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BRS MUSCULOSKELETAL > 1b// Management of Specific Fractures > Flashcards

1b// Management of Specific Fractures Flashcards

1
Q

What is the common nomenclature for orthopaedics? (4)

A

look
feel
move
x-ray

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2
Q

What is the nomenclature for trauma? (6)

A
  • Reduce
  • Hold
    – Plaster
    – External fixator
    – Internal fixation
  • Rehabilitate
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3
Q

How do you assess and manage a trauma?

A

The fracture is usually the least important bit

Keep the patient alive first – ATLS
– Airway
– Breathing
– Circulation
– Disability (ie neurology)

Treat as part of ‘C’ occasionally or in secondary survey (ortho is sometimes blood)

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4
Q

How do you assess a fracture? (5)

A

Pain
Swelling
Crepitus
Deformity
“Collateral damage”
- Nerve
- Vessel

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5
Q

What are the investigations you do for fractures?

A

XR (in most cases)

CT sometimes indicated
- To make diagnosis
- To assess pattern

MRI if unsure

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6
Q

What would you see on a radiograph?

A

Name/ Date
Location: which bone and which part of bone?
Pieces: simple/multifragmentary?
Pattern: transverse/oblique/spiral
Displaced/undisplaced?
Translated/angulated?
X/Y/Z plane

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7
Q

Which ones out of transverse, oblique and spiral fractures are high or low energy?

A

transverse and oblique= high E

spiral= low E

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8
Q

What does the plane on a radiograph tell you?

A

type of displacement

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9
Q

What are the types of displacement?

A

translation (medial/ lateral/ dorsal/ volar)

angulation (valgus/ varus)

Rotation (internal/ external)

Impaction

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10
Q

What do the planes X/ Y/ Z show on a translation displacement?

A

x= medial/ lateral

y= proximal/ distal

z= anterior/ posterior

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11
Q

What do the planes X/ Y/ Z show on an angulation displacement?

A

x= varus/ vulgus

y= internal/ external rotation

z= dorsal/ volar

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12
Q

What are the 2 types of fracture healing?

A

indirect and direct fracture healing

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13
Q

What is direct fracture healing?

A

Anatomical reduction
Absolute stability/compression
No callus

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14
Q

What is indirect fracture healing?

A

Sufficient reduction
Micromovement
Callus

(without micromovement there is no indirect healing)

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15
Q

What are the steps of indirect fracture healing?

A

1) inflammation

2) repair

3) remodelling

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16
Q

Describe the inflammation stage (part 1) of indirect fracture healing.

A
  • haematoma formation
  • release of cytokines
  • granulation tissue and blood vessel formation
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17
Q

Describe the repair stage of indirect fracture healing (part 2)

A
  • soft callus formation (type II collagen- cartilage)
  • converted to hard callus (type I collagen- bone)
  • calcium and hydroxyapatite gets laid down
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18
Q

Describe the remodelling stage of indirect fracture healing (part 3)

A
  • callus responds to activity, external forces, functional demands and growth
  • excess bone is removed
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19
Q

What is the law of bone growth and remodelling?

A

Wolff’s Law: Bone Grows and Remodels in response to the forces that are placed on it

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20
Q

What is the normal time of bone healing? And what is the variation, and what does the variation depend on?

A

6 weeks

Actually 3-12 Weeks depending on site & patient

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21
Q

When are signs of healing visible on an x-ray?

A

from 7-10 dyas

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22
Q

How long does it take phalanges, metacarpals, and distal radius to heal?

A

Phalanges: 3 weeks
Metacarpals: 4-6 weeks
Distal radius: 4-6 weeks

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23
Q

How long does it take for the forearm, tibia, femur to heal?

A

Forearm: 8-10 weeks
Tibia: 10 weeks
Femur: 12 weeks

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24
Q

How do you manage a fracture?

A

Reduce
- open or closed

hold
-internal or external fixation

rehabilitate
- early/ late
- weight bearing
- physiotherapy

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25
Q

Describe the options for reduction.

A
26
Q

What are the types of fixations?(5)

A

plaster
external monoplanar
internal extramedullary
internal intramedullary
external multiplanar

27
Q

What are the 2 types of fracture complications?

A

general (early or late)

specific

28
Q

What are the general fracture complications? (4)

A

Fat embolus
DVT
Infection
Prolonged immobility (UTI, chest infections, sores)

29
Q

What are the specific fracture complications? (6)

A

Neurovascular injury
Muscle/tendon injury
Non union/mal union
Local infection
Degenerative change (intraarticular)
Reflex sympathetic dystrophy

30
Q

What are the factors that affect fracture healing? (6)

A

mechanical environment:
- movement
- forces

biological environment:
- blood supply
- immune function
- infection
- nutrition

31
Q

What are causes of fractured neck of femur?

A

Osteoporosis (older)
Trauma (younger)
Combination

32
Q

What is the history of someone with a fractured neck of femur fracture?

A

Age

Comorbidity:respiratory/cardiovascular/diabetes/cancer

Preinjury mobility:independent/ shopping/ walking/ sports

Social hx: relatives, stairs, ethanol

33
Q

Do you know the anatomy of the neck of femur fracture?

A
34
Q

What are the names of these neck of femur fractures?

A
35
Q

What is most likely to happen in an intracapsular NoF fracture?

A

blood supply is more likely to be compromised
- Avascular necrosis
- non-union

36
Q

How do you manage NoF fractures?

A

extracapsular fractures= fix

intracapsular fracture= a bit more complex

37
Q

What does the decision of fix or replace depend on for NoF fractures?

A

depends on location/ displacement and age

38
Q

Describe the decision making process for NoF management.

A
39
Q

What is this meant to look like, and what is this?

A

dislocated shoulder

40
Q

What is the presentation normally like for shoulder dislocation?

A

variable hx but often direct trauma

pain

restricted movement

loss of normal shoulder contour

41
Q

What is the most common shoulder dislocation?

A

anterior

42
Q

What do you do for a shoulder dislocation, and what can you find?

A

assess neurovascular status- axillary nerve

Anterior shoulder dislocation is the most common occurring dislocation at the shoulder, which can cause direct trauma (compression or traction) to the axillary nerve

43
Q

What investigations do you do for a dislocated shoulder?

A

x-ray prior to any manipulation- identify fracture e.g., humeral neck, greater tuberosity avulsion or glenoid

scapular- Y-view/ modified axillary in addition to AP

44
Q

What is the management of shoulde rdislocation?

A

Numerous techniques to reduce a dislocated shoulder…

Vigorous manipulation or twisting manipulation should be avoided to avoid fractures

Safest method is to use traction-counter traction +/- gentle internal rotation to disimpact humeral head

Ensure adequate patient relaxation-
Entonox; benzodiazepines

If alone could use Stimson method

Undertake in safe environment, especially in elderly e.g., resus, ask for senior/ anesthetic support early on if necessary

45
Q

What does AP stand for in x-rays?

A

anterior-posterior

46
Q

What are shoulder dislocation complications?

A

Hill-Sachs defect
Bankart lesion

47
Q

What are the 2 wrist fractures you should know?

A

distal radius fracture

scaphoid fracture

48
Q

Distal radius fracture anatomy.

A
49
Q

What are the possible managements of distal radius fractures?

A

cast/ splint

MUA and K-wire

ORIF

50
Q

What is a cast/ splint for distal radius fracture?

A

Temporary treatment for any distal radius fracture- reduction of fracture and placement into cast until definitive
fixation

Definitive if minimally displaced,extra articular fracture

51
Q

What is a MUA and k-wire for distal radius fracture?

A

For fractures that are extra- articular but have instability, particularly in children, manipulation under anaesthetics (MUA) in theatre with K-wire fixation can be used. Wires can then be removed in clinic post-op

52
Q

What is ORIF for distal radius fracture?

A

any displaced, unstable fractures not suitable for K-wires or with intra-articular involvement may benefit from open reduction internal fixation with plate and screws

53
Q

Anatomy of scaphoid fracture.

A
54
Q
A

tibia plateau fracture

55
Q

What does the proximal tibia comprise of?

A

The proximal tibia comprises a key weight bearing surface as part of your knee joint, articulating with the distal femur

56
Q

Describe the tibial joint surface.

A

it is relatively flat and comprises of both medial and lateral plateaus with a central tibial spine acting as an insertion point for ligaments

57
Q

What can cause a tibial plateau fracture?

A

Any extreme valgus/ varus force or axial loading across the knee can cause a tibial plateau fracture, with impaction of the femoral condyles causing the
comparatively soft bone of the tibial plateau to depress or split

58
Q

What type of injury is not uncommon from tibial plateau fractures?

A

concomitant ligamentous or meniscal injury is not uncommon

59
Q

What is the management for tibial plateau fractures?

A

non-operative: only truly undisplaced fractures with good joint like congruency assessed on CT or high fidelity imaging

operative:
- predominance of treatment will be operative
- restoration of articular surface using combination of plate and screws
- bone graft or cement may be necessary to prevent further depression after fixation

60
Q
A

trimalleolar fracture

61
Q

What is the management of ankle fractures?

A
62
Q

Describe Weber A, B, C.

A

BRS MUSCULOSKELETAL (12 decks)

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