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Fractures Flashcards

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1
Q

Which sex is more prone to femoral fractures

A

Females - particularly elderly

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2
Q

Which age groups get femoral fractures

A

Vast majority are the elderly (over 60)

Young people occasionally with high energy trauma

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3
Q

List some risk factors for femoral fractures

A 
Age over 50 
Female
Osteoporosis 
Smoking 
Malnutrition 
Excess alcohol 
Neurological impairment 
Impaired vision
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4
Q

What does a fracture require to heal

A

Adequate blood supply

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5
Q

List the blood supply to the femoral head

A

Intramedullary artery of the shaft of femur
Medial and lateral circumflex branches of profundal femoris artery
Artery of the ligamentum teres
Foveal branch of obturator artery

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6
Q

What are the types of proximal femoral fracture

A

Intracapsular - displaced or undisplaced
- subcapitlal and transcervical

Extracapsular - Basicervical, intertrochanteric, subtrochanteric

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7
Q

Which type of femoral fracture is more likely to heal

A

Extracapsular

Both sides of fracture have a blood supply - no disruption

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8
Q

What are the major risks with intracapsular fractures

A

Significant risk of not healing due to disruption of blood supply
AVN

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9
Q

How does a proximal femoral fracture present

A 
History of a fall 
Pain 
Inability to weight bear 
Shortening of limb 
External rotation
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10
Q

What are some complications of immobility after surgery

A

UTI
Pressure sores
DVT

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11
Q

How do you treat an intracapsular fracture

A

Hip replacement
Either total or hemi-arthroplasty
Total replacement reserved for those who are young and fit - better ROM and longevity

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12
Q

How do you treat an extracapsular fracture

A

Pinning - variety of methods

Dynamic hip screw is popular

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13
Q

Why is incidence of hip fractures rising

A

Ageing population

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14
Q

What are the 11 standards of care for hip fractures

A

Transfer to ortho ward within 4 hours
Big 6 intervention in A and E
Receive inpatient bundle of care within 24hrs
Undergo surgery within 36hrs
No repeated fasting and fluids 2hr before op
Cemented arthroplasty (unless otherwise indicated
Geriatric assessment within 3 days
Early mobilisation and physio assessment w2 days post-op
Occupational therapy assessment by 3 days after admission
Bone health assessment prior to leaving ortho ward
Recovery optimised by MDT and discharge within 30 days

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15
Q

What are the big 6 interventions that should be carried out in A and E for a hip fracture

A 
Analgesia 
NEWS
Pressure area inspection 
Blood tests 
Fluid therapy 
Delirium screening
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16
Q

Give examples of pre-op analgesia

A

Strong opiates - morphine
Lots of side effects

Local nerve blocks
- avoids side effects

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17
Q

What makes pressure sores more likely

A

Delays to surgery
Frail or malnourished patients
Failure to mobilise early

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18
Q

Pressure sores take a long time to develop - true or false

A

False

Can start to develop within 30 mins of lying on hard surface

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19
Q

What are some key signs of dehydration

A

Low urine output

Concentrated urine

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20
Q

What are some key signs of fluid overload

A

Oedema

Crackles in the chest

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21
Q

Describe the WHO pain ladder

A

1- paracetamol or NSAID
2- codeine
3- strong opiate such as morphine

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22
Q

What is resuscitation

A

Process of correcting physiological disorders in an acutely unwell patient

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23
Q

List some clinical indicators of a deteriorating patient

A

Tachypnoea
Tachycardia
Hypotension
Reduced conscious level

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24
Q

All patients get high flow oxygen - true or false

A

TRUE

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25
What is hypoxic drive
Long term pulmonary disease leads to CO2 retention | High CO2 means breathing switches and becomes driven by oxygen levels
26
What causes a torus fracture
Fall onto outstretched hand | Seen in kids
27
What is a plastic deformation fracture
Unique to children Bone bends and becomes deformed rather than snapping Needs manual correction which takes a lot of force
28
Children's bones have remodelling potential - true or false
TRUE
29
What is Wollfs Law
Healthy bone will adapt to the load under which it is placed
30
What is Hueter-Volkman's Law
Compression forces inhibit bone growth and tensile forces stimulate growth
31
List factors that would make you suspect NAI
History that doesn't match nature/severity of injury Vague or changing stories Accusation of child hurting themselves deliberately Delay in seeking help Child dressed inappropriately for scenario
32
What are some key signs of NAI
Fractures in children under 2 - pre-walking Injuries in various healing stages More injuries than you'd expect Injuries scattered across body Increased intercranial pressure in infant Intra-abdominal trauma in child Injury that doesn't fit story
33
What would you look for in a neurovascular exam
``` Colour Cap refill Skin temp O2 sats Pulse Sensation Sweating Skin wrinkling in water - if nerve damaged this wont happen ```
34
What hand movement would you do to test the median nerve
OK sign
35
What hand movement would you do to test the radial nerve
Thumb's up or Hitchhiker's thumb
36
What hand movement would you do to test the ulnar nerve
Star fish | Splay all fingers
37
What injury commonly affects the radial nerve
Humeral shaft fracture
38
What injury commonly affects the ulnar nerve
supracondylar, forearm and hand fractures
39
What injury commonly affects the median nerve
Elbow dislocation
40
What causes fractures to displace?
Muscle action and gravity | Initial force on impact
41
What type of splint is used for femoral fractures
Thomas splint
42
What is Gallows traction
Legs are suspended to apply traction to legs | Used in femoral shaft fractures
43
What are the pros and cons of pinning long bones
Gives predictable position for rapid healing and early mobilization Comes with surgical risks - infection and anaesthetics
44
When would you operate on a child fracture
Displaced intra-articular fractures Displaced growth plate injuries Open fractures
45
List common fixation techniques and when they are used
Flexible nails - diaphysis K wires - metaphysis Wires and screws - epiphysis
46
Why can you not put a screw across the physis when fixing a fracture
It will cause premature stop in growth
47
Describe the 5 types of Salter-Harris fractures
Grade 1 - Straight across physis - separates epiphysis and metaphyis Grade 2 -Transversely through physis but exits through metaphysis forming triangular fragment Grade 3 - Crosses physis and exits through epiphysis at joint space Grade 4 - Through everything! Extends upwards from the joint line, through the physis and out the metaphysis Grade 5 - Crush injury to growth plate
48
What is the most common type of shoulder dislocation
Anterior
49
What injury typically causes anterior shoulder dislocation
Fall onto outstretched hand with an externally rotated shoulder
50
What injury typically causes posterior shoulder dislocation
Direct blow to front of shoulder | Associated with seizures
51
What injury shows up with the light bulb sign
Posterior shoulder dislocation | Looks like light bulb on x-ray
52
How do you manage a dislocated shoulder
Closed reduction under sedation Open reduction - severe/complex cases Stabilisation and rehab
53
Risk of re-dislocation increases as you age - true or false
False | Decreases with age
54
What injury typically causes an elbow dislocation
Fall onto outstretched hand
55
What directions can an elbow dislocate in
Posterior Anterior Medial/lateral
56
How do you manage an elbow dislocation
Closed reduction under sedation Open reduction - rarely needed 2 weeks in sling and rehab
57
What injuries can cause an interphalangeal joint dislocation
Hyperextension | Direct axial blow
58
What directions do IPJ's dislocate in
almost always pos
59
How do you manage an IPJ dislocation
Closed reduction under local nerve block Open reduction - rare 2 weeks in buddy strapping If unstable strap into Edinburgh position
60
What injury typically causes a patellar dislocation
Sudden quads contraction with a flexing knee
61
Which direction does the patella dislocate in
Lateral
62
Who commonly gets patellar dislocations
Teenagers | More common in girls
63
What increases your risk of a patellar dislocation
``` Hypermobility Under-developed lateral femoral condyle Increased Q angle Lateral quads insertions Weak vastus medialis ```
64
What forms the Q angle
Line from ASIS to midpoint of patella 2nd line from tibial tuberosity through midline of patella The angle the 2 lines form is the Q angle
65
How does a patellar dislocation present
Clear history Pain medially Effusion Positive patella apprehension test
66
How do you manage a patellar dislocation
``` Reduce with knee extension Radiographs Aspirate Brace Physio Surgery if repeat dislocations ```
67
Who is most commonly affected by knee dislocations
Teenagers | More common in girls
68
What surrounding structures can be injured in a knee dislocation
Popliteal artery or vein Peroneal nerve Ligaments
69
How do you manage a knee dislocation
Reduction under sedation Surgical reduction if needed Stabilise in splint or by external fixation
70
Which injuries can cause a hip dislocation
High velocity injury - RTA | Fall from height
71
Which direction does a hip normally dislocate in
Posterior
72
which fractures are often associated with a hip dislocation
Posterior acetabular wall | Femur
73
How does a dislocated hip present
Flexed, internally rotated and adducted knee
74
what urgent management is needed for a dislocated hip
neurovascular assessment radiographs and CT urgent reduction stabilise in tractions if required
75
What are the definitive managements for hip dislocations
Fixation of associated fractures | Fixation of other injuries in poly-trauma
76
What are some potential complications of a hip dislocation
Sciatic nerve palsy Avascular necrosis of the femoral head Secondary osteoarthritis of hip
77
What is an open fracture
Bone disruption where there is an overlying break in the skin and tissue High energy injury The break in sin communicates directly with the fracture and its haematoma
78
What is the other name for an open fracture
Compound fracture
79
What is a comminited fracture
One with 3 or more pieces
80
What is an avulsion fracture
Where a small piece of the bone is pulled off by a muscle or tendon which is attached to it
81
What is meant by the translation of a fracture
The extent to which the fracture fragments are not axially aligned - e.g. shifted to the left/right Typically you describe the displacement of the distal fragment relative to the proximal one Express as a % of bone width and the direction
82
What is meant by the angulation of a fracture
Extent to which fracture fragments are not anatomically aligned in a angular fashion - what is the angle between fragments Typically you describe the angle that the distal fragment is pointing relative to where it should be Describe in degrees or as valgus, parallel or varus
83
What is meant by the rotation of a fracture
Extent to which fracture fragments are rotated relative to each other Typically you describe which direction the distal fragment is rotated relative to the proximal portion of the bone
84
Aside from an obvious break in the bone, which other x-ray signs may suggest fracture
Periosteal reaction - whiter area on bone Callus Visible fat pad in elbow- means there is an effusion in the joint, typically a intraarticular elbow fracture Lipohaemarthrosis - blood and flat leak out. less dense fat floats on top creating a line
85
What is a segmental fracture
A fracture with at least 2 fracture lines which together isolate a segment of bone - have a piece basically floating in the middle, unattached to anything
86
What is ORIF
Open reduction and internal fixation
87
What are some of the risks of hemiarthroplasty
Dislocation risk Infection risk Risk of loosening
88
What is the difference between unipolar and bipolar hemiarthroplasty
Unipolar - only the femoral head is replaced and it connects to the natural socket Bipolar - femoral head is replaced but you also place artificial liners in the socket - better ROM and less likely to erode the acetabulum
89
The higher the grade of salter harris fracture, the more likely they are to cause growth disturbance - true or false
True

MSK (21 decks)

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