operative options for retention of a fracture?

A
  • Plates and screws
  • IM nails
  • External fixator
  • Percutaneous screws.
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17
Q

Week 118 - Fractured Hip: What are the indications for internal fixation?

A
  • Displaced intra-articular fractures.
  • Fractures with tenuous blood supply.
  • Multiple injuries.
  • More than one fracture in a single limb.
  • Pathology of long bones.
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18
Q

Week 118 - Fractured Hip: What would you expect to see in arterial vascular trauma from a fracture?

A
  • Painful
  • Pale or plum coloured
  • Paraesthetic
  • Pulseless
  • Perishing cold
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19
Q

Week 118 - Fractured Hip: What is fat embolism? What is the classic triad of symptoms?

A
  • Fat globule in lung parenchyma and peripheral circulation post long bone fracture or major trauma.
  • Respiratory, Neurological, Petechial Rash.
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20
Q

Week 118 - Fractured Hip: What is compartment syndrome and what are the complications?

A
  • Muscle swelling within a closed osseo-fascial compartment leading to increased pressure.
  • Capillary ischaemia and death > neurovascular damage.
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21
Q

Week 118 - Fractured Hip: What are the three symptoms of compartment syndrome?

A

PAIN
PAIN out of proportion of injury.
PAIN on passive stretch of muscles.

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22
Q

Week 118 - Fractured Hip: What are two signs of compartment syndrome that come on late and show that you are too late.

A
  • Pins and Needles

* Pulselessness

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23
Q

Week 118 - Fractured Hip: What is non union?

A
  • Fracture has failed to unite and healing process is no longer active.
  • Fracture will never unite unless treatment is altered.
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24
Q

Week 118 - Fractured Hip: What are the two main types of non-union?

A
  • Hypertrophic non-union.

* Atrophic non-union.

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25
Week 118 - Fractured Hip: What is hypertrophic non-union?
* Inadequate stability but bone ends are viable. * Sclerotic and flared bone ends make excessive callus - 'Elephants foot'. * Visible fracture line filled with fibrous tissue / cartilage. * Good blood supply. * Stabilise and union will occur.
26
Week 118 - Fractured Hip: What is Atrophic non-union?
* No evidence of cellular activity. * Bone ends are rounded and sclerotic. * Treatment is less reliable and more complex than for hypertrophic non-union. * Bone ends are removed and rigid stabilisation.
27
Week 118 - Fractured Hip: Where are the most common places that avascular necrosis of bone occurs?
• Femoral head, scaphoid, talus, lunate.
28
Week 118 - Fractured Hip: What is myositis ossificans? What are the most common locations?
* Calcified soft tissue near joints. * Restricts movement. * Elbow fracture / dislocation. * Acetabular fracture.
29
Week 118 - Fractured Hip: What are the local signs of osteitis?
* Tenderness * Swelling * Smell * Discharge
30
Week 118 - Fractured Hip: What is the treatment for osteitis?
* Sample of exudate. * High doses of appropriate antibiotics. * Drainage * Removal of implants?
31
Week 118 - Fractured Hip: What is the definition of a pathological fracture?
Fracture occurring following minimal stress through abnormal bone.
32
Week 118 - Fractured Hip: What are the five types of cancer that most commonly produces bone mets?
* Breast * Thyroid * Bronchus * Prostate * Kidney
33
Week 118 - Fractured Hip: What are stress fractures?
These are fractures that occur in healthy people, with healthy bones, from repeated forces.
34
Week 118 - Fractured Hip: What are the three types of fracture that are specific to children?
* Greenstick fracture * Buckle fracture * Plastic deformity
35
Week 118 - Fractured Hip: What is the difference between child and adult bone?
* Childs periosteum is thicker and more metabolically active. * There is increased collagen, more porous and elasticity in childrens bones.
36
Week 118 - Fractured Hip: What are the key stages of treatment for open fractures?
* Thorough debridement. * Skeletal stabilisation. * Early skin cover. * Rehabilitation.
37
Week 118 - Fractured Hip: What are the two types of bone?
* Trabecular - Scaffolding | * Cortical - Shell
38
Week 118 - Fractured Hip: What is a Colles fracture?
Fracture of the distal radius with dorsal and radial displacement of the wrist and hand.
39
Week 118 - Fractured Hip: What are the risk factors for developing osteoporosis?
* Age * Female * Genetics * Oestrogen deficiency (Early menopause / late menarche)
40
Week 118 - Fractured Hip: What is a DEXA scan used for and how are the results presented?
* Measures peak bone density and compares it to mean peak bone density. * Results are presented as standard deviations above or below mean peak bone mass. (T-score)
41
Week 118 - Fractured Hip: How does the z-score differ form the t-score?
* z-score compares for age also whilst t-score compares against young adult. * T-score is best for assessing fracture risk.
42
Week 118 - Fractured Hip: How does the T-score classification system work?
* 0 > -1 - Normal. * -1 > -2.5 - Osteopenia. * -2.5 or below - Osteoporosis. * -2.5 or below with fracture is severe osteoporosis.
43
Week 118 - Fractured Hip: Which DEXA scoring system is used for young adults and children?
• Z-score
44
Week 118 - Fractured Hip: What is the lifestyle treatment for osteoporosis?
* Adequate calcium and vitamin D intake. * Exercise * Modify risk factors * Falls prevention/intervention * Raise awareness.
45
Week 118 - Fractured Hip: What is the medical treatment for osteoporosis?
* Decrease bone resorption - Bisphosphonates, RANK ligand inhibitors. * Increase bone formation - Teriparatide, Strontium Ranelate.
46
Week 118 - Fractured Hip: What is the mechanism of action of bisphosphonates? Give examples and give the side effects.
* Inhibit osteoclasts. * Alendronic acid, Risedronate, Zolendronic acid, ibandronate. * GI disturbances * Rare - osteonecrosis of the jaw, atypical femoral fracture.
47
Week 118 - Fractured Hip: What is Denosumab?
* RANK ligand inhibitor. * Prevents osteoclast differentiation, activation and survival. * SC injection every 6 months, * Side-effects - Rare- osteonecrosis of the jaw and atypical fractures.
48
Week 118 - Fractured Hip: What is teriparatide?
* Recombinant human parathyroid hormone. * Normally PTH causes bone loss, but this is given in pulses which increases bone production and increases BMD. * Side effects - Bone/muscle pain
49
Week 118 - Fractured Hip: What are the actions of vitamin D? (5)
* Maintain calcium homeostasis * Maintain bone health * Increase Ca2+ from the gut * Increase phosphate absorption from the gut * Osteoclast function/maturation
50
Week 118 - Fractured Hip: How does vitamin D deficiency lead to reduced bone mineral density?
• Low VitD > Reduced Ca2+ from gut > Reduced serum Ca2+ > Increased PTH > Ca2+ absorbed from bone > reduced BMD.
51
Week 118 - Fractured Hip: What are some of the causes of Vitamin D deficiency?
* Inadequate sunlight. * Inadequate diet. * Malabsorption * Medication (Rifampicin, Phenytoin) * Abnormal Vit. B metabolism. * Hypophosphataemia
52
Week 118 - Fractured Hip: What is osteomalacia / rickets?
Vitamin D deficiency in adults / children.
53
Week 118 - Fractured Hip: What are the symptoms of osteomalacia?
* Bone pain/tenderness * Proximal muscle weakness * Back pain * Stress fractures
54
Week 118 - Fractured Hip: What blood results give you a diagnosis of vitamin D deficiency?
* Serum 25(OH) Vit D - low * Serum PTH - increased * Serum calcium - low/normal * Serum phosphate - low * Alkaline phosphatase - Increased
55
Week 118 - Fractured Hip: What is Paget's disease?
Disordered bone metabolism - Osteoclast overactivity - Followed by compensatory osteoblast activity - Leads to disordered woven bone - Weaker than normal bone
56
Week 118 - Fractured Hip: What are the bones that are commonly affected by Paget's disease?
* Spine * Pelvis * Skull * Femur
57
Week 118 - Fractured Hip: What are the symptoms of Paget's disease?
* Direct - Bone pain (deep, constant, worse on weight bearing, pathological fracture) * Indirect - High cardiac output, compression effects depending on site.
58
Week 118 - Fractured Hip: What are some of the compression symptoms of Paget's disease?
* Skull - Cranial nerve palsies, Basilar invagination. | * Spine - Sciatica/nerve root entrapment, Cauda equina syndrome.
59
Week 118 - Fractured Hip: What is the treatment of Paget's? Who Should be treated?
* Symptomatic, in danger of nerve compression, around a weight bearing joint. * Bisphosphonates - Risedronate, Zolendronate.
60
Week 118 - Fractured Hip: In terms of levels of Ca, P, Alk. P what would you expect to find in osteoporosis?
• All normal
61
Week 118 - Fractured Hip: In terms of levels of Ca, P, Alk. P what would you expect to find in osteomalacia?
* Ca - Normal or Low * P - Low * Alk. P - High
62
Week 118 - Fractured Hip: In terms of levels of Ca, P, Alk. P what would you expect to find in Paget's disease?
* Ca - Normal * P - Normal * Alk. P - High
63
Week 118 - Fractured Hip: What is Gardens classification of hip fractures?
1) Incomplete fracture, undisplaced. 2) Complete fracture, undisplaced. 3) Complete fracture, incompletely displaced. 4) Complete fracture, complete displacement.
64
Week 118 - Fractured Hip: What are the four surgical options for the treatment of intracapsular hip fracture?
* Dynamic hip screw. * Cannulated screw. * Hemiarthroplasty. * Total hip replacement.
65
Week 118 - Fractured Hip: What are the surgical options for the treatment of an extracapsular hip fracture?
* Dynamic hip screw. | * Intermedullary femoral nail.
66
Week 118 - Fractured Hip: A dynamic hip screw is the preferred method of surgery for hip fractures in which situations?
* Provides optimal stability. * Preferred in extra-capsular hip fractures, since the risk of AVN is lower. * Used in younger patients with intracapsular hip fractures wherever possible.
67
Week 118 - Fractured Hip: What is a cannulated screw?
* A surgical option where additional rotary stability is required, a further screw is added to a dynamic hip screw. * Preferred in extracapsular fractures due to lower risk of avascular necrosis, but is also used for intracapsular fractures in younger patients.
68
Week 118 - Fractured Hip: Hemiarthroplasty.
* Most common surgical treatment for fractured hips. * Used for intracapsular fractures or when the risk of AVN is high. * The femoral head is replaced by a prosthesis.
69
Week 118 - Fractured Hip: What is the FRAX tool used for?
• This assesses 10 year hip, spine, shoulder and forearm fracture risk.
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