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- Y6 Orthopaedics & Rheumatology > Fractures (trauma, stress, pathological) incl. classifications, radiology, management, complications, healing and stability > Flashcards

Fractures (trauma, stress, pathological) incl. classifications, radiology, management, complications, healing and stability Flashcards

1
Q

What are the three types of connective tissues?

A
  1. Bony -osteoid made by osteoblasts
  2. Cartilagenous - chondroid made by chondroblasts
  3. Fibrous - collagenous tissue made by fibroblasts
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2
Q

What types of collagen are found in skin and bone?

A

Skin - types I and III

Bone - types I

Hyaline cartilage - type II

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3
Q

What are the parts of a long bone? Which part is most metabolically active?

A

Epiphysis, metaphysis (near epiphyseal lin) and diaphysis

Metaphysis is most metabolically active

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4
Q

What orientation do pathological fractures usually have?

A

They are usually transverse

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5
Q

Does bone growth occur equally along the bones?

A

No - ‘to the elbow I grow, from the knee I flee’

Bone growth is more active at the farthest ends from the elbow and nearest to the knee

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6
Q

What are the types of joints?

A
  1. Fibrous joints/syndesmoses
  2. Cartilaginous joints/synchondroses
  3. Synovial joints - allow greatest mobility
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7
Q

What is hilton’s law?

A

The nerve supply of a joint is the same as that of the overlying muscles moving the joint and the skin over the insertions

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8
Q

What is the name for an injury where skin is sheared from the deeper layers?

A

Degloving injury

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9
Q

How are gunshot wounds classified and which are more common?

A

Low-velocity - more common e.g. by handgun or revolver

High-velocity e.g. assault rifle

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10
Q

Why are high-velocity gunshot wounds more dangerous despite looking innocent?

A

Phenomenon known as cavitation

Organs are pulled along the path of the bullet

Air/debris may be sucked in causing more contamination

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11
Q

What is a comminuted fracture?

A

When bone is broken into more than 2 fragments

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12
Q

What are the different ways of describing fracture type?

A

Transverse - usually due to force applied directly to the site

Spiral or oblique fracture - due to twisting force

Greenstick - cortex on concave side usually remains intact

Crush fracture - cancellous bone due to compression fracture

Burst fracture - usually in short bone like vertebrae due to impaction of the disc

Avulsion - caused by traction and bony fragment torn off by tendon/ligament

Fracture dislocation/subluxation - malalignment of joint surfaces

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13
Q

What is a ‘complicated’ fracture?

A

One that is associated with damage to nerves, vessels or internal organs

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14
Q

What type of fracture?

A

Crush fracture

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15
Q

What is the difference between dislocation and subluxation?

A

dislocation is a complete loss of congruity of the joint surfaces

subluxation is a partial loss of contact of the joint surface

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16
Q

What type of fracture?

A

Burst fracture

17
Q

Summarise the salter-harris classification.

A
18
Q

In the stages of fracture healing when does callus formation occur? What about complete radiological union?

A
19
Q

What are the 3 main principles of fracture management?

A
  1. Reduce
  2. Immobilise/maintain reduction
  3. Rehabilitate
20
Q

Should open fractures be closed straight away?

A

No - risk of infection needs to be eliminated first, sepsis excluded

Sometimes closure can be done early if there is little contamination and the open fracture is less than 6 hours old

21
Q

What are the reasons for fracture reduction?

A
  1. Cosmesis
  2. Function
  3. Mobility
  4. Union
  5. Neurovascular compromise
22
Q

What are the advantages and disadvantages of the plaster of Paris?

A
23
Q

What are the types of fracture reduction?

A
  1. Manipulation under anaesthesia
  2. Traction - slow reduction when manipulation is inappropriate e.g. risky anaesthetic
  3. Open reduction - accurate but risk of infection
  4. Closed reduction and fixation
24
Q

What are 3 different techniques used for maintaining fracture stability?

A

Intrinsic stability i.e. require no stabilisation

External splintage -

  • casting - e.g. plaster of Paris (but this is heavy), polythene, plastazote
  • cast bracing - hinged or jointed
  • traction - usually needs in patient stay so less used now;many different types
  • frame fixation

Internal fixation - bone stability promotes soft tissue healing;

  • screws
  • plates
  • compression plates
  • IM nails
  • wires
25
Q

What are the advantages and disadvantages of internal fracture fixation?

A
26
Q

In what situations is fracture fixation important?

A
  • When external splinatge is not adequate reduction
  • When early movement is needed
  • When you must avoid long periods of immobility e.g. elderly
  • In cases of multiple trauma to simplify treatment
  • In some pathological fractures where union is uncertain
27
Q

Name this traction.

A

Gallows or Bryant traction

28
Q

What fractures is this traction used for?

A

Tibial or femoral fractures

29
Q
A
30
Q

What are the main immediate complications from fracture?

A
  1. Shock - from haemorrhage which is internal or external
  2. Injury to important organs e.g. brain, lung, liver
  3. Injury to nerves or vessels
  4. Skin loss or damage
31
Q

What are the intermediate complications of fracture (i.e. occuring during treatment)?

A
  1. DVT/PE
  2. Chest infection
  3. Renal calculi, acute retention, other UTI
  4. Fat embolism syndrome - usually 3-10 days after fracture of long bone, cause unknown. Presents as confusion and resp difficulties
  5. Crush syndrome - extensive tissue damage results in ATN with renal failure; may be prevented by removing damaged tissue

Locally:

  1. Compartment syndrome
  2. Gangrene
  3. Pressure sores and nerve palsies
  4. Infection and wound breakdown
  5. Loss of alignment
  6. Tetanus and gas gangrene
32
Q

What are the late complications of fractures?

A

General - PTSD or psychological disturbance

Local

  1. Delayed and non-union
  2. Late wound sepsis with skin breakdown
  3. Failure of internal fixation
  4. Joint stiffness and contracture
  5. Regional pain syndrome - previously known as reflex sympathetic dystrophy, Sudek’s atrophy or algodystrophy. Unknown cause. Causes pain, swelling and discolouration with patchy porosis on XR which then resolves after weeks-months.
  6. Osteoarthritis
33
Q

What is a sign of delayed union?

A

No callus formation

34
Q

Name 3 factors which affect fracture union.

A
  • Age - favourable in young, no effect in old
  • Fracture site - blood supply
  • Degree of violence - slower
  • Infection
  • Immobilisation
  • Bone or generalised disease
  • Distraction of the bone ends

- Y6 Orthopaedics & Rheumatology (57 decks)

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