1b// Management of Specific Fractures Flashcards by rachael a

What is the common nomenclature for orthopaedics? (4)

look
feel
move
x-ray

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What is the nomenclature for trauma? (6)

Reduce
Hold
– Plaster
– External fixator
– Internal fixation
Rehabilitate

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How do you assess and manage a trauma?

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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How do you assess a fracture? (5)

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

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What are the investigations you do for fractures?

XR (in most cases)

CT sometimes indicated
- To make diagnosis
- To assess pattern

MRI if unsure

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What would you see on a radiograph?

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

transverse and oblique= high E

spiral= low E

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What does the plane on a radiograph tell you?

type of displacement

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What are the types of displacement?

translation (medial/ lateral/ dorsal/ volar)

angulation (valgus/ varus)

Rotation (internal/ external)

Impaction

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

x= medial/ lateral

y= proximal/ distal

z= anterior/ posterior

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

x= varus/ vulgus

y= internal/ external rotation

z= dorsal/ volar

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What are the 2 types of fracture healing?

indirect and direct fracture healing

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What is direct fracture healing?

Anatomical reduction
Absolute stability/compression
No callus

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What is indirect fracture healing?

Sufficient reduction
Micromovement
Callus

(without micromovement there is no indirect healing)

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What are the steps of indirect fracture healing?

1) inflammation

2) repair

3) remodelling

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

haematoma formation
release of cytokines
granulation tissue and blood vessel formation

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

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

callus responds to activity, external forces, functional demands and growth
excess bone is removed

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What is the law of bone growth and remodelling?

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

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

6 weeks

Actually 3-12 Weeks depending on site & patient

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

from 7-10 dyas

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

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

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

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

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How do you manage a fracture?

Reduce
- open or closed

hold
-internal or external fixation

rehabilitate
- early/ late
- weight bearing
- physiotherapy

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Describe the options for reduction.

What are the types of fixations?(5)

plaster external monoplanar internal extramedullary internal intramedullary external multiplanar

What are the 2 types of fracture complications?

general (early or late) specific

What are the general fracture complications? (4)

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

What are the specific fracture complications? (6)

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

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

mechanical environment: - movement - forces biological environment: - blood supply - immune function - infection - nutrition

What are causes of fractured neck of femur?

Osteoporosis (older) Trauma (younger) Combination

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

Age Comorbidity:respiratory/cardiovascular/diabetes/cancer Preinjury mobility:independent/ shopping/ walking/ sports Social hx: relatives, stairs, ethanol

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

What are the names of these neck of femur fractures?

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

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

How do you manage NoF fractures?

extracapsular fractures= fix intracapsular fracture= a bit more complex

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

depends on location/ displacement and age

Describe the decision making process for NoF management.

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

dislocated shoulder

What is the presentation normally like for shoulder dislocation?

variable hx but often direct trauma pain restricted movement loss of normal shoulder contour

What is the most common shoulder dislocation?

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

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

What investigations do you do for a dislocated shoulder?

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

What is the management of shoulde rdislocation?

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

What does AP stand for in x-rays?

anterior-posterior

What are shoulder dislocation complications?

Hill-Sachs defect Bankart lesion

What are the 2 wrist fractures you should know?

distal radius fracture scaphoid fracture

Distal radius fracture anatomy.

What are the possible managements of distal radius fractures?

cast/ splint MUA and K-wire ORIF

What is a cast/ splint for distal radius fracture?

Temporary treatment for any distal radius fracture- reduction of fracture and placement into cast until definitive fixation Definitive if minimally displaced,extra articular fracture

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

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

What is ORIF for distal radius fracture?

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

Anatomy of scaphoid fracture.

tibia plateau fracture

What does the proximal tibia comprise of?

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

Describe the tibial joint surface.

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

What can cause a tibial plateau fracture?

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

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

concomitant ligamentous or meniscal injury is not uncommon

What is the management for tibial plateau fractures?

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

trimalleolar fracture

What is the management of ankle fractures?

Describe Weber A, B, C.