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Flashcards in Fractures Deck (246):
1

What are the features of a fracture?

pain
loss of function
tenderness
deformity
swelling
crepitus
abnormal movement or positioning
soft tissue

2

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

3

What is an apophysis?

bony outgrowth independent of a centre of ossification

4

What is fracture disease?

muscle atrophy; stiff joints and osteoporosis

5

What are the indications for ORIF?

failed conservative Rx; 2 #s in 1 limb; bilateral indentical #s; intra-articular #s; open #s

6

When might external fixation be used?

burns; loss of skin and bone or open #

7

What are the 7 A's of open #s?

ATLS
assessment- neurovascular and soft tissues
antisepsis- swab wound and irrigate
alignment
anti-tetanus
antibiotics- ceftriaxone +/- metronidazole
analgesia

8

What is the mnemonic for Salter-Harris #s?

SALTR-
S- slipped
A-above
L-lower
T-through
R-rammed

9

What are the immediate complications of fractures?

internal bleeding
external bleeding
organ injury
nerve/skin injury
vessel injury (limb ischaemia)

10

What ar teh later local complications of fractures?

skin necrosis/gangrene
pressure sore
infection
non or delayed union

11

What are the lateral geeneral complications of #s?

venous or fat embolism; PE; pneumonia; renal stones

12

What are the signs of a fat embolism?

confusion; dyspneoa; increased pulse' decrased PaO2; fits; coma; increased Temp; petechial rash

13

What prevents fat embolism?

early fixation of #s

14

What is the viscious cycle of compartment syndrome?

pressure--vascular occlusion-- hypoxia-- necrosis-- increased pressure

15

What are the signs of compartment syndrome?

erythema; mottling; blisters; swelling; pain on passive stretching

16

What are hte late complications of #s?

wound sepsis
failure of fixation
joint stiffness, contracture or malalignment
CRPS
non-union
delayed union

17

What is non-union defined as?

no evidence of progression towards healing

18

What causes non-unions?

abnormal biology eg infection; blood supply or mechanics

19

What is delayed union?

when a # has not healed within the time expected for THAT #

20

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

21

What are the two types of CRPS?

type 1- no nerve injury
type 2- if nerve lesions are present

22

What are the signs of CRPS?

only local sign (no systenic)- pain (burning); allodynia; vasomotor instability; abnormal sweating
patchy oseopenia

23

Where a # clavicle most common?

middle third

24

What is the management of a fractured clavicle?

broad arm sling with x-rays at 6 weeks

25

What are the potential neurovascular injuries with a clavicle# ?

brachial plexus; sublcavlisn vessels

26

What other complication can you get with clavicle #?

pnuemothorax

27

How do AC dislocations commonly happen?

fall onto the point of hte hsoulder

28

What are the signs of AC dislocation?

tender prominence over ACJ; adduction of arm across body is very painful

29

What is the mx of AC dislocation?

sling support and early mobilisation

30

Who tends to get #s of proximal humerus?

osteoporotic #s in the elderly after FOOSH

31

How is a minimally siplaced proximal humeral # treated?

conservative with a sling

32

How is a persistently displaced proximal humeral # treated?

interal fixation

33

How is a head splitting or 3/4 part # trated?

arthoplasty

34

What is the most common pattern of a proximal hermal #?

# of surgical neck with medial displacement of humeral shaft due to pectoralis major pull

35

What neurovascular injury can occur with prox. humeral #?

brachial plexus/ axillary nerve/ artery

36

How is axillary nerve injury assessed?

loss of sensation in regimental patch area

37

How a humeral shaft # mostly treated?

splinting with a humeral brace and collar and cuff sling

38

How should a humeral shaft# in polytrauma be treated?

internal fixation with IM nail, plate or screw

39

How is non-union with a humeral shaft# treated?

plating and bone graft

40

what can be injured in a humeral shaft #?

radial nerve

41

What are the signs of radial nerve injury?

wrist drop and loss of sensation in the 1st dorsal web space

42

What are the signs of an anterior shoulder dislocation?

loss of shoulder contour; anterior bulge from head of humerus- may be palpated in axilla

43

What is the mechanism for anterior shoulder dislocations?

excessive external rotation or fall onto back of shoulder

44

What is the recurrence rate for ant. shoulder dislocations in pts <20?

80%

45

What is Hamilton's ruler sign?

used for anterior shoulder dislcations- ruler touches both acromion and lateral epicondyle

46

What is a Bankart lesion?

detachment of anterior glenoid labrum

47

What is a Hill-Sach's lesion?

impact # of posterior head of humerus from hitting against anterior glenoid

48

What is the treatment for an anterior shoulder dislocation?

simple reduction

49

What is the mechanism in a posterior shoulder dislocation?

posterior force on adducted and internally rotated arm

50

What are the signs of a posterior shoulder dislocation?

limitation of external rotation

51

What type of xray should be done to assess if there is a posterior shoulder dislocation?

lateral

52

What is seen on a lateral xray with a post. shoudler dislocation?

light bulb sogn

53

How typically gets supracondylar humeral #s?

children (5-7yo)

54

What can be injured in a supracondylar #?

brachial artery, median radial or ulnar nerve

55

How can further injury to the brachial artery be prevented in a supracondylar #?

keep elbow in extension

56

What is the xray sign in an elbow intra-articular #?

posterior fat pad sign

57

What is the treatment for an intra-articular elbow#?

ORIF with anatomic reduction and rigid fixation

58

What is the mechanims for an elbow dislocation?

FOOSH

59

What is the typically dislocation for the elbow?

posterior

60

What is the management of an uncomplicated elbow dislocation?

closed reduction under sedation

61

What is the mechanism of olecranon #?

a fall onto the point of the elbow

62

What is a simple transverse avulsion # of olecranon treated with?

tension band wiring

63

What muscle is responsible for avulsion in olecranon #?

triceps brachii

64

How is a communicated olecranon # treated?

ORIF with a plate and screws

65

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

66

What is the sign on xray of a radial head #?

posterior fat pad sign

67

How are undisplaced radial head #s treated?

collar and cuff

68

How are displaced/fragmented radial head #s treated?

internal fixation or excision of radial head and replacement

69

What can be injured in radial head #s?

radial nerve

70

What is the terrible triad?

radial head#; elbow dislocation; coronoid process #

71

How are elbow epicondyle #s treated?

fixed with screw

72

How are coronoid #s treated?

ORIF with screw

73

What is the mnemonic for Galleazzi and Monteggia #s?

GRUesome MURder

74

What is a Galleazzi #?

radius # wtih distal ulnar dislocation

75

What is a Monteggia #?

ulnar # with radial dislocation

76

What is the name for an ulnar shaft #?

nightstick #

77

How are ulnar shaft #s treated?

conservatively

78

Who gets Colles #s?

osteoporotic post-menopausal women who FOOSH

79

Describe a Colles #?

dorsal angulation and displacement producing a dinner fork wrist deformity

80

What are hte complications of a Colles #?

median nerve compression; EPL rupture; CRPS; loss of grip strength

81

How is a stable, minimally displaced Colles# treated?

plaster

82

How is a displaced, simple colles# treated?

MUA

83

How is a displaced, comminuted Colles# treated?

MUA and k-wiring, ORIF

84

How is a # of both bones of the forearm treated?

ORIF with plates and screws

85

How is a # of radius and ulna in a child with minimal angulation treated?

plaster

86

Describe a Smith's #?

volarly displaced and angulated # of distal radiu

87

How does a Smiths # occur?

falling onto back of a flexed wrist

88

How is a Smiths # treated?

ORIF using plates and screws

89

Why is management for a Smiths different than a Colles?

Smith's tend to be very unstable

90

What is a Barton's #?

intra-articular # invovling either the dorsal/volar aspect of distal radius; carpal bones sublux with displaced rim fragment

91

What is another name for a Volar Barton's?

intra-articular Smith's

92

What is another name for a dorsal Barton's ?

intra-articular Colle's

93

How are Barton's #s treated>

ORIF

94

How are comminuted intra-articular distal radius # treated?

external fixation +/- k wires

95

What is the mechanism for Scaphoid #s?

FOOSH

96

What are the signs of a scaphoid #s?

tenderness in anatomical snuff box; pain on compressing the thumb metacarpal

97

What are the xrays that hsould be done when a scaphoid # is suspected?

AP, lateral and 2 oblique views

98

What is a clinical scaphoid #?

when # does not show up on xray but suspected clinically

99

How are clinical scaphoid #s treated?

wrist spinted and xrayed again in 2 weeks

100

How is an undisplaced scaphoid # treated?

plaster cast for 6-12 weeks

101

How is a displaced scaphoid # treateed?

special compression screw

102

How is scaphoid # with non-union treated?

screw fixation and bone graft

103

What forms the anatomical snuffbox?

EPL medially and EPB and abductor pollicis longus laterally

104

What can cause non-union in a scaphoid #?

synovial fluid inhibiting # healing or AVN or proximal pole

105

What is a mallet finger?

avulsion of the extensor tenon from its insertion onto the terminal phalanx

106

What is a mallet finger caused by?

forced flecion of extended DIPJ

107

What is the sign of a mallet finger?

inability to extend DIPJ

108

What is the treatment for a mallet finger?

spint holidng DIPJ extended

109

What is a Bennet's #?

carpometacarpal #/dislocation of the thumb

110

What is the treatment for a Bennet's #?

percutaneous wire fixation

111

How are #s of the 3,4 and 5 MC treated?

conservatively

112

What is the name for a 5th MC neck #?

boxers #

113

How much angulation can be tolerated wtih a 5th MC neck '?

45 degrees

114

What ist he treatment for a boxers #?

manipulation with neighbour strapping or k-wire stabilisation

115

How are stable phalangeal #s treated?

neighbour strapping or splintage

116

How are significantly displaced or angulated phalangeal #s treated?

MUA

117

How are unstable phalangeal #s treated?

k-wiring or fixation with small screws

118

How are intra-articular phalangeal #s treated?

k wires or small screws

119

What is the other name for an intracapsular fracture?

subcapital

120

What are hte two types of extracapsular fractures?

intertrochanteric and subtrochanteric

121

What is the treatment for a subcapital #?

THR or arthroplasty

122

What are the adv/disadv for a THR?

high risk of dislocation but better function

123

What are the features of a subcapital #?

external rotation, adduction and shortening

124

What is th feature seen on xray of a subcapital #?

interrupted Shenton's line

125

What is Shenton's line?

the smooth curve from the lower border of the superrior pubic ramus to less trochanter

126

How are extracapsular #s treated?

internal fixation with compression or dynamic hip screw

127

What can be done pre-op to stabilise a subtrochanteric #?

Thomas Splint

128

How do subtrochanteric #s typically happen?

fall onto the side in the elderly

129

What should be looked for in a femoral shaft#?

other injuries as # is high energy

130

What nerve may be damaged in a femoral shaft#?

sciatic nerve

131

What are the complications of a femoral shaft#?

substantial blood loss; fat embolism and ARDS

132

What are the steps in treatment of a femoral shaft #?

analgesia- femoral nerve block; Thomas Splint; closed reduction and IM nail

133

How do distal femoral #s happen?

osteoporotic bone with fall onto a flexed knee

134

What position does the leg take in a distal femoral #?

flexed position- due to gastrocneumius pull

135

What is the sign of a hip dislocation?

interall rotated

136

How are distal femoral #s treated?

plate and screws

137

What is there a high risk of with knee dislocations?

vascular and nerve injury and compartment sydrome

138

What is the treatment for a knee dilocation?

external fixation

139

What may be required after a knee dislocation?

mulit-ligament reconstruction

140

How does a patellar # typically occur?

fall onto flexed knee of dashboard injury

141

What type of dislocation typically happens with patellar dislocations?

lateral

142

How do patellar dilocations typically occur?

direct blow or a contracion of quadricpes with a rotation force

143

What are the predispoations for a patellar discloation?

generalised ligamentous laxity; valgus alignment of the knee; rotation malalignment (femoral neck anteversion); shallow trochlear groove

144

What are the signs of a patellar dislocation?

tenderness over medial retinaculum; haemarthrosis

145

What is a complication of a patellar discloation?

osteochondral # with detached fragments

146

What is the treatment of a patellar dislocation?

temporary splintage wtih PT to strengthen vastus medialis

147

How many patients have a further patellar dislocation after their first one?

10%

148

What type of fracture is a proximal tibial #

high energy

149

What imagin is done with intra-articular tibial #s?

CT to plan surgery

150

What is the tx for intra-articular tibial #s?

reduction of articular surface and plates and screws

151

What often needs to happen for intra-artiular tibial #s?

TKR

152

If there is significant soft tissue damage with an intra-articular tibial #?

temp ex-fix

153

What is the usual mechanism of injury with proximal tibial #s?

valgus stress

154

What is the suual pattern of injury with proximal tibial #s?

laterla plateau # with MCL failure

155

What injury can happen with proximal tibial #s?

common fibular nerve

156

What is the sign of injury to the common fibular nerve?

foot drop

157

What # is the commonest cause of compartment syndrome after trauma?

tibial shaft '

158

What type of # is more common with tibial shaft #?

open #

159

If there is less than 50% diplacement and <5 degrees angulation what is the treatment for tibial shaft #?

above the knee cast

160

How are comminuted and opne# tibial shaft # treated?

IM nailing or ex-fix

161

How long do tibial shaft #s take to heal?

up to 16 weeks to union and a year to heal

162

What is a Pilon #?

intra-articular #s of distal tibia

163

What is the treatment for Pilon #?

ORIF

164

What is the mechanism for Pilon#?

fall from height or rapid decelration

165

What is the imaging for Pilon# and why?

cT to check for other injuries

166

What is the treatment for undisplaced extra-articular distal tibial #s?

conservative

167

What is the treatment for unstable extra-articular distal tibial # that isnt too distal?

IM nail

168

what is the treatment for unstable extra-articular distal tibial # that is too distal?

plating

169

How do most ankle injuries occur?

inversion injury or rotation force on a planted foot

170

WHat is the most common soft tissue ankle sprain?

lateral ankle ligaments

171

What are the lateral ankle ligamnet>

anterior and posterior talo-fibular and calcaneofibular

172

What are the signs of lateral ankle ligamnet sprain?

prain; brusing and tenderness over lateral ligaments

173

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

174

What determines if an ankle # is stable?

if there is inbolvement of medial side- ligaments or bone

175

What is the treatement for a stbale snkle #?

cast/splint for 6 weeks

176

When should you suspect rupture of the deltoid ligament?

bruising and tenderness medially

177

What is seen on xray with a ruptured deltoid ligament?

talar shift and tilt

178

What is the treatment for an unstable ankle #?

ORIF

179

What is the treatment for bimalleolar ankle #?

ORIF

180

What should be looked for in a calcaneal #?

spinal injuries

181

What is the typical mechanism for calcaneal #?

fall from height onto heel

182

What determines the prognossi of a calcaeneal #?

extent of subtalar joint involvement and communition

183

What is the treatment for calcaneal #?

ORIF is debated

184

WHat is the mechanism of injury with talar #s?

forced dorsiflexion from rapid deceleration

185

What are the two types of talar #?

undisplaced or displcaed with subluxation of subtalar joint

186

What is the treatment for a displaced talar #?

closed/open reduction and screw fixation

187

Why is there a high risk of aVN with talar #s?

talus gets distal blood supply

188

What is a Lisfranc #/dislocation?

# of base of 2nd MT and dislcoation of base of 2nd MT with or without dislocation of other MTs

189

What are the signs of a Lisfranc?

grossly swollen, bruised foot, unable to weight bear

190

What should be done is xray is noral but suspicion of Lisfranc?

CT

191

What is the treatemtn for Lisfranc #s?

closed or open reduction with screw fixation

192

What is the commonest metatarsal #?

base of 5th MT

193

what type of # is a # of the base of 5th MT?

avulsion # due to fibularis brevis tendon

194

What is the treatment for a # of base of 5th MT?

conservativ efor 4-6 weeks

195

What is a Jones #?

# of proximal diaphysis of 5th MT

196

What is the problem with Jones #?

proximal diaphysis of 5th MT gets a poor blood supply

197

What is the treatemnt for a jones #?

screw fixation

198

What is the treatemtn for non-union with a Jones #?

beon graft and fixation

199

What is the treatment for a # of 1st MT?

fixaetion

200

What is the treatment for 2nd MT #?

cast until pain subsides

201

What is the tretment for #s of other metatarsals that are minimally displcaed?

cast

202

what is the treatment for other MT #s that are displaced?

k-wires

203

What is the treatment for # toes?

protection in a stout boot

204

What is the treatmetn ofr an intra-articular # of base of proximal phalanx of hallux?

reduction nd fixation

205

What is the treatment for toe discloation?

closed reduction and neighbour strapping or k wiring

206

What type of # do the elderly typically get in the thoracic spine?

wedge insufficiency #s

207

What is spinal shock?

complete loss of sensation and mottor functio nand refleces below the level of injury for 24 hours

208

What is the bulbocavernous reflex?

contraction of anal sphincter with a squeeze of glans penis, taping mons pubis or pulling on urethral catheter

209

what does the return of the bulbocavernous reflex indicate?

end of spinal shock

210

What causes neurogenic shock?

temporary shutdown of sympathetic outflow from cord from T1-L2

211

What happen in neurogenic shock?

hypotension and bradycardia for 24-48 horus

212

What is the treatment for neurogenic shock?

IV fluids

213

What is complete spinal cord injury?

no sensory or voluntary motor function below level of injury

214

What is incomplete spinal cord injury?

some neurologic function present distal to injury

215

What indictes incomplete spinal injury?

sacral sparing

216

What is sacral sparing?

perianal sensation; voluntary anal sphincter contractio nand hallux flexion

217

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

218

What are the 3 types of pelvic #?

lateral compression; vertical shear; anteroposterior compression

219

What causes a lateral compression #?

side impact

220

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

221

What is the mechanism for vertical shear pelvic #s?

axial force on one hemipelvis

222

What is the sign of a vertical shear peliv #?

one leg shortened due to that side being displcaed superiorly

223

What is the otehr name for an anteroposterio compression injury?

open book#

224

What happens in open book #?

# of pubic symphysis

225

What is the initial treatment for an open book#?

pelvic binding

226

What should be done if there is ongoing haemodynamic instability with a pelivc #?

angiogram adn emboliation or open packing pelivs

227

What is mandatory in a # pelvis?

PR exam

228

What type of a # is an acetabualr #?

high energy

229

What type of pelvic # due osteoporotic elderly tend to get?

lateral compression #

230

What imaging should be done with acetabular #?

CT

231

What causes acetabular #s?

hip dislocation- typically posteior wall

232

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

233

What age should childrens #s be treated as adult #s?

12-14

234

What are the common #s of the distal radius in children?

buckle #s; greenstick #s and salter harris II #s

235

What branch of the median nerve is often damaged ina supracondylar # of the elbow?

anterior interosseous branch

236

What indicates that t/here is injury to the anterior interosseous branch

child is unable to make OK sign- loss of FPL and FDP

237

What is the tx for femoral shaft #s in 2-6 yos?

Thomas Splint

238

What is the tx for children older than 6 for femoral shaft #s?

IM nailing

239

What is a Toddler's #?

undisplaced spiral # of tibial shaft

240

What is the definitive managemtn for femoral shaft #s?

closed reduction and IM nails

241

What is the sign of a posterior shoulder dislocation?

excessive internal rotation

242

What aspect of the vertebral body is affected in a wedge #?

anterior

243

What type of alignment is not well tolerated in a boxers #?

rotational

244

Why is rotational malalignment badly tolerated in a boxers #?

can lead to grip problems

245

What are the signs of a posterior hip dislocation?

internal rotation ; adduction and flexion

246

What are the signs of an anterior hip dislcoation?

extended and externally rotated