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Clin Med - MSK > Lecture 8 - Fractures Overview > Flashcards

Lecture 8 - Fractures Overview Flashcards

1
Q

Closed fracture

A

Simple fracture

Skin over the fracture is intact

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2
Q

Open fracture

A

Compound fracture
Overlying skin is disrupted
“Open wound”

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3
Q

Nondisplaced

A

Fracture fragments are in anatomic alignment

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4
Q

Displaced

A

Fracture fragments are NOT in anatomic alignment

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5
Q

Angulated

A

Fracture fragments are malaligned at an angle

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6
Q

Segmental

A

Fx with at least two fracture lines that together isolate a segment of bone

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7
Q

Comminuted

A

Fx that results in two or more fragments

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8
Q

Transverse

A

Fx line forms a right angle with longitudinal axis

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9
Q

Oblique

A

Angulated fx line

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10
Q

Spiral

A

Complete fx resulting from rotational force

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11
Q

Intra Articular

A

Involving the joint space

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12
Q

Extra articular

A

No involvement of joint space

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13
Q

Impacted

A

Fx in which one of the fragment is driven into another fragment

Looks like transverse but there is a hyperdense area on the fracture showing bone over bone

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14
Q

Compression fracture

A

Vertebral collapse

Seen in osteoporosis and kyphosis

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15
Q

Greenstick

A

One side broken; opposing side bent

More common in kids d/t softer bones

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16
Q

Occult fracture

A

Fx that does not appear on x-ray

Hypodense areas will be seen on x-ray around the fracture (like the fat pads —sail sign for humerus fracture)

Like you cant seen the bone fracture but you can see tissue problems or something —-ask you radiology tech to help you retake the image so you can get a different view that will possibly show the fracture

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17
Q

Avulsion

A

Release of small portion of bone at location of tendon insertion

Tendon is pulling off part of the bone

18
Q

Stable fracture

A

A fx that tends to remain in alignment after reduction

19
Q

Unstable fracture

A

A fx that tends to displace after reduction

20
Q

What are the 5 Ps of compartment syndrome?

A

Pain (most sensitive sign)
Pressure
Paresthesias
Paresis/Paralysis (paralysis is a pore prognosis)
Pallor/Pulselessness (capillary flow is what we are referring to, not arterial flow) 0-80 mmhg is the normal pressure in these compartments

21
Q

Salter-Harris Classification

A 
Type 1_S - straight across 
Type 2_A - above 
Type 3 _ L - lower or below 
Type 4 _T - two or through 
Type 5_ER -erasure of growth plate or crush

Look at notes from radiology (i think they were more detailed)

Bigger risk for children d/t if growth plate being damaged can cause permanent damage

22
Q

What must you always always always ask when assessing a pt coming in for fracture?

A

HOW did this happen?
You need to assess the MOA to determine the force needed to cause the fx

This could shed light on other injuries (possibly internal) or possibly cancer if there wasn’t force needed to cause the fracture

23
Q

What question do you need to aim to answer when assessing tenderness on a pt with a fx?

A

Is it general tenderness or pinpoint tenderness

Pinpoint tenderness is a very particular fracture

24
Q

What portions of the neuro exam needs to be done when assessing someone with a fx?

A

Pulses —in the field: if there are no distal pulses you would move the bones around —if there is a pulse you would just leave the fracture where it is

25
Q

What is the stepwise approach to getting images for a pt with suspected fracture?

A

Xray is baseline for everyone

If you don’t see anything you would move to CT scan

If there is a reason not to have extra radiation or something then you could instead do MRI in place of CT

26
Q

What is the treatment for fracture?

A

Pain control (try very hard not to use opioids)
-NSAIDs
-RICE;
—rest: for a short period of time, like 24-48 hours (to allow inflammation to do its role), no more—risk of atrophy of muscles
—ice:maybe alternate with heat, 20 minutes with breaks of a few hours
—compression
—elevation

Not all need casting and splinting —have the pt do RICE and come back in 7-10 days for re-evaluation

Casting:
3 weeks to 5-6 months
Follow up with ortho (get referral)

27
Q

RICE

A

Rest:
Only rest for 24-48 hours
Ice:
Control the level of inflammation
-inflammation is good because it is trying to help things but it also causes pain
-theory: ice limits the fluid able to get to that injured area
—20-30 minutes at a time and then you are ICE free for a couple of hours
Compression:
Control level of inflammation from the outside
Elevation:
Trying to not let fluid to get to injury to slow inflammation

28
Q

Casting vs splinting

A

Watch video posted online in fracture overview folder

Splinting is not the same thing as a brace
Splinting is applied by a tech that keeps the arm in a very specific position (like a half cast)

29
Q

What are the two different types of compartment syndrome?

A

Internal cause

External cause - like a cast, preventing the expansion of anything

30
Q

Treatment for compartment?

A

Stic catheter meter —aim to get it into compartment you think is involved
If pressure is <30mmHg —> fasciotomy

31
Q

Clavicle fracture

A

90% caused by fall onto the shoulder

Typically athletes that get pushed to the side

Looking for tenting of the skin —disjointed fx
Compare both sides (will often see bilateral fractures)
Bruising, breaks in the skin

Image: upright xray of the shoulder (always tell the tech what fx you are expecting)

Look everywhere because the force was a lot, they might have other fractures

Figure 8 brace +/- sling to take off pressure of UE
May take as little as 2 weeks
No sports

32
Q

proximal humerus fracture

A

FOOSH is common
Shoulder pain with movement (not sensitive or specific)

PE:
Swelling
Neuro - sensation, distal pulses
Sargents Patch: oval space on distal portion of deltoid —numbness there could be axillary nerve damage —could be from the fracture itself or even the inflammation

AP view of shoulder, internal and external rotation of shoulder if possible

Non-operatively is the treatment for most folks
No weight bearing for 10 weeks and wearing a sling for that time
2 weeks with passive range of motion

Takes 3-4 months for this to heal

33
Q

Humeral shaft fx

A

Might actually have arm shortening

Osteopenia is common underlying condition

Non-operative healing is common in 90% of cases
Cast with sling

Heals in a few weeks

25 degrees of malunion —pt wont notice much of a difference

Oblique and spiral fractures = hanging arm cast

If surgery:
ORIF with pins to keep it in place
Surgery is not common

34
Q

Radial head fracutre

A

Fat pads on xray
Inflammation causes fat pads to be noticeable

FOOSH common injury

PE:
Edema over elbow
Tenderness over radial head

Tx:
Sling
Splint with 90 degree rotation (6-8 weeks)
Recheck via Xray every couple of weeks

35
Q

Colles Fracture

A

Distal radius
FOOSH

Fx of distal, radial, metapheaseal region

PE:
When you compare their hands, there is a clear shape to the back of their hand from this displacement

Xray of the wrist always if pt present with pain after a fall because it could be a colles fx

Tx:
Below the elbow all the way to metacarpal joint

ORIF is less common d/t the MC age of pts presenting with this are older pts

36
Q

Scaphoid Fx

A

FOOSH injury
Pt will have pinpoint tenderness over the anatomical snuff box

Tx:
Splint it

RISK:
Proximal third of the scaphoid has a large vascular supply —risk for avascular necrosis!!

37
Q

What are the bones of the hand?

A 
Scaphoid
Lunate
Triquetrum
Pisiform
Hamate
Capitate
Trapezoid
Trapezium

1st metacarpal = thumb
Etc

38
Q

Monteggia Fx

A

Anterior dislocation of radial head and fx of the proximal 1/3 of ulnar

Falling on elbow

Always keep this fx in mind with pts presenting with FOOSH

Commonly seen with scaphoid fxs
Keep an eye out

39
Q

Galeazzi Fracture

A

FOOSH

Always look for scaphoid
Check snuffbox tenderness (if first third is affected cause cause that avascular necrosis)

Just always check snuff box if arm fx from fall

40
Q

Boxers fx

A

Transverse fx of 5th metacarpal

AP and Oblique view on xray might be helpful d/t natural curvature of the 5th metacarpal

MC fx of the hand?

Closed reduction via stabilization —pull and push out (consider nerve block d/t pain —-no pain meds d/t these pts typically being under the influence of EtOH)

Splint
Follow up with hand surgery

41
Q

What is the most common fracture of a young person with hip fracture?

A

MVA

42
Q

Jones fracture

A

Base of the 5th metatarsal

Most common metatarsal fracture

Typically occurs when you are changing or pivoting direction
Inversion of ankle

Always ask the pt about what their hobbies are and when they feel pain

Common to just assume plantar fasciitis —dont be that person —get a good hx and get an xray

Cast for 8 weeks
No weight bearing
Periodic xrays

+/- surgery right off the bat

Clin Med - MSK (10 decks)

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