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