ALS Lecture 5 - Diagnosis and Management of Fractures and Soft Tissue Injuries DONE

Question 1

if fracture is suggested clinically, but radiographic film appears negative, patient should initially be treated as though

Answer 1

a fracture was present

Question 2

radiography is performed before

Answer 2

attempted reduction (except when delay is harmful)

Question 3

open/compound

Answer 3

skin breached by bone

Question 4

closed/simple

Answer 4

fracture not exposed

Question 5

directions of fracture lines

Answer 5

transverse, oblique, spiral, comminuted

Question 6

comminuted fracture

Answer 6

shards of bone

Question 7

complete fracture

Answer 7

straight through bone

Question 8

incomplete fracture

Answer 8

does not go right through bone

Question 9

avulsion fracture

Answer 9

tendon pulled, brings small chunk of bone with it

Question 10

impaction fracture

Answer 10

forceful collapse of one fragment of bone into or onto another

Question 11

pathologic fracture

Answer 11

due to underlying disease (e.g. osteoporosis, tumour deposits)

Question 12

stress fracture

Answer 12

small, undisplaced, due to repeated stress, common in sportspeople

Question 13

label the different types of fracture diagram

Answer 13

done

Question 14

crepitus

Answer 14

sensation/noise when joint is moved (clicking, creaking, grating, popping, etc)

Question 15

infection as a fracture complication is associated most with

Answer 15

open fractures

Question 16

haemorrhage can be a fracture complication because there is

Answer 16

rich blood supply to skeleton

Question 17

risk of haemorrhage is greatest in which fractures?

Answer 17

pelvis or shaft of femur

Question 18

compartment syndrome

Answer 18

serious, acute emergency, pressure increases, restricts blood flow

Question 19

signs of compartment syndrome

Answer 19

pain, paraesthesia

Question 20

treatment of compartment syndrome

Answer 20

complete fasciotomy

Question 21

avascular necrosis is particularly a risk with these fractures

Answer 21

head of femur, talus, scaphoid, lunate, capitate

Question 22

fat embolism syndrome

Answer 22

fat in circulation after long bone fracture or major trauma

Question 23

immobilisation complications

Answer 23

pneumonia, DVT, PE, UTI, ulcers, infection, muscle atrophy

Question 24

subluxation

Answer 24

partial loss of continuity between 2 surfaces

Question 25

dislocation

Answer 25

complete loss of continuity between 2 surfaces

Question 26

fracture dislocation

Answer 26

fracture and disruption of articulation

Question 27

DEXA scan assesses

Answer 27

bone density

Question 28

DEXA scans generate a

Answer 28

T-score

Question 29

normal T-score

Answer 29

> - 1

Question 30

osteopenia

Answer 30

- 1 to - 2.5

Question 31

osteoporosis

Answer 31

< - 2.5

Question 32

x-rays benefits

Answer 32

easy, inexpensive, great for most fractures

Question 33

fracture line is most visible on x-ray when it is

Answer 33

parallel to x-ray beam

Question 34

fracture line is invisible on x-ray when it is

Answer 34

90 degrees to x-ray beam

Question 35

x-rays must always be

Answer 35

done in multiple planes

Question 36

normal x-ray doesn't

Answer 36

100% rule out fracture so if risk is high enough use another imaging technique

Question 37

radionucleotide bone scanning is very good at detecting which type of fractures?

Answer 37

stress, occult

Question 38

label the diagrams of x-ray, CT and radionucleotide bone scanning

Answer 38

done

Question 39

gold standard for fractures

Answer 39

CT

Question 40

MRI disadvantages

Answer 40

expensive, time consuming, limited bone detail, can't be used if have metal (e.g. pacemakers)

Question 41

MRI advantages for fractures

Answer 41

most advanced, non-invasive

Question 42

US used in

Answer 42

soft tissue injury (e.g. Achilles tendon)

Question 43

US benefits

Answer 43

no radiation, quick, cheap, can see joint movement in real time

Question 44

sprains

Answer 44

ligamentous injury

Question 45

tendinitis

Answer 45

tendon inflammation due to over use

Question 46

common tendinitis sites

Answer 46

rotator cuff, Achilles tendon, radial wrist and elbow

Question 47

bursitis

Answer 47

painful inflammation of a bursa

Question 48

common bursitis sites

Answer 48

olecranon, subacromial, greater trochanter of femur, prepatellar bursa

Question 49

undisplaced fracture

Answer 49

bones remain aligned

Question 50

displaced fracture

Answer 50

bone shifted so ends not in alignment

Question 51

spiral fracture

Answer 51

usually rotational injury

Question 52

label the fracture pictures

Answer 52

done

Question 53

stages of bone healing (6)

Answer 53

1. haematoma 2. inflammatory phase 3. resorption of heamatoma 4. remodelling 5. mineralisation 6. reabsorption of callus

Question 54

stage 1 of bone healing, haematoma

Answer 54

ruptured vessels across fracture line, haematoma bridges fragments

Question 55

stage 2 of bone healing, inflammatory phase

Answer 55

granulation tissue forms on fracture surfactes

Question 56

stage 3 of bone healing, resorption of haematoma

Answer 56

first continuity between fragments, pro-callus, no structural rigidity

Question 57

stage 4 of bone healing, remodelling

Answer 57

callus formed on periosteal and endosteal surfaces, biological splint

Question 58

stage 5 of bone healing, mineralisation

Answer 58

callus mineralised by deposition of calcium phosphate

Question 59

stage 6 of bone healing, reabsorption of callus

Answer 59

original fracture surfaces develop bony union

Question 60

fractures are easier to see after about 10days of injury because the bone surrounding the fracture becomes

Answer 60

less dense due to resorption

Question 61

types of abnormal union

Answer 61

delayed, malunion, non-union, pseudoarthrosis

Question 62

delayed union

Answer 62

longer than normal for that location

Question 63

malunion

Answer 63

residual deformity

Question 64

non-union

Answer 64

failure to unite

Question 65

pseudoarthrosis

Answer 65

non-union results in false joint

Question 66

principles of definitive fracture management (5)

Answer 66

1. open wound management 2. reduction and stabilisation 3. splinting/bandaging/casts 4. surgery 5. rehabilitation

Question 67

reduction done for

Answer 67

not every fracture, every dislocation

Question 68

open fixation includes

Answer 68

pins and plates for life, external or internal

Question 69

in any open wound we must consider and exclude

Answer 69

nerve injury

Question 70

grading muscle strains (1-3)

Answer 70

1. pain only (few fibres) 2. pain, weakness (significant fibres) 3. pain, weakness, loss of function (very large tear)

Question 71

managing soft tissue injuries

Answer 71

POLICE

Question 72

POLICE

Answer 72

protect, optimal loading, ice, compression, elevation

Question 73

optimal loading

Answer 73

right movement for injury

Question 74

optimal loading is important as it ensures our

Answer 74

tendons are mainly type 1 collagen

Question 75

type 1 collagen can only be made if the

Answer 75

tendon is stimulated properly by optimal loading§