Fractures Flashcards
(35 cards)
important history points: wrist fractures
- mechanism of injury
- hand dominance
- smoking status
- PMHx - diabetest/thryoid prolongs healing time
- DHx - NSAIDs and steroids prolong healing time
colle v smith
colle = outsward - palm to ground (calle a taxi)
dorsal angulation
distal radius #
dinner fork deformirty
extra-articular
smith = inward - dorsum to ground
volar angulation
distal radius #
very unstable and usually requires ORIF
rule of 22, 11, 11: wrist #
displaced v undisplaced
radal inclination on AP view <22degrees
radial heigh <11mm
radial (volar) tile >11 degrees
rx: wrist #
undisplaced = short arm casr
displaced = closed reduction undr sedation (shotr arm cast) or anaesthetic (K wires)
open reduction under anaesthetic with IF (ORIF)
short arm MUS to K wires MUA to ORIF
follow up: short arm cast
XR 1,2,3 and 6
physio and remove cast - encourage mobilisation week 6
follow up: K wires
pin site and XR week 1
wires removed week 3
remove cat and mobilise wk6
follow up: ORIF
wound check wk 1-2
change to removable splint wk 2-4 and wean
complications: wirst #
pain
N/V damage
Volkmann’s contaracture
arthritis
carpal tunnel
Barton’s: wirst #
partial fracture/subluxation
part of articular surface still attached to shaft
volar displacement
ORIF
rx: ankle #
undisplaced - short leg cast or removable support boot
displaced (unstable) - CR MUS - moulded short leg cast
then - CRGA - rare (only if unfit for open)
then GA ORIF
displacement: ankle #
normal if:
* medial clear space = 4cm (widening = talar shift and subluxation)
* ssyndesmosis tibia/fibula present
ankle #: XR
AP (mortician view (15 degree internal rotation)
lateral
rx: ankle dislocation
(talar shift - medial clear space >4mm)
reduce and shoer leg cast to stablise
rx: stable fibular #
- short leg cast
- XR wk 1, 2, 3 and 6
- non WB until wk6 and wean to fully WB
boot for definite stable injury and WB earlier with boot
def: maisonneuvre #
- high fibular #
- causes tearing of syndesmosis
- unstable
- ORIF
Weber classification: fibular #
Weber A: below syndesmosis and stable - non-op
Weber B: at syndesmosis and both stable and unstable if displaced on WB - op = ORIF and non-op
Weber C: above syndesmosis and unstable - ORIF + syndesmosis screw
complications: fibular #
- stiffness
- arthritis
- N/V damage
- compartment syndrome
- metal work failure
- tendon injury
- infection
- anaesthetic risk
initial assessment: femoral/tibial #
- n/v assessment inc pulses
- shock
- fat embolism
- splint ASAP (thomas splint = femoral #, back slab = tibial #)
- open/closed injury ?washout
ind: CT in #
communituresd or intraarticular
rx: tibial #
undisplaced = stable = long leg cast
displaced = unstable = sedation CR and long leg cast
then GACR = IM nail or external fixation if extensive tissue damage or highly cominuted)
them GA ORIF = if near joint
rx: conservative tibial #
6wk long leg cast NWB
6 week partial WB
out of cast and WB as tolerated thereafter
Gustilo-Anderson grade
I - open <1cm and clean
II - opwn 1-10cm without extensive soft tissue damage/flaps/avulsions
IIIA - adequate soft tissue coverage of # despite extensive soft tissue laceration/flaps or high energy trauma irrespective of wound size
IIIB - extensive soft tissue injury loss with periosteal stripping and bone exposure
IIIC - open assoc with vascular injury of any size
rx: open fractures
- give IV co-amox early
- dress wound and splint
- tetanus prophylaxis
- within 24 hours take to theatre, wash, debride, stabilise
IM nail = I - IIIA
external fxation IIIB/C
IIIC usually amputated (MESS score)
rx: femoral#
GA CR IM nail mst common
GA ORIF rare but in intra-articular distal femoral #
