Flashcards in Fractures Deck (246):
What are the features of a fracture?
loss of function
abnormal movement or positioning
What is the metaphysis?
the ossified portion of bone in a transitional one between the epiphysis and the diaphysis- should always have a smoothly curved cortex
What is an apophysis?
bony outgrowth independent of a centre of ossification
What is fracture disease?
muscle atrophy; stiff joints and osteoporosis
What are the indications for ORIF?
failed conservative Rx; 2 #s in 1 limb; bilateral indentical #s; intra-articular #s; open #s
When might external fixation be used?
burns; loss of skin and bone or open #
What are the 7 A's of open #s?
assessment- neurovascular and soft tissues
antisepsis- swab wound and irrigate
antibiotics- ceftriaxone +/- metronidazole
What is the mnemonic for Salter-Harris #s?
What are the immediate complications of fractures?
vessel injury (limb ischaemia)
What ar teh later local complications of fractures?
non or delayed union
What are the lateral geeneral complications of #s?
venous or fat embolism; PE; pneumonia; renal stones
What are the signs of a fat embolism?
confusion; dyspneoa; increased pulse' decrased PaO2; fits; coma; increased Temp; petechial rash
What prevents fat embolism?
early fixation of #s
What is the viscious cycle of compartment syndrome?
pressure--vascular occlusion-- hypoxia-- necrosis-- increased pressure
What are the signs of compartment syndrome?
erythema; mottling; blisters; swelling; pain on passive stretching
What are hte late complications of #s?
failure of fixation
joint stiffness, contracture or malalignment
What is non-union defined as?
no evidence of progression towards healing
What causes non-unions?
abnormal biology eg infection; blood supply or mechanics
What is delayed union?
when a # has not healed within the time expected for THAT #
What are hte causes of delayed union?
# in a bone that has finished growing
poor blood supply or avascular fragment
comminuted/ infected #s
generalised sieases eg malignancy or infection
distraction of bone ends by muscel- ORIF prevents
What are the two types of CRPS?
type 1- no nerve injury
type 2- if nerve lesions are present
What are the signs of CRPS?
only local sign (no systenic)- pain (burning); allodynia; vasomotor instability; abnormal sweating
Where a # clavicle most common?
What is the management of a fractured clavicle?
broad arm sling with x-rays at 6 weeks
What are the potential neurovascular injuries with a clavicle# ?
brachial plexus; sublcavlisn vessels
What other complication can you get with clavicle #?
How do AC dislocations commonly happen?
fall onto the point of hte hsoulder
What are the signs of AC dislocation?
tender prominence over ACJ; adduction of arm across body is very painful
What is the mx of AC dislocation?
sling support and early mobilisation
Who tends to get #s of proximal humerus?
osteoporotic #s in the elderly after FOOSH
How is a minimally siplaced proximal humeral # treated?
conservative with a sling
How is a persistently displaced proximal humeral # treated?
How is a head splitting or 3/4 part # trated?
What is the most common pattern of a proximal hermal #?
# of surgical neck with medial displacement of humeral shaft due to pectoralis major pull
What neurovascular injury can occur with prox. humeral #?
brachial plexus/ axillary nerve/ artery
How is axillary nerve injury assessed?
loss of sensation in regimental patch area
How a humeral shaft # mostly treated?
splinting with a humeral brace and collar and cuff sling
How should a humeral shaft# in polytrauma be treated?
internal fixation with IM nail, plate or screw
How is non-union with a humeral shaft# treated?
plating and bone graft
what can be injured in a humeral shaft #?
What are the signs of radial nerve injury?
wrist drop and loss of sensation in the 1st dorsal web space
What are the signs of an anterior shoulder dislocation?
loss of shoulder contour; anterior bulge from head of humerus- may be palpated in axilla
What is the mechanism for anterior shoulder dislocations?
excessive external rotation or fall onto back of shoulder
What is the recurrence rate for ant. shoulder dislocations in pts <20?
What is Hamilton's ruler sign?
used for anterior shoulder dislcations- ruler touches both acromion and lateral epicondyle
What is a Bankart lesion?
detachment of anterior glenoid labrum
What is a Hill-Sach's lesion?
impact # of posterior head of humerus from hitting against anterior glenoid
What is the treatment for an anterior shoulder dislocation?
What is the mechanism in a posterior shoulder dislocation?
posterior force on adducted and internally rotated arm
What are the signs of a posterior shoulder dislocation?
limitation of external rotation
What type of xray should be done to assess if there is a posterior shoulder dislocation?
What is seen on a lateral xray with a post. shoudler dislocation?
light bulb sogn
How typically gets supracondylar humeral #s?
What can be injured in a supracondylar #?
brachial artery, median radial or ulnar nerve
How can further injury to the brachial artery be prevented in a supracondylar #?
keep elbow in extension
What is the xray sign in an elbow intra-articular #?
posterior fat pad sign
What is the treatment for an intra-articular elbow#?
ORIF with anatomic reduction and rigid fixation
What is the mechanims for an elbow dislocation?
What is the typically dislocation for the elbow?
What is the management of an uncomplicated elbow dislocation?
closed reduction under sedation
What is the mechanism of olecranon #?
a fall onto the point of the elbow
What is a simple transverse avulsion # of olecranon treated with?
tension band wiring
What muscle is responsible for avulsion in olecranon #?
How is a communicated olecranon # treated?
ORIF with a plate and screws
What is the sign of a radial head #?
elbow is swollen adn tender over the radial head- flexion/extension may be possible but supination/pronantion will not
What is the sign on xray of a radial head #?
posterior fat pad sign
How are undisplaced radial head #s treated?
collar and cuff
How are displaced/fragmented radial head #s treated?
internal fixation or excision of radial head and replacement
What can be injured in radial head #s?
What is the terrible triad?
radial head#; elbow dislocation; coronoid process #
How are elbow epicondyle #s treated?
fixed with screw
How are coronoid #s treated?
ORIF with screw
What is the mnemonic for Galleazzi and Monteggia #s?
What is a Galleazzi #?
radius # wtih distal ulnar dislocation
What is a Monteggia #?
ulnar # with radial dislocation
What is the name for an ulnar shaft #?
How are ulnar shaft #s treated?
Who gets Colles #s?
osteoporotic post-menopausal women who FOOSH
Describe a Colles #?
dorsal angulation and displacement producing a dinner fork wrist deformity
What are hte complications of a Colles #?
median nerve compression; EPL rupture; CRPS; loss of grip strength
How is a stable, minimally displaced Colles# treated?
How is a displaced, simple colles# treated?
How is a displaced, comminuted Colles# treated?
MUA and k-wiring, ORIF
How is a # of both bones of the forearm treated?
ORIF with plates and screws
How is a # of radius and ulna in a child with minimal angulation treated?
Describe a Smith's #?
volarly displaced and angulated # of distal radiu
How does a Smiths # occur?
falling onto back of a flexed wrist
How is a Smiths # treated?
ORIF using plates and screws
Why is management for a Smiths different than a Colles?
Smith's tend to be very unstable
What is a Barton's #?
intra-articular # invovling either the dorsal/volar aspect of distal radius; carpal bones sublux with displaced rim fragment
What is another name for a Volar Barton's?
What is another name for a dorsal Barton's ?
How are Barton's #s treated>
How are comminuted intra-articular distal radius # treated?
external fixation +/- k wires
What is the mechanism for Scaphoid #s?
What are the signs of a scaphoid #s?
tenderness in anatomical snuff box; pain on compressing the thumb metacarpal
What are the xrays that hsould be done when a scaphoid # is suspected?
AP, lateral and 2 oblique views
What is a clinical scaphoid #?
when # does not show up on xray but suspected clinically
How are clinical scaphoid #s treated?
wrist spinted and xrayed again in 2 weeks
How is an undisplaced scaphoid # treated?
plaster cast for 6-12 weeks
How is a displaced scaphoid # treateed?
special compression screw
How is scaphoid # with non-union treated?
screw fixation and bone graft
What forms the anatomical snuffbox?
EPL medially and EPB and abductor pollicis longus laterally
What can cause non-union in a scaphoid #?
synovial fluid inhibiting # healing or AVN or proximal pole
What is a mallet finger?
avulsion of the extensor tenon from its insertion onto the terminal phalanx
What is a mallet finger caused by?
forced flecion of extended DIPJ
What is the sign of a mallet finger?
inability to extend DIPJ
What is the treatment for a mallet finger?
spint holidng DIPJ extended
What is a Bennet's #?
carpometacarpal #/dislocation of the thumb
What is the treatment for a Bennet's #?
percutaneous wire fixation
How are #s of the 3,4 and 5 MC treated?
What is the name for a 5th MC neck #?
How much angulation can be tolerated wtih a 5th MC neck '?
What ist he treatment for a boxers #?
manipulation with neighbour strapping or k-wire stabilisation
How are stable phalangeal #s treated?
neighbour strapping or splintage
How are significantly displaced or angulated phalangeal #s treated?
How are unstable phalangeal #s treated?
k-wiring or fixation with small screws
How are intra-articular phalangeal #s treated?
k wires or small screws
What is the other name for an intracapsular fracture?
What are hte two types of extracapsular fractures?
intertrochanteric and subtrochanteric
What is the treatment for a subcapital #?
THR or arthroplasty
What are the adv/disadv for a THR?
high risk of dislocation but better function
What are the features of a subcapital #?
external rotation, adduction and shortening
What is th feature seen on xray of a subcapital #?
interrupted Shenton's line
What is Shenton's line?
the smooth curve from the lower border of the superrior pubic ramus to less trochanter
How are extracapsular #s treated?
internal fixation with compression or dynamic hip screw
What can be done pre-op to stabilise a subtrochanteric #?
How do subtrochanteric #s typically happen?
fall onto the side in the elderly
What should be looked for in a femoral shaft#?
other injuries as # is high energy
What nerve may be damaged in a femoral shaft#?
What are the complications of a femoral shaft#?
substantial blood loss; fat embolism and ARDS
What are the steps in treatment of a femoral shaft #?
analgesia- femoral nerve block; Thomas Splint; closed reduction and IM nail
How do distal femoral #s happen?
osteoporotic bone with fall onto a flexed knee
What position does the leg take in a distal femoral #?
flexed position- due to gastrocneumius pull
What is the sign of a hip dislocation?
How are distal femoral #s treated?
plate and screws
What is there a high risk of with knee dislocations?
vascular and nerve injury and compartment sydrome
What is the treatment for a knee dilocation?
What may be required after a knee dislocation?
How does a patellar # typically occur?
fall onto flexed knee of dashboard injury
What type of dislocation typically happens with patellar dislocations?
How do patellar dilocations typically occur?
direct blow or a contracion of quadricpes with a rotation force
What are the predispoations for a patellar discloation?
generalised ligamentous laxity; valgus alignment of the knee; rotation malalignment (femoral neck anteversion); shallow trochlear groove
What are the signs of a patellar dislocation?
tenderness over medial retinaculum; haemarthrosis
What is a complication of a patellar discloation?
osteochondral # with detached fragments
What is the treatment of a patellar dislocation?
temporary splintage wtih PT to strengthen vastus medialis
How many patients have a further patellar dislocation after their first one?
What type of fracture is a proximal tibial #
What imagin is done with intra-articular tibial #s?
CT to plan surgery
What is the tx for intra-articular tibial #s?
reduction of articular surface and plates and screws
What often needs to happen for intra-artiular tibial #s?
If there is significant soft tissue damage with an intra-articular tibial #?
What is the usual mechanism of injury with proximal tibial #s?
What is the suual pattern of injury with proximal tibial #s?
laterla plateau # with MCL failure
What injury can happen with proximal tibial #s?
common fibular nerve
What is the sign of injury to the common fibular nerve?
What # is the commonest cause of compartment syndrome after trauma?
tibial shaft '
What type of # is more common with tibial shaft #?
If there is less than 50% diplacement and <5 degrees angulation what is the treatment for tibial shaft #?
above the knee cast
How are comminuted and opne# tibial shaft # treated?
IM nailing or ex-fix
How long do tibial shaft #s take to heal?
up to 16 weeks to union and a year to heal
What is a Pilon #?
intra-articular #s of distal tibia
What is the treatment for Pilon #?
What is the mechanism for Pilon#?
fall from height or rapid decelration
What is the imaging for Pilon# and why?
cT to check for other injuries
What is the treatment for undisplaced extra-articular distal tibial #s?
What is the treatment for unstable extra-articular distal tibial # that isnt too distal?
what is the treatment for unstable extra-articular distal tibial # that is too distal?
How do most ankle injuries occur?
inversion injury or rotation force on a planted foot
WHat is the most common soft tissue ankle sprain?
lateral ankle ligaments
What are the lateral ankle ligamnet>
anterior and posterior talo-fibular and calcaneofibular
What are the signs of lateral ankle ligamnet sprain?
prain; brusing and tenderness over lateral ligaments
When should an ankle xray be done?
any severe localised tenderness (bony tenderenss) of stial tibia or fibula OR inability to weight bear for 4 steps
What determines if an ankle # is stable?
if there is inbolvement of medial side- ligaments or bone
What is the treatement for a stbale snkle #?
cast/splint for 6 weeks
When should you suspect rupture of the deltoid ligament?
bruising and tenderness medially
What is seen on xray with a ruptured deltoid ligament?
talar shift and tilt
What is the treatment for an unstable ankle #?
What is the treatment for bimalleolar ankle #?
What should be looked for in a calcaneal #?
What is the typical mechanism for calcaneal #?
fall from height onto heel
What determines the prognossi of a calcaeneal #?
extent of subtalar joint involvement and communition
What is the treatment for calcaneal #?
ORIF is debated
WHat is the mechanism of injury with talar #s?
forced dorsiflexion from rapid deceleration
What are the two types of talar #?
undisplaced or displcaed with subluxation of subtalar joint
What is the treatment for a displaced talar #?
closed/open reduction and screw fixation
Why is there a high risk of aVN with talar #s?
talus gets distal blood supply
What is a Lisfranc #/dislocation?
# of base of 2nd MT and dislcoation of base of 2nd MT with or without dislocation of other MTs
What are the signs of a Lisfranc?
grossly swollen, bruised foot, unable to weight bear
What should be done is xray is noral but suspicion of Lisfranc?
What is the treatemtn for Lisfranc #s?
closed or open reduction with screw fixation
What is the commonest metatarsal #?
base of 5th MT
what type of # is a # of the base of 5th MT?
avulsion # due to fibularis brevis tendon
What is the treatment for a # of base of 5th MT?
conservativ efor 4-6 weeks
What is a Jones #?
# of proximal diaphysis of 5th MT
What is the problem with Jones #?
proximal diaphysis of 5th MT gets a poor blood supply
What is the treatemnt for a jones #?
What is the treatemtn for non-union with a Jones #?
beon graft and fixation
What is the treatment for a # of 1st MT?
What is the treatment for 2nd MT #?
cast until pain subsides
What is the tretment for #s of other metatarsals that are minimally displcaed?
what is the treatment for other MT #s that are displaced?
What is the treatment for # toes?
protection in a stout boot
What is the treatmetn ofr an intra-articular # of base of proximal phalanx of hallux?
reduction nd fixation
What is the treatment for toe discloation?
closed reduction and neighbour strapping or k wiring
What type of # do the elderly typically get in the thoracic spine?
wedge insufficiency #s
What is spinal shock?
complete loss of sensation and mottor functio nand refleces below the level of injury for 24 hours
What is the bulbocavernous reflex?
contraction of anal sphincter with a squeeze of glans penis, taping mons pubis or pulling on urethral catheter
what does the return of the bulbocavernous reflex indicate?
end of spinal shock
What causes neurogenic shock?
temporary shutdown of sympathetic outflow from cord from T1-L2
What happen in neurogenic shock?
hypotension and bradycardia for 24-48 horus
What is the treatment for neurogenic shock?
What is complete spinal cord injury?
no sensory or voluntary motor function below level of injury
What is incomplete spinal cord injury?
some neurologic function present distal to injury
What indictes incomplete spinal injury?
What is sacral sparing?
perianal sensation; voluntary anal sphincter contractio nand hallux flexion
What is central cord syndrome?
a type of incomplete spinal injury that happen after a hyperextension injury in c-spine with OA- no # or dislocation
What are the 3 types of pelvic #?
lateral compression; vertical shear; anteroposterior compression
What causes a lateral compression #?
describe a pelivc lateral compression injury?
# through pubic rami or ischium with sacral compression# or SI joint disruption with one half of pelvic displaced medially
What is the mechanism for vertical shear pelvic #s?
axial force on one hemipelvis
What is the sign of a vertical shear peliv #?
one leg shortened due to that side being displcaed superiorly
What is the otehr name for an anteroposterio compression injury?
What happens in open book #?
# of pubic symphysis
What is the initial treatment for an open book#?
What should be done if there is ongoing haemodynamic instability with a pelivc #?
angiogram adn emboliation or open packing pelivs
What is mandatory in a # pelvis?
What type of a # is an acetabualr #?
What type of pelvic # due osteoporotic elderly tend to get?
lateral compression #
What imaging should be done with acetabular #?
What causes acetabular #s?
hip dislocation- typically posteior wall
What is the significance of the periosteum in childrens #s?
is much thicker and tends to remain intact- more stable and provides lots of osteoblasts for repair
What age should childrens #s be treated as adult #s?
What are the common #s of the distal radius in children?
buckle #s; greenstick #s and salter harris II #s
What branch of the median nerve is often damaged ina supracondylar # of the elbow?
anterior interosseous branch
What indicates that t/here is injury to the anterior interosseous branch
child is unable to make OK sign- loss of FPL and FDP
What is the tx for femoral shaft #s in 2-6 yos?
What is the tx for children older than 6 for femoral shaft #s?
What is a Toddler's #?
undisplaced spiral # of tibial shaft
What is the definitive managemtn for femoral shaft #s?
closed reduction and IM nails
What is the sign of a posterior shoulder dislocation?
excessive internal rotation
What aspect of the vertebral body is affected in a wedge #?
What type of alignment is not well tolerated in a boxers #?
Why is rotational malalignment badly tolerated in a boxers #?
can lead to grip problems
What are the signs of a posterior hip dislocation?
internal rotation ; adduction and flexion