Fractures Flashcards
1
Q
Open fracture
A
Open wound
Due to a spike of fractured bone puncturing the skin
2
Q
Closed fracture
A
Skin is in tact
3
Q
Displacement
A
Direction of translation of the DISTAL fragment
- can be described as medially/laterally/anteriorly/posteriorly displaced
4
Q
Displacement terms in the hand and forearm
A
Direction of translation of the DISTAL fragment
- can be described as ulnar/radial/volar/dorsal displacement
5
Q
Angulation
A
Direction which the distal fragment points towards and the degree of this deformity
- can be described as medially/laterally/anteriorly/posterior angulation
6
Q
Angulation terms in the hand and forearm
A
can be described as ulnar/radial/volar/dorsal displacement
7
Q
Angulation terms in the lower limb
A
Varus/valgus/anteriorly/posteriorly
8
Q
Intra-articular fracture
A
Fracture extends into the joint
9
Q
Extra-articular fracture
A
Fracture does not extend into the joint
10
Q
Name the 5 fracture patterns
A
Transverse Oblique Spiral Comminuted Segmental
11
Q
Transverse fracture
A
clean fracture straight across horizontally
12
Q
Oblique fracture
A
diagonal fracture (at an angle)
13
Q
Spiral fracture
A
From twisting injuries
In an S shape
14
Q
Comminuted fracture
A
Fracture with 3 or more fragments
15
Q
Segmental fracture
A
Bone has fractured in 2 separate places
Very unstable
16
Q
X ray
A
Usually need an AP and lateral view
17
Q
CT
A
Can determine the degree of articular damage
18
Q
MRI
A
Detects occult fractures (clinical suspicion of fracture but normal X-ray)
19
Q
Primary bone healing
A
Minimal fracture gap and the bone simply fills the gap with new bone from osteoblasts
20
Q
Secondary bone healing
A
Gap at the fracture site which needs to be filled temporarily (by cartilage) in order for new bone to be laid down
21
Q
Initial fracture management
A
Analgesia (IV morphine)
22
Q
Immediate management if there is obvious displacement / dislocation
A
IV morphine
Immediate reduction
23
Q
Management of stable fractures
A
Non operative
- splint
- immobilisation (cast)
- bracing
- rehabilitation
24
Q
Management of unstable fractures
A
Reduction under anaesthetic
Surgical stabilisation
- internal fixation
- external fixation
25
Unstable intra-articular fracture management
ORIF
| - using plate and screws
26
Who gets traction?
Children
27
Examples of internal fixators
IM nail
Plate
Screws
28
Examples of external fixators
Pins which go through the skin and into the bone
29
Open fracture initial management
```
Antiseptic dressing
IV broad spectrum antibiotics
Surgical debridement ASAP
Removal of infected bone
Internal or external fixation
```
30
Intra-articular fracture commonly causes which complication?
Post-traumatic osteoarthritis
31
C-spine clearing in a conscious and co-operative patient
X-ray and if this is clear then remove the C-spine collar
32
C-spine clearing in a trauma patient
X-ray
| CT scan
33
What are the 3 different X-ray views required for C-spine fractures
AP view
Lateral view
Peg open mouth view
34
Examination required for pelvic fractures?
PR examination
| - need to assess sacral nerve root function and look for the presence of PR blood
35
Pelvic fracture : Antero-posterior compression injury
Open book fracture
36
Pelvic fracture : Antero-posterior compression injury management
Prompt reduction
| Pelvic binder
37
NOF fracture - features
Can't weight bear
Shortening of affected limb
External rotation of affected limb
38
NOF fracture - complications
AVN
39
Intracapsular hip fracture
Fracture is within the capsule
| Arterial supply to the femoral head could be disrupted if fracture is displaced leading to AVN
40
Intracapsular hip fracture - management in elderly
Hemi-arthroplasty
OR
Total hip replacement
41
Intracapsular hip fracture - management in young and active individual
Fixation
42
Extracapsular hip fracture
Fracture is outwith the capsule so the blood supply is still in tact. All will heal eventually
43
Extracapsular hip fracture - types (2)
Inter-trochanteric
| Sub-trochanteric
44
Extracapsular hip fracture - management
Internal fixation
| - hip screw (or IM nail)
45
Extracapsular hip fracture - management of a subtrochanteric fracture
Thomas' splint
Analgesia
Intramedullary nail
46
Femoral shaft fracture - management
Analgesia
Thomas' splint
Closed reduction
Internal fixation - IM nail
47
Distal femoral fracture - cause
Fall onto the flexed knee
48
Distal femoral fracture - management
Internal fixation
| - plate and screws
49
What is a plataeu fracture?
Proximal tibial fracture
50
Proximal tibial fracture is an EXTRA/INTRA articular fracture?
INTRA-articular
51
Proximal tibial fracture - clinical features
Valgus stress
52
Proximal tibial fracture - investigations
CT scan
53
Proximal tibial fracture - management
Internal fixation
| - plate and screws
54
Tibial shaft fracture - stable - management
Above knee plaster cast
55
Tibial shaft fracture - unstable - management
Internal fixation
| - IM nail
56
What is a pilon fracture?
Distal tibial fracture
(ankle fracture)
Emergency
57
Distal tibial fracture is an EXTRA/INTRA articular fracture?
INTRA-articular
58
Distal tibial fracture - investigation
CT scan
59
Distal tibial fracture - management
Urgent ORIF with plate and screws if no soft tissue swelling
If extensive soft tissue swelling, stabilise with external fixation then do internal fixation once soft tissues settle
60
Ankle fractures - likely mechanism of injury
Twisting forces, twisting force on a planted foot
61
Stable ankle fracture
Isolated distal fibular fracture
62
Unstable ankle fracture
Distal fibular fracture with rupture of deltoid ligament (medial bruising) or bimalleolar fracture
63
Stable ankle fracture - management
Walking cast / moon boot for 6 weeks
64
Unstable ankle fracture - management
ORIF
| - plate and screws
65
Calcaneal fracture
Can be extra-articular or intra-articular (subtler joint)
66
Calcaneal fracture - cause
Fall from height onto the heel
67
Talar fracture (displaced) - management
Open or closed reduction and internal fixation
68
Talar fracture (displaced) - complications
AVN
| - as talus gets blood supply from distal
69
Midfoot (lisfranc) fracture
Fracture of the base of the 2nd metatarsal
70
Midfoot (lisfranc) fracture - clinical features
Grossly swollen
Bruised foot
Unable to weight bear
71
Midfoot (lisfranc) fracture - management
Closed or open reduction with internal fixation
72
Fracture of base of 5th metatarsal - management
Walking cast or moonlit for 4-6 weeks
73
Where on the foot is a common site of a stress fracture?
2nd metatarsal
74
Management of stress fracture
Cast until pain subsides
75
Extra-articular OPEN fracture of the toe - management
Debridement
| Stabilise with wires
76
Dislocation of toes - management
Closed reduction and buddy strapping / wiring
77
Humeral neck fracture - cause
FOOSH
| Fall on to shoulder
78
Humeral neck fracture - location
Surgical neck
79
Humeral neck fracture - elderly - management
Conservative
| - sling
80
Humeral neck fracture - v displaced and young - management
Internal fixation
81
Humeral neck fracture - complications
Brachial plexus injury
Axillary nerve injury
Avascular necrosis
82
Humeral shaft fracture - displaced - management
Internal fixation
| - IM nail
83
Humeral shaft fracture - non-displaced - management
Functional humeral brace
84
Humeral shaft fracture - complications
Radial nerve injury
| - wrist drop and loss of sensation in first dorsal web space
85
Olecranon fracture - cause
Fall onto point of elbow
86
Olecranon fracture - management
ORIF
| - plate and screws
87
Radial head fracture - cause
FOOSH
88
Radial head fracture - investigations
X ray
| - if undisplaced this shows fat pad sign
89
Radial head fracture - undisplaced - management
Fat pad sign on x-ray
| Needs sling
90
Radial head fracture - displaced - management
Surgery
91
Nightstick fracture - managemnt
Conservative
| - sling
92
Fracture of both radius and ulna - management
ORIF
| - plate and screws
93
Monteggia fracture dislocation
Ulnar fracture with radial head dislocation
94
Monteggia fracture dislocation - management
ORIF of ulnar fracture
95
Galeazzi fracture dislocation
Radial fracture with dislocation at distal ulna
96
Galeazzi fracture dislocation - management
ORIF of radial fracture
97
Colles fracture
Distal radius fracture
| Dorsal displacement or angulation of distal fragment
98
Colles fracture is INTRA/EXTRA articular?
Extra-articular
99
Colles fracture - cause
FOOSH (with wrist extended)
100
Colles fracture - who gets it
Elderly
101
Colles fracture - investigation
X-ray
| - dinner fork deformity
102
Colles fracture - minimally displaced/angulated - management
Plaster cast 6 weeks
103
Colles fracture - displaced/unstable - management
Manipulation
104
Colles fracture - complications
Carpal tunnel syndrome
| - Median nerve compression
105
Smiths fracture
Distal radius fracture
| Volarly displaced or angulated
106
Smiths fracture is INTRA/EXTRA articular?
EXTRA-articular
107
Smiths fracture - cause
Fall onto the back of a flexed wrist
108
Smiths fracture - management
ORIF
| - plate and screws
109
Bartons fracture
Disal radius fracture
| Radio-carpal displacement
110
Bartons fracture is INTRA/EXTRA articular?
Intra-articular
| - i.e. it involves the wrist joint
111
Bartons fracture - managemnt
ORIF
| - plate and screws
112
Scaphoid fracture - cause
FOOSH
113
Scaphoid fracture - clinical features
Tenderness/pain in the anatomical snuff box
114
Scaphoid fracture - investigation
X-ray
| - 4 views required
115
Scaphoid fracture with no x-ray findings - management
Wrist splint
116
Undisplaced scaphoid fracture - management
Plaster cast
117
Displaced scaphoid fracture - management
Compression screw
118
Scaphoid fracture - complications
AVN
| - scaphoid has a unique blood supply
119
Boxers fracture
Fracture of the 5th MCP due to punching injury
120
Boxers fracture - management
Buddy strapping the affected digit to the adjacent finger
121
Lunate fracture
Anterior dislocation into the carpal tunnel compresses the median nerve
122
Childhood fractures - supracondylar fracture of elbow cause
Trampoline
123
Childhood fractures - supracondylar fracture of elbow clinical features
Can't make OK sign with hand
124
Childhood fractures - supracondylar fracture of elbow risks
Median nerve damage
| Brachial artery damage
125
Childhood femoral shaft fractures - management (child under )
Gallows traction
| Hip Spica cast
126
Childhood femoral shaft fractures - management (child 2-6)
Thomas splint
| Hip Spica cast
127
Childhood femoral shaft fractures - management (child 6-12)
Flexible IM nail
128
Childhood femoral shaft fractures - management (child over 12)
IM nail
