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Fractures Flashcards

1
Q

Definition of an open fracture

A

A fracture in which there is a direct communication between the external environment and the fracture

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2
Q

Importance of open fractures

A

higher energy injury
increased infection rate
soft tissue complications
long term morbidity

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3
Q

Gustilo classification of open fractures

A 
type 1
- wound < 1cm 
- clean 
- simple fracture pattern 
type 2
- wound > 1cm 
- moderate soft tissue damage 
- adequate skin coverage
- simple fracture pattern 
type 3 
- extensive soft tissue damage
- complex fracture pattern 
- 3A = adequate peritoneal coverage 
- 3B = tissue loss requiring soft tissue covering procedure (such as flap or graft)
- 3C = vascular injury requiring repair
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4
Q

Management of open fractures

A

Full ATLS assessment and treatment
tetanus and antibiotic prophylaxis
repeated exam n/v status
wounds only handled to remove gross contamination
photograph/cover (saline swab) and stabilise limb
no provisional irrigation/exposure
radiographs

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5
Q

Indications for emergency urgent surgery in open fractures

A 
polytraumatised patient 
marine or farmyard environment 
Gross contamination 
Neurovascular compromise 
compartment syndrome
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6
Q

What is a polytraumatised patient?

A

Multiple fractures that start the affect the physiology of the patient

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7
Q

What is compartment syndrome?

A

increasing pressure within a compartment -> causes swelling until it cannot swell anymore -> this increases the pressure and then the blood supply is cut off

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8
Q

4Cs of surgical debridement and fixation

A

colour
contraction
consistency
capacity to bleed

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9
Q

What are multiple debridements associated with?

A

poorer outcomes

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10
Q

scoring system to identify chance of amputation looks at…..

A

limb ischaemia
age range of patient (older = less likely to recover)
shock
injury mechanism

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11
Q

What counts as a low energy injury?

A

stab
gunshot
simple fracture

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12
Q

What counts as a medium energy injury?

A

Dislocation

open/multiple fractures

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13
Q

What counts as a high energy injury?

A

High speed MVA

rifle shot

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14
Q

What consists of a very high energy injury?

A

high speed trauma with gross contamination

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15
Q

Types of fracture patterns

A

transverse/short oblique
communication/butterfly fragments
segmental
with bone loss

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16
Q

types of soft tissue injury patterns

A

skin loss such that direct tension free closure is not possible
Degloving
injury to the muscles
injury to 1 or more major arteries

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17
Q

Definition of dislocation

A

complete joint disruption

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18
Q

Definition of subluxation

A

partial dislocation - not fully out of the joint

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19
Q

Investigations of dislocation

A

clinical

radiological

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20
Q

What ways does the shoulder dislocate?

A

Anterior

Posterior

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21
Q

Deformity of a dislocated shoulder

A

squared off

locked in internal rotation

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22
Q

deformity of a dislocated elbow

A

olecranon prominent posterior

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23
Q

which ways does the elbow dislocate?

A

posterior

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24
Q

which ways does the hip dislocate?

A

posterior

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25
Deformity of a dislocated hip
Leg short, flexed internal rotation adduction
26
what way does the knee dislocate?
anteroposterior
27
deformity of a dislocated knee
loss of normal contour | extended
28
Which is the most common dislocation of the ankle?
Lateral
29
Deformity of a dislocated ankle
externally rotated | prominent medial malleous
30
Most common dislocation of subtalar joint
lateral
31
deformity of a dislocated subtalar joint
lateral displaced os calcis
32
indications for rib fracture fixation
``` large flail segments paradoxical breathing multiple rib fractures significant displacement intrathoracic pathology e.g. herniation chest wall deformity inability to control pain conventionally (including thoracic epidural) ```
33
Management of rib fracture
Conservatively with adequate analgesia
34
Risk factors of rib fracture
``` Blunt trauma to chest wall Major trauma Osteoporosis Steriod use COPD Cancer metastases ```
35
Presentation of rib fracture
Severe sharp chest wall pain - pain more severe with deep breaths or coughing Chest wall tenderness over fracture sites Crackles / reduced breath sounds if underlying lung injury - can also cause a drop in sats
36
What is flail chest?
A serious consequence of multiple rib fractures that can occur during trauma
37
What causes flail chest?
Two or more rib fractures along 3 or more consecutive ribs, usually anteriorly
38
What can flail chest cause if left untreated?
Serious contusional lung injury
39
Treatment of flail chest
Invasive ventilation | Surgery
40
Investigations of rib fracture
CT | CXR
41
Why is a CT the best investigation for rib fracture?
Shows the fractures in 3D and also the associated soft tissue injuries
42
What may inadequate ventilation predispose to?
Chest infections
43
When should surgical fixation of a rib fracture be considered?
If pain is still an issue and failed to heal within 12 weeks conservative management
44
When does compartment syndrome occur?
Following fractures | Following reperfusion injury in vascular patients
45
What is compartment syndrome?
Raised pressure within a closed anatomical space - which eventually compromises tissue perfusion resulting in necrosis
46
Two main fractures that have compartment syndrome as a complication
Supracondylar fractures | Tibial shaft injuries
47
Presentation of compartment syndrome
``` Pain especially on movement (even passive) Paraesthesia Pallor Arterial pulsation may still be felt Paralysis of the muscle group may occur ```
48
Investigations of compartment syndrome
Measurement of intracompartmental pressure measurements - excess > 20mmHg abnormal - > 40 mmHg diagnostic
49
Treatment of compartment syndrome
Prompt and extensive fasciotomies
50
How long does death of muscle groups occur in compartment syndrome?
4 - 6 hours
51
Intra vs extra capsular hip fracture
Intra - fracture proximal to the intertrochanteric line (line between greater and lesser trochanters) Extra - fracture distal to this line
52
Treatment of intra vs extra capsular hip fractures
Intra - internal fixation (cannulated hip screw) - (good pre morbid function) - hemiarthroplasty (poor pre morbid function) - total hip replacement if displaced Extra - Dynamic hip screw
53
Presentation of scaphoid fracture
Tenderness in the anatomical snuffbox dorsally or | Tenderness in the scaphoid scaphoid tubercle volarly
54
Xray of scaphoid fractures
Occult on initial x ray | Becomes evident on repeat xrays 14 - 21 days following injury
55
Which type of fractures is compartment syndrome most associated with?
Supracondylar | Tibial shaft
56
Management for subluxation of radial head
Passive supination of elbow joint whilst elbow flexed to 90 degrees
57
Management of a trochanteric fracture
Sliding hip screw
58
Management of a sub trochanteric fracture
Intramedullary nail
59
What are the extracapsular fractures?
Trochanteric fractures | Subtrochanteric fractures
60
What is vital to be done in rib fractures?
Adequate analgesia - to ensure breathing is not affected by pain - inadequate ventilation may predispose to chest infections
61
Management of an open fracture
1. IV Ax 2. Photography 3. Application of saline soaked gauze with impermeable dressing
62
What would excessive use of breakthrough analgesia make you think of the diagnosis?
Compartment syndrome
63
When does fat embolism syndrome occur?
Between 12 and 72 hours
64
Triad of fat embolism
Resp distress Cerebral signs Petechial rash
65
What is used to classify neck of femur fractures?
Garden classification system

MSK (25 decks)

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