fractures Flashcards
1
Q
what is primary bone healing
A
bone simply bridges gap with new bone from osteoblasts
2
Q
what is secondary bone healing
A
- fracture occurs
- haematoma occurs with inflammation from damaged tissues
- macrophages and osteoclasts remove debris and resorb the bone ends
- granulation tissue forms from fibroblasts and new blood vessels
- chondroblasts form cartilage
- osteoblasts lay down bone matrix
- calcium mineralisation produces immature woven bone
- remodelling occurs with organization along lines of stress into lamellar bone
3
Q
how long does it take for soft callus to form
A
2-3 weeks
4
Q
how long does it take for hard callus to form
A
6-12 weeks
5
Q
does smoking affect bone healing
A
yes due to vasospasm
6
Q
what can cause a hypertrophic non-union
A
too much movement at site of fracture
7
Q
what are the 5 types of fractures
A
- transverse
- oblique
- spiral
- comminuted
- segmental
8
Q
what is a transverse fracture
A
-pure bending force where the cortex on one side fails in compression and the cortex on the other side in tension
basically line through the middle of the bone width ways
9
Q
what is an oblique fracture
A
like a diagonal line
10
Q
what causes oblique fractures
A
shearing force
-fall from a high, deceleration
11
Q
can oblique fractures shorten and angulate
A
tend to shorten
may angulate
12
Q
what is a spiral fracture
A
its a squigly line diagonally
13
Q
what causes spiral fractures
A
torsional forces
14
Q
what is a comminuted fracture
A
fractures with three or more segments
15
Q
what is a segmental fracture
A
bone is fractured in two separate places
16
Q
what do intra-articular fractures have a greater risk of
A
stiffness, pain and post-traumatic osteoarthritis
17
Q
in what ways can a distal fragment be displaced in a fracture
A
anteriorly or posteriorly
18
Q
how can a distal fragment be translated
A
medially or laterally
19
Q
what is angulation
A
direction in which the distal fragment points towards and the degree of this deformity
20
Q
what is an anterior displacement called in the forearm and hand
A
volar
21
Q
what is a posterior displacement called in the forearm and hand
A
dorsal
22
Q
what is a medial translation called in the forearm and hand
A
ulnar
23
Q
what is a lateral translation called in the forearm and hand
A
radial
24
Q
what angulations do you get in the upper limb
A
radial/ulnar and dorsal/volar
25
what kind of angulations do you get in the lower limb
varus and valgus
26
initial management of a femoral shaft fracture
thomas splint
27
how do you treat displaced or angulated fractures where the angle is deemed unacceptable
fixed with closed reduction and cast application
28
what fractures need ORIF (open reduction and internal fixation)
- unstable extra-articular diaphyseal fractures
| - displaced intra-articular fractures
29
which fractures should you not do ORIF
- fractures where the soft tissue is too swollen
- fractures where blood supply is tenuous or ORIF may cause haemorrhage (e.g. femoral shaft)
- where plate fixation may be too prominent (e.g. tibia)
30
when is CRIIF used (closed reduction and indirect internal fixation)
- fractures where soft tissue is swollen
- where blood supply is tenuous or ORIF may cause haemorrhage
- where plate fixation may be too prominent
31
what are some early local complications of fractures
- compartment syndrome
- vascular injury with ischaemia
- nerve compression or injury
- skin necrosis
32
what are some early systemic complications of fractures
- hypovolaemia
- fat embolism
- shock
- acute respiratory distress syndrome
- acute renal failure
- systemic inflammatory response syndrome
- multi-organ dysfunction syndrome
- death
33
what are some late local complications of fractures
- stiffness, loss of function
- chronic regional pain syndrome
- infection
- non-union/mal-union
- Volkmann's ischaemic contracture
- post traumatic osteoarthritis
- DVT
34
late systemic complication of fracture
pulmonary embolism
35
what causes compartment syndrome
rising pressure from bleeding and exudate within a fracture compresses the venous system
-results in congestion within the muscle and secondary ischaemia
36
presentation of compartment syndrome
severe pain in comparison to the grade of injury and pain on passive movement
37
treatment for compartment syndrome
emergency fasciotomies
| -wounds left open for a period then closed
38
what happens if compartment syndrome is left untreated
ischaemic muscle will necrose resulting in fibrotic contracture known as Volkmann's ischaemia contracture and poor function
39
what is neurapraxia
nerve has temporary conduction defect from compression or stretch
-resolves over time
40
what is axonotmesis
long nerve cell axon distal to the point of injury die in a process known as wallerian degeneration
41
what is neurotmesis
complete transection of nerve
42
what is a colle's fracture
complete fracture of the radius bone of the forearm close to the wrist resulting in an upward displacement of the radius and obvious deformity
43
what nerve injury is associated with colles fracture
acute median nerve compression/carpal tunnel syndrome
44
what nerve injury is associated with anterior dislocation of the shoulder
axillary nerve palsy
45
nerve injury associated with humeral shaft fracture
radial nerve palsy (in spiral groove)
46
nerve injury associated with supracondylar fracture of the elbow
median nerve injury (usually anterior interosseous branch)
47
nerve injury associated with posterior dislocation of the hip
sciatic nerve injury
48
nerve injury associated with bumper injury to lateral knee
common peroneal nerve palsy
49
what artery damage does a knee dislocation risk
popliteal artery injury
50
what artery does paediatric supracondylar fracture of the elbow risk
brachial artery injury
51
artery damage associated with shoulder trauma
axillary artery compromise
52
risk associated with pelvic fractures
life threatening haemorrhage from arterial or venous bleeding
53
what are the signs that you should immediate review and intervene by a vascular surgeon
- pain
- pallor
- pulseless
- perishingly cold
- paraesthesia
- paralysis
54
what is tenting of skin
The skin is very slow to return to normal, or the skin "tents" up during a check. This can indicate severe dehydration that needs quick treatment
55
what is blanching of the skin
a sign of restricted blood flow to an area of the skin causing it to become paler than the surrounding area
56
what is de-gloving
shearing force on the skin resulting in avulsion of the skin from its underlying blood vessels
57
signs of good fracture healing
- resolution of pain
- function and movement at fracture site
- absence of point tenderness
- no local oedema
58
signs of non-union
- ongoing pain
- ongoing oedema
- movement at the fracture site
- bridging callus may be seen on X-ray
59
hypertrophic non-union
-instability and excessive motion at the fracture site
60
what is atrophic non-union
rigid fixation with a fracture gap, lack of blood supply to the fracture site, chronic disease or soft tissue interposition
61
what type of fractures have bad blood supply
- scaphoid waist fractures
- fractures of the distal clavicle
- subtrochanteric fractures of the femur
- jones fracture of the fifth metatarsal
62
which is one of the slowest healing bone
tibia
63
which fractures are prone to developing AVN
fractures of the femoral neck, scaphoid and talus
64
what is systemic inflammatory response syndrome
amplification of inflammatory cascades in response to trauma with pyrexia, tachycardia, tachypnoea and leukocytosis
65
what can lead to MODS
- hyovolaemia
- SIRS
- ARDS
66
what is an inside out fracture
spike of fractured bone from within puncturing the skin
67
what is an outside in fracture
laceration of the skin from tearing or penetrating injury
68
what is debridement
removal of all contamination and excision of non-viable soft tissue
69
what are the three grades of ligament ruptures
```
grade 1 (sprain)
grade 2 (partial tear)
grade 3 (complete tear)
```
70
mainstay treatment for soft tissue injuries
RICE
71
which tendon tears require surgical repair for restoration of function
quadriceps tendon
| patellar tendon
72
which complete tendon tears can be treated conservatively
- achilles tendon
- rotator cuff
- long head of biceps brachii
- distal biceps
73
most common bacteria for septic arthritis
staph aureus
74
who gets E.coli septic arthritis
- elderly
- IV drug users
- seriously ill
75
how is the periosteum different in children
its thicker and tends to remain intact
76
at what age are fractures treated as adult fractures
12-14
77
what is Salter-Harris classification I
pure physeal separation
78
what is Salter-Harris II
similar but small metaphyseal fragment attached to physis and epiphysis
79
what is salter-harris II and IV
intra-articular and splitting the physis
80
what is salter-harris V
compression injury to the physis with subsequent growth arrest
81
which is the most common physeal fracture
salter-harris II
82
what is a monteggia fracture
a fracture of the ulnar shaft with concomitant dislocation of the radial head
83
what is a Galeazzi fracture
a fracture of the middle to distal third of the radius associated with dislocation or subluxation of the distal radioulnar joint
84
where are supracondylar fractures
supracondylar region of distal humerus
85
treatment for a femoral shaft fracture in children 2-6
thomas splint or hip spica cast
86
treatment for femoral shaft fracture in children 6-12
flexible intramedullary nails, traction and cast
