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Week 118 - Fractured Hip Flashcards

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
Q

Week 118 - Fractured Hip: What is hypertrophic non-union?

A
  • 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.
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26
Q

Week 118 - Fractured Hip: What is Atrophic non-union?

A
  • 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.
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27
Q

Week 118 - Fractured Hip: Where are the most common places that avascular necrosis of bone occurs?

A

• Femoral head, scaphoid, talus, lunate.

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28
Q

Week 118 - Fractured Hip: What is myositis ossificans? What are the most common locations?

A
  • Calcified soft tissue near joints.
  • Restricts movement.
  • Elbow fracture / dislocation.
  • Acetabular fracture.
29
Q

Week 118 - Fractured Hip: What are the local signs of osteitis?

A
  • Tenderness
  • Swelling
  • Smell
  • Discharge
30
Q

Week 118 - Fractured Hip: What is the treatment for osteitis?

A
  • Sample of exudate.
  • High doses of appropriate antibiotics.
  • Drainage
  • Removal of implants?
31
Q

Week 118 - Fractured Hip: What is the definition of a pathological fracture?

A

Fracture occurring following minimal stress through abnormal bone.

32
Q

Week 118 - Fractured Hip: What are the five types of cancer that most commonly produces bone mets?

A
  • Breast
  • Thyroid
  • Bronchus
  • Prostate
  • Kidney
33
Q

Week 118 - Fractured Hip: What are stress fractures?

A

These are fractures that occur in healthy people, with healthy bones, from repeated forces.

34
Q

Week 118 - Fractured Hip: What are the three types of fracture that are specific to children?

A
  • Greenstick fracture
  • Buckle fracture
  • Plastic deformity
35
Q

Week 118 - Fractured Hip: What is the difference between child and adult bone?

A
  • Childs periosteum is thicker and more metabolically active.
  • There is increased collagen, more porous and elasticity in childrens bones.
36
Q

Week 118 - Fractured Hip: What are the key stages of treatment for open fractures?

A
  • Thorough debridement.
  • Skeletal stabilisation.
  • Early skin cover.
  • Rehabilitation.
37
Q

Week 118 - Fractured Hip: What are the two types of bone?

A
  • Trabecular - Scaffolding

* Cortical - Shell

38
Q

Week 118 - Fractured Hip: What is a Colles fracture?

A

Fracture of the distal radius with dorsal and radial displacement of the wrist and hand.

39
Q

Week 118 - Fractured Hip: What are the risk factors for developing osteoporosis?

A
  • Age
  • Female
  • Genetics
  • Oestrogen deficiency (Early menopause / late menarche)
40
Q

Week 118 - Fractured Hip: What is a DEXA scan used for and how are the results presented?

A
  • 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
Q

Week 118 - Fractured Hip: How does the z-score differ form the t-score?

A
  • z-score compares for age also whilst t-score compares against young adult.
  • T-score is best for assessing fracture risk.
42
Q

Week 118 - Fractured Hip: How does the T-score classification system work?

A
  • 0 > -1 - Normal.
  • -1 > -2.5 - Osteopenia.
  • -2.5 or below - Osteoporosis.
  • -2.5 or below with fracture is severe osteoporosis.
43
Q

Week 118 - Fractured Hip: Which DEXA scoring system is used for young adults and children?

A

• Z-score

44
Q

Week 118 - Fractured Hip: What is the lifestyle treatment for osteoporosis?

A
  • Adequate calcium and vitamin D intake.
  • Exercise
  • Modify risk factors
  • Falls prevention/intervention
  • Raise awareness.
45
Q

Week 118 - Fractured Hip: What is the medical treatment for osteoporosis?

A
  • Decrease bone resorption - Bisphosphonates, RANK ligand inhibitors.
  • Increase bone formation - Teriparatide, Strontium Ranelate.
46
Q

Week 118 - Fractured Hip: What is the mechanism of action of bisphosphonates? Give examples and give the side effects.

A
  • Inhibit osteoclasts.
  • Alendronic acid, Risedronate, Zolendronic acid, ibandronate.
  • GI disturbances
  • Rare - osteonecrosis of the jaw, atypical femoral fracture.
47
Q

Week 118 - Fractured Hip: What is Denosumab?

A
  • 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
Q

Week 118 - Fractured Hip: What is teriparatide?

A
  • 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
Q

Week 118 - Fractured Hip: What are the actions of vitamin D? (5)

A
  • Maintain calcium homeostasis
  • Maintain bone health
  • Increase Ca2+ from the gut
  • Increase phosphate absorption from the gut
  • Osteoclast function/maturation
50
Q

Week 118 - Fractured Hip: How does vitamin D deficiency lead to reduced bone mineral density?

A

• Low VitD > Reduced Ca2+ from gut > Reduced serum Ca2+ > Increased PTH > Ca2+ absorbed from bone > reduced BMD.

51
Q

Week 118 - Fractured Hip: What are some of the causes of Vitamin D deficiency?

A
  • Inadequate sunlight.
  • Inadequate diet.
  • Malabsorption
  • Medication (Rifampicin, Phenytoin)
  • Abnormal Vit. B metabolism.
  • Hypophosphataemia
52
Q

Week 118 - Fractured Hip: What is osteomalacia / rickets?

A

Vitamin D deficiency in adults / children.

53
Q

Week 118 - Fractured Hip: What are the symptoms of osteomalacia?

A
  • Bone pain/tenderness
  • Proximal muscle weakness
  • Back pain
  • Stress fractures
54
Q

Week 118 - Fractured Hip: What blood results give you a diagnosis of vitamin D deficiency?

A
  • Serum 25(OH) Vit D - low
  • Serum PTH - increased
  • Serum calcium - low/normal
  • Serum phosphate - low
  • Alkaline phosphatase - Increased
55
Q

Week 118 - Fractured Hip: What is Paget’s disease?

A

Disordered bone metabolism

  • Osteoclast overactivity
  • Followed by compensatory osteoblast activity
  • Leads to disordered woven bone
  • Weaker than normal bone
56
Q

Week 118 - Fractured Hip: What are the bones that are commonly affected by Paget’s disease?

A
  • Spine
  • Pelvis
  • Skull
  • Femur
57
Q

Week 118 - Fractured Hip: What are the symptoms of Paget’s disease?

A
  • Direct - Bone pain (deep, constant, worse on weight bearing, pathological fracture)
  • Indirect - High cardiac output, compression effects depending on site.
58
Q

Week 118 - Fractured Hip: What are some of the compression symptoms of Paget’s disease?

A
  • Skull - Cranial nerve palsies, Basilar invagination.

* Spine - Sciatica/nerve root entrapment, Cauda equina syndrome.

59
Q

Week 118 - Fractured Hip: What is the treatment of Paget’s? Who Should be treated?

A
  • Symptomatic, in danger of nerve compression, around a weight bearing joint.
  • Bisphosphonates - Risedronate, Zolendronate.
60
Q

Week 118 - Fractured Hip: In terms of levels of Ca, P, Alk. P what would you expect to find in osteoporosis?

A

• All normal

61
Q

Week 118 - Fractured Hip: In terms of levels of Ca, P, Alk. P what would you expect to find in osteomalacia?

A
  • Ca - Normal or Low
  • P - Low
  • Alk. P - High
62
Q

Week 118 - Fractured Hip: In terms of levels of Ca, P, Alk. P what would you expect to find in Paget’s disease?

A
  • Ca - Normal
  • P - Normal
  • Alk. P - High
63
Q

Week 118 - Fractured Hip: What is Gardens classification of hip fractures?

A

1) Incomplete fracture, undisplaced.
2) Complete fracture, undisplaced.
3) Complete fracture, incompletely displaced.
4) Complete fracture, complete displacement.

64
Q

Week 118 - Fractured Hip: What are the four surgical options for the treatment of intracapsular hip fracture?

A
  • Dynamic hip screw.
  • Cannulated screw.
  • Hemiarthroplasty.
  • Total hip replacement.
65
Q

Week 118 - Fractured Hip: What are the surgical options for the treatment of an extracapsular hip fracture?

A
  • Dynamic hip screw.

* Intermedullary femoral nail.

66
Q

Week 118 - Fractured Hip: A dynamic hip screw is the preferred method of surgery for hip fractures in which situations?

A
  • 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
Q

Week 118 - Fractured Hip: What is a cannulated screw?

A
  • 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
Q

Week 118 - Fractured Hip: Hemiarthroplasty.

A
  • 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
Q

Week 118 - Fractured Hip: What is the FRAX tool used for?

A

• This assesses 10 year hip, spine, shoulder and forearm fracture risk.

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