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MSK > Fractures > Flashcards

Fractures Flashcards

1
Q

What are the features of a fracture?

A 
pain
loss of function
tenderness
deformity
swelling
crepitus
abnormal movement or positioning
soft tissue
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2
Q

What is the metaphysis?

A

the ossified portion of bone in a transitional one between the epiphysis and the diaphysis- should always have a smoothly curved cortex

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3
Q

What is an apophysis?

A

bony outgrowth independent of a centre of ossification

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4
Q

What is fracture disease?

A

muscle atrophy; stiff joints and osteoporosis

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5
Q

What are the indications for ORIF?

A

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

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6
Q

When might external fixation be used?

A

burns; loss of skin and bone or open #

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7
Q

What are the 7 A’s of open #s?

A

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

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8
Q

What is the mnemonic for Salter-Harris #s?

A 
SALTR- 
S- slipped
A-above
L-lower
T-through
R-rammed
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9
Q

What are the immediate complications of fractures?

A 
internal bleeding
external bleeding
organ injury
nerve/skin injury
vessel injury (limb ischaemia)
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10
Q

What ar teh later local complications of fractures?

A

skin necrosis/gangrene
pressure sore
infection
non or delayed union

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11
Q

What are the lateral geeneral complications of #s?

A

venous or fat embolism; PE; pneumonia; renal stones

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12
Q

What are the signs of a fat embolism?

A

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

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13
Q

What prevents fat embolism?

A

early fixation of #s

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14
Q

What is the viscious cycle of compartment syndrome?

A

pressure–vascular occlusion– hypoxia– necrosis– increased pressure

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15
Q

What are the signs of compartment syndrome?

A

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

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16
Q

What are hte late complications of #s?

A 
wound sepsis
failure of fixation
joint stiffness, contracture or malalignment
CRPS
non-union
delayed union
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17
Q

What is non-union defined as?

A

no evidence of progression towards healing

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18
Q

What causes non-unions?

A

abnormal biology eg infection; blood supply or mechanics

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19
Q

What is delayed union?

A

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

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20
Q

What are hte causes of delayed union?

A

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

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21
Q

What are the two types of CRPS?

A

type 1- no nerve injury

type 2- if nerve lesions are present

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22
Q

What are the signs of CRPS?

A

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

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23
Q

Where a # clavicle most common?

A

middle third

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24
Q

What is the management of a fractured clavicle?

A

broad arm sling with x-rays at 6 weeks

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25
Q

What are the potential neurovascular injuries with a clavicle# ?

A

brachial plexus; sublcavlisn vessels

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26
Q

What other complication can you get with clavicle #?

A

pnuemothorax

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27
Q

How do AC dislocations commonly happen?

A

fall onto the point of hte hsoulder

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28
Q

What are the signs of AC dislocation?

A

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

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29
Q

What is the mx of AC dislocation?

A

sling support and early mobilisation

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30
Q

Who tends to get #s of proximal humerus?

A

osteoporotic #s in the elderly after FOOSH

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31
Q

How is a minimally siplaced proximal humeral # treated?

A

conservative with a sling

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32
Q

How is a persistently displaced proximal humeral # treated?

A

interal fixation

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33
Q

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

A

arthoplasty

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34
Q

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

A

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

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35
Q

What neurovascular injury can occur with prox. humeral #?

A

brachial plexus/ axillary nerve/ artery

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36
Q

How is axillary nerve injury assessed?

A

loss of sensation in regimental patch area

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37
Q

How a humeral shaft # mostly treated?

A

splinting with a humeral brace and collar and cuff sling

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38
Q

How should a humeral shaft# in polytrauma be treated?

A

internal fixation with IM nail, plate or screw

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39
Q

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

A

plating and bone graft

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40
Q

what can be injured in a humeral shaft #?

A

radial nerve

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41
Q

What are the signs of radial nerve injury?

A

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

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42
Q

What are the signs of an anterior shoulder dislocation?

A

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

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43
Q

What is the mechanism for anterior shoulder dislocations?

A

excessive external rotation or fall onto back of shoulder

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44
Q

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

A

80%

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45
Q

What is Hamilton’s ruler sign?

A

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

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46
Q

What is a Bankart lesion?

A

detachment of anterior glenoid labrum

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47
Q

What is a Hill-Sach’s lesion?

A

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

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48
Q

What is the treatment for an anterior shoulder dislocation?

A

simple reduction

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49
Q

What is the mechanism in a posterior shoulder dislocation?

A

posterior force on adducted and internally rotated arm

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50
Q

What are the signs of a posterior shoulder dislocation?

A

limitation of external rotation

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51
Q

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

A

lateral

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52
Q

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

A

light bulb sogn

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53
Q

How typically gets supracondylar humeral #s?

A

children (5-7yo)

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54
Q

What can be injured in a supracondylar #?

A

brachial artery, median radial or ulnar nerve

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55
Q

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

A

keep elbow in extension

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56
Q

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

A

posterior fat pad sign

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57
Q

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

A

ORIF with anatomic reduction and rigid fixation

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58
Q

What is the mechanims for an elbow dislocation?

A

FOOSH

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59
Q

What is the typically dislocation for the elbow?

A

posterior

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60
Q

What is the management of an uncomplicated elbow dislocation?

A

closed reduction under sedation

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61
Q

What is the mechanism of olecranon #?

A

a fall onto the point of the elbow

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62
Q

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

A

tension band wiring

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63
Q

What muscle is responsible for avulsion in olecranon #?

A

triceps brachii

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64
Q

How is a communicated olecranon # treated?

A

ORIF with a plate and screws

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65
Q

What is the sign of a radial head #?

A

elbow is swollen adn tender over the radial head- flexion/extension may be possible but supination/pronantion will not

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66
Q

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

A

posterior fat pad sign

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67
Q

How are undisplaced radial head #s treated?

A

collar and cuff

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68
Q

How are displaced/fragmented radial head #s treated?

A

internal fixation or excision of radial head and replacement

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69
Q

What can be injured in radial head #s?

A

radial nerve

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70
Q

What is the terrible triad?

A

radial head#; elbow dislocation; coronoid process #

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71
Q

How are elbow epicondyle #s treated?

A

fixed with screw

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72
Q

How are coronoid #s treated?

A

ORIF with screw

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73
Q

What is the mnemonic for Galleazzi and Monteggia #s?

A

GRUesome MURder

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74
Q

What is a Galleazzi #?

A

radius # wtih distal ulnar dislocation

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75
Q

What is a Monteggia #?

A

ulnar # with radial dislocation

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76
Q

What is the name for an ulnar shaft #?

A

nightstick #

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77
Q

How are ulnar shaft #s treated?

A

conservatively

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78
Q

Who gets Colles #s?

A

osteoporotic post-menopausal women who FOOSH

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79
Q

Describe a Colles #?

A

dorsal angulation and displacement producing a dinner fork wrist deformity

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80
Q

What are hte complications of a Colles #?

A

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

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81
Q

How is a stable, minimally displaced Colles# treated?

A

plaster

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82
Q

How is a displaced, simple colles# treated?

A

MUA

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83
Q

How is a displaced, comminuted Colles# treated?

A

MUA and k-wiring, ORIF

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84
Q

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

A

ORIF with plates and screws

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85
Q

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

A

plaster

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86
Q

Describe a Smith’s #?

A

volarly displaced and angulated # of distal radiu

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87
Q

How does a Smiths # occur?

A

falling onto back of a flexed wrist

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88
Q

How is a Smiths # treated?

A

ORIF using plates and screws

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89
Q

Why is management for a Smiths different than a Colles?

A

Smith’s tend to be very unstable

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90
Q

What is a Barton’s #?

A

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

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91
Q

What is another name for a Volar Barton’s?

A

intra-articular Smith’s

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92
Q

What is another name for a dorsal Barton’s ?

A

intra-articular Colle’s

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93
Q

How are Barton’s #s treated>

A

ORIF

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94
Q

How are comminuted intra-articular distal radius # treated?

A

external fixation +/- k wires

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95
Q

What is the mechanism for Scaphoid #s?

A

FOOSH

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96
Q

What are the signs of a scaphoid #s?

A

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

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97
Q

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

A

AP, lateral and 2 oblique views

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98
Q

What is a clinical scaphoid #?

A

when # does not show up on xray but suspected clinically

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99
Q

How are clinical scaphoid #s treated?

A

wrist spinted and xrayed again in 2 weeks

100
Q

How is an undisplaced scaphoid # treated?

A

plaster cast for 6-12 weeks

101
Q

How is a displaced scaphoid # treateed?

A

special compression screw

102
Q

How is scaphoid # with non-union treated?

A

screw fixation and bone graft

103
Q

What forms the anatomical snuffbox?

A

EPL medially and EPB and abductor pollicis longus laterally

104
Q

What can cause non-union in a scaphoid #?

A

synovial fluid inhibiting # healing or AVN or proximal pole

105
Q

What is a mallet finger?

A

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

106
Q

What is a mallet finger caused by?

A

forced flecion of extended DIPJ

107
Q

What is the sign of a mallet finger?

A

inability to extend DIPJ

108
Q

What is the treatment for a mallet finger?

A

spint holidng DIPJ extended

109
Q

What is a Bennet’s #?

A

carpometacarpal #/dislocation of the thumb

110
Q

What is the treatment for a Bennet’s #?

A

percutaneous wire fixation

111
Q

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

A

conservatively

112
Q

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

A

boxers #

113
Q

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

A

45 degrees

114
Q

What ist he treatment for a boxers #?

A

manipulation with neighbour strapping or k-wire stabilisation

115
Q

How are stable phalangeal #s treated?

A

neighbour strapping or splintage

116
Q

How are significantly displaced or angulated phalangeal #s treated?

A

MUA

117
Q

How are unstable phalangeal #s treated?

A

k-wiring or fixation with small screws

118
Q

How are intra-articular phalangeal #s treated?

A

k wires or small screws

119
Q

What is the other name for an intracapsular fracture?

A

subcapital

120
Q

What are hte two types of extracapsular fractures?

A

intertrochanteric and subtrochanteric

121
Q

What is the treatment for a subcapital #?

A

THR or arthroplasty

122
Q

What are the adv/disadv for a THR?

A

high risk of dislocation but better function

123
Q

What are the features of a subcapital #?

A

external rotation, adduction and shortening

124
Q

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

A

interrupted Shenton’s line

125
Q

What is Shenton’s line?

A

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

126
Q

How are extracapsular #s treated?

A

internal fixation with compression or dynamic hip screw

127
Q

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

A

Thomas Splint

128
Q

How do subtrochanteric #s typically happen?

A

fall onto the side in the elderly

129
Q

What should be looked for in a femoral shaft#?

A

other injuries as # is high energy

130
Q

What nerve may be damaged in a femoral shaft#?

A

sciatic nerve

131
Q

What are the complications of a femoral shaft#?

A

substantial blood loss; fat embolism and ARDS

132
Q

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

A

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

133
Q

How do distal femoral #s happen?

A

osteoporotic bone with fall onto a flexed knee

134
Q

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

A

flexed position- due to gastrocneumius pull

135
Q

What is the sign of a hip dislocation?

A

interall rotated

136
Q

How are distal femoral #s treated?

A

plate and screws

137
Q

What is there a high risk of with knee dislocations?

A

vascular and nerve injury and compartment sydrome

138
Q

What is the treatment for a knee dilocation?

A

external fixation

139
Q

What may be required after a knee dislocation?

A

mulit-ligament reconstruction

140
Q

How does a patellar # typically occur?

A

fall onto flexed knee of dashboard injury

141
Q

What type of dislocation typically happens with patellar dislocations?

A

lateral

142
Q

How do patellar dilocations typically occur?

A

direct blow or a contracion of quadricpes with a rotation force

143
Q

What are the predispoations for a patellar discloation?

A

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

144
Q

What are the signs of a patellar dislocation?

A

tenderness over medial retinaculum; haemarthrosis

145
Q

What is a complication of a patellar discloation?

A

osteochondral # with detached fragments

146
Q

What is the treatment of a patellar dislocation?

A

temporary splintage wtih PT to strengthen vastus medialis

147
Q

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

A

10%

148
Q

What type of fracture is a proximal tibial #

A

high energy

149
Q

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

A

CT to plan surgery

150
Q

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

A

reduction of articular surface and plates and screws

151
Q

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

A

TKR

152
Q

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

A

temp ex-fix

153
Q

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

A

valgus stress

154
Q

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

A

laterla plateau # with MCL failure

155
Q

What injury can happen with proximal tibial #s?

A

common fibular nerve

156
Q

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

A

foot drop

157
Q

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

A

tibial shaft ‘

158
Q

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

A

open #

159
Q

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

A

above the knee cast

160
Q

How are comminuted and opne# tibial shaft # treated?

A

IM nailing or ex-fix

161
Q

How long do tibial shaft #s take to heal?

A

up to 16 weeks to union and a year to heal

162
Q

What is a Pilon #?

A

intra-articular #s of distal tibia

163
Q

What is the treatment for Pilon #?

A

ORIF

164
Q

What is the mechanism for Pilon#?

A

fall from height or rapid decelration

165
Q

What is the imaging for Pilon# and why?

A

cT to check for other injuries

166
Q

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

A

conservative

167
Q

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

A

IM nail

168
Q

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

A

plating

169
Q

How do most ankle injuries occur?

A

inversion injury or rotation force on a planted foot

170
Q

WHat is the most common soft tissue ankle sprain?

A

lateral ankle ligaments

171
Q

What are the lateral ankle ligamnet>

A

anterior and posterior talo-fibular and calcaneofibular

172
Q

What are the signs of lateral ankle ligamnet sprain?

A

prain; brusing and tenderness over lateral ligaments

173
Q

When should an ankle xray be done?

A

any severe localised tenderness (bony tenderenss) of stial tibia or fibula OR inability to weight bear for 4 steps

174
Q

What determines if an ankle # is stable?

A

if there is inbolvement of medial side- ligaments or bone

175
Q

What is the treatement for a stbale snkle #?

A

cast/splint for 6 weeks

176
Q

When should you suspect rupture of the deltoid ligament?

A

bruising and tenderness medially

177
Q

What is seen on xray with a ruptured deltoid ligament?

A

talar shift and tilt

178
Q

What is the treatment for an unstable ankle #?

A

ORIF

179
Q

What is the treatment for bimalleolar ankle #?

A

ORIF

180
Q

What should be looked for in a calcaneal #?

A

spinal injuries

181
Q

What is the typical mechanism for calcaneal #?

A

fall from height onto heel

182
Q

What determines the prognossi of a calcaeneal #?

A

extent of subtalar joint involvement and communition

183
Q

What is the treatment for calcaneal #?

A

ORIF is debated

184
Q

WHat is the mechanism of injury with talar #s?

A

forced dorsiflexion from rapid deceleration

185
Q

What are the two types of talar #?

A

undisplaced or displcaed with subluxation of subtalar joint

186
Q

What is the treatment for a displaced talar #?

A

closed/open reduction and screw fixation

187
Q

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

A

talus gets distal blood supply

188
Q

What is a Lisfranc #/dislocation?

A

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

189
Q

What are the signs of a Lisfranc?

A

grossly swollen, bruised foot, unable to weight bear

190
Q

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

A

CT

191
Q

What is the treatemtn for Lisfranc #s?

A

closed or open reduction with screw fixation

192
Q

What is the commonest metatarsal #?

A

base of 5th MT

193
Q

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

A

avulsion # due to fibularis brevis tendon

194
Q

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

A

conservativ efor 4-6 weeks

195
Q

What is a Jones #?

A

of proximal diaphysis of 5th MT

196
Q

What is the problem with Jones #?

A

proximal diaphysis of 5th MT gets a poor blood supply

197
Q

What is the treatemnt for a jones #?

A

screw fixation

198
Q

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

A

beon graft and fixation

199
Q

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

A

fixaetion

200
Q

What is the treatment for 2nd MT #?

A

cast until pain subsides

201
Q

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

A

cast

202
Q

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

A

k-wires

203
Q

What is the treatment for # toes?

A

protection in a stout boot

204
Q

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

A

reduction nd fixation

205
Q

What is the treatment for toe discloation?

A

closed reduction and neighbour strapping or k wiring

206
Q

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

A

wedge insufficiency #s

207
Q

What is spinal shock?

A

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

208
Q

What is the bulbocavernous reflex?

A

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

209
Q

what does the return of the bulbocavernous reflex indicate?

A

end of spinal shock

210
Q

What causes neurogenic shock?

A

temporary shutdown of sympathetic outflow from cord from T1-L2

211
Q

What happen in neurogenic shock?

A

hypotension and bradycardia for 24-48 horus

212
Q

What is the treatment for neurogenic shock?

A

IV fluids

213
Q

What is complete spinal cord injury?

A

no sensory or voluntary motor function below level of injury

214
Q

What is incomplete spinal cord injury?

A

some neurologic function present distal to injury

215
Q

What indictes incomplete spinal injury?

A

sacral sparing

216
Q

What is sacral sparing?

A

perianal sensation; voluntary anal sphincter contractio nand hallux flexion

217
Q

What is central cord syndrome?

A

a type of incomplete spinal injury that happen after a hyperextension injury in c-spine with OA- no # or dislocation

218
Q

What are the 3 types of pelvic #?

A

lateral compression; vertical shear; anteroposterior compression

219
Q

What causes a lateral compression #?

A

side impact

220
Q

describe a pelivc lateral compression injury?

A

through pubic rami or ischium with sacral compression# or SI joint disruption with one half of pelvic displaced medially

221
Q

What is the mechanism for vertical shear pelvic #s?

A

axial force on one hemipelvis

222
Q

What is the sign of a vertical shear peliv #?

A

one leg shortened due to that side being displcaed superiorly

223
Q

What is the otehr name for an anteroposterio compression injury?

A

open book#

224
Q

What happens in open book #?

A

of pubic symphysis

225
Q

What is the initial treatment for an open book#?

A

pelvic binding

226
Q

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

A

angiogram adn emboliation or open packing pelivs

227
Q

What is mandatory in a # pelvis?

A

PR exam

228
Q

What type of a # is an acetabualr #?

A

high energy

229
Q

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

A

lateral compression #

230
Q

What imaging should be done with acetabular #?

A

CT

231
Q

What causes acetabular #s?

A

hip dislocation- typically posteior wall

232
Q

What is the significance of the periosteum in childrens #s?

A

is much thicker and tends to remain intact- more stable and provides lots of osteoblasts for repair

233
Q

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

A

12-14

234
Q

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

A

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

235
Q

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

A

anterior interosseous branch

236
Q

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

A

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

237
Q

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

A

Thomas Splint

238
Q

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

A

IM nailing

239
Q

What is a Toddler’s #?

A

undisplaced spiral # of tibial shaft

240
Q

What is the definitive managemtn for femoral shaft #s?

A

closed reduction and IM nails

241
Q

What is the sign of a posterior shoulder dislocation?

A

excessive internal rotation

242
Q

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

A

anterior

243
Q

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

A

rotational

244
Q

Why is rotational malalignment badly tolerated in a boxers #?

A

can lead to grip problems

245
Q

What are the signs of a posterior hip dislocation?

A

internal rotation ; adduction and flexion

246
Q

What are the signs of an anterior hip dislcoation?

A

extended and externally rotated

MSK (39 decks)

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