Ortho 1 Flashcards
How can you describe a fracture?
Complexity
Type
Comminution - number of pieces broken into
Location - bone and location = radial shaft
Displacement
What are the different complexities of fracture?
Simple = closed Compound = open
What are the different types of fractures?
FIGTACOS
Fissure Impaction Greenstick Transverse Avulsion Comminuted Oblique Spiral
What is the displacement mean in terms of fractures?
Displacement - degree of movement of bone from normal location
I) translation (sideways movement, as % of bone diameter)
ii) Angulation (bend in degrees)
iii) Shortening (collapse, in cm)
What is emergency management of open fractures?
7As
ATLS - ABC fashion, correct shock and give blood if 1.5L is lost
Assessment - neurovascular status, soft tissues and photograph wound
Antisepsis - swab wound, irrigate with sterile 0.9% saline, then cover with large anti-septic soaked dressing
Alignment - aligh fracture and splint
Anti-tetanus - check status and immunize appropriately
Antibiotics - 3rd gen cephalosporin - ceftriaxone + metronidazole
Analgesia
When would a closed reduction not be recommended?
- It has previously failed
- 2 fractures in one limb
- bilateral identical fractures
- intra-articular fractures
- open fractures
What’s the difference between external fixtation and internal fixation?
External - when there is another set of clamps, screws outside the skin (good for burns, loss of skin and bone or an open fracture)
Internal fixation - plates, screws, nails or wires within the skin
How could you estimate fracture healing time?
Rule of 3s
Closed, paediatric, metaphyseal, upper lime fracture is the simples = heal in 3 weeks
- any complicating factors will double healing time
e. g. adult, diaphyseal, forearm - 12 weeks
e. g. open, adult, diaphyseal, tibia - 48 weeks
What are methods of reduction?
Manipulation
Traction I) skin ii) fixed iii) skeletal - pin through bone iv) balanced v) gallows
What is the Gustillo classification of open fractures?
Type I - low energy wounds - <1cm = bone piercing skin
Type II - low energy wounds >1 cm, causing moderate soft tissue damage
Type III - all high energy
a) adequate local soft tissue coverage
b) inadequate local soft tissue coverage
c) arterial injury needing repair
What is the Salter-Harris classification of epiphyseal injury? When would you commonly see each fracture?
I - in babies and pathological conditions (scurvy)
II - commonest injury, fracture line above the growth plate
III - there is a displaced fragment, with fracture line through the growth plate
IV - union across the growth plate may interfere with bone growth
V - compression of the epiphysis causes deformity and stunting
SALTER S - straight across A - above growth plate L- lower or below growth plate T - two or through ER - ERasure or growth plate or cRush
Where do you see the commonest fractures?
Clavicle Arm Wrist (colles') Hip Ankle
How can you externally splint a fracture? When would you use internal fixation?
Splints/Plaster casts
NOT CIRCUMFERENTIAL - allow swelling to avoid COMPARTMENT SYNDROME
What are the bones of the wrist?
Scared Lovers Try Positions That They Can’t Handle
Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate
What fractures can occur in the wrist?
Colles’ (distal radius with dorsal (UP) displacement fragments)
Smith’s (distal radius with volar (DOWN) displacement)
Barton’s (fracture dislocation of radiocarpal joint)(
Scaphoid (vulnerable blood supply - high risk of non-union and avascular necrosis)
What causes scaphoid fracture? How does it present?
FOOSH injury (falling on outstretched hand)
- tenderness in anatomical snuffbox
- possibly radial nerve sensory damage
What is the cause of a Colles’ fracture? How would you investigate it?
Normally a FOOSH injury with forced dorsiflexion (palm to floor) of wrist. Often seen in osteoporotic elderly patients
Can cause median nerve damage
XR - dinner fork on lateral XR
What would you see on XR of Smith’s fracture?
Garden spade deformity
What are the types of hip fracture?
Intracapsular - femoral neck between edge of femoral head and insertion to capsule
Extracapsular