Fractures Flashcards
(40 cards)
How is a foot/ankle # investigated?
Neurovascular compromise or dislocation → reduce THEN Xray
Displaced: Xray AP& Lateral then reduce
CT: Suspected ligament injury
Post-reduction Xray
How is a foot/ankle # managed?
Reduce if dislocated/displaced Back-slab cast for 4-6w Elevate limb Surgery Physio: Early mobilisation
What are the indications for surgery of a foot/ankle #
Open reduction Internal rotation Unstable # Joint incongruity Syndesmoid disruption (Weber B,C)
How are ankle (fibular) # categorised?
Weber classification:
A) Fibular # BELOW syndesmosis- intact
B) Fibular # AT LEVEL of syndesmosis
C) Fibular # ABOVE syndesmosis = rupture of syndesmosis
What is a Pott’s #?
Fracture/fracture-dislocation of distal tibia & fibular
Involves >2 elements of ankle ring
What is a Maisonneuve #?
Pronantion & external rotation injury
Spiral # of proximal fibular = disruption of syndesmosis & widened ankle joint
What is a Colle’s fracture?
Extra-articular # of distal radius
DISTAL fragment angulates DORSALLY
What is the mechanism of a Colle’s #?
Falling onto outstretched hand w/pronated forearm in dorsiflexion
Proximal row of carpal bones transfer energy to distal radius along long axis
Most # dorsally angulated & impacted
Who commonly get Colle’s?
Elderly
Frail
Osteoporosis
What are the Sx of a Colle’s?
Pain
Dinner fork deformity
Tender & swollen
How is a Colle’s investigated?
Xray
How is a Colle’s treated?
Analgesia Immobilise in Back-slab Elevate w/sling MUA Surgery: ORIF- unstable # or poor closed reduction
What are the complications of a Colle’s?
Carpal tunnel syndrome
Median nerve palsy
Reflex sympathetic dystrophy (Sudek’s atrophy)
What is a Smith’s #?
Distal fragment is impacted & tilted to angulate palm
Fall on flexed wrist
How are hip # classified?
# of proximal femur (5cm below lesser trochanter) Intracapsular: Femoral neck between edge of femoral head & inter-trochanteric line Extracapsular: a) Inter-trochanteric: Distal to insertion of capsule involving/between 2 trochanters b) Sub-trochanteric: <5cm below lesser trochanter involving proximal femoral shaft at/distal to trochanters
What are the Sx of an intracapsular NOF?
Leg shortened + externally rotated- decoupled gluteals from joint
Tenderness over hip +/- greater trochanter esp on rotation
Inability to weight bear
Signs of long lie: Dehydration, AKI, hypothermia
How is a NOF investigated?
Xray: Shenton’s lines
MRI: -ve Xray but high suspicion
CT: MRI not available in <24hours
How are intracapsular # classified?
Garden Classification:
1) Trabeculae angulated, inf cortex intact
2) Trabeculae in line, # visible, cortex undisplayed
3) Complete # line, <50% displacement/rotation of head
4) Gross/complete displacement of head
How is a NOF managed?
Intracapsular: -Undisplaced: Internal fixation -Displaced: Hemi-Arthroplasty, THR Extracapsular: -IM nail, dynamic hip screw IV Access &ECG
What are the Sx of an extra capsular #?
Pain in groin Radiates to thigh Worse on external rotation & flexion Bruising around joint Inability to weight bear Shortened limb ↓RoM
What are the complications of a NOF?
Intracapsular: Avascular necrosis
Mortality: 10% at 6w, 30% at 1yr
How do femoral shaft # occur?
High-energy injury: Fall, crush, high speed RTC
What are the types of femoral shaft #?
Transverse Spiral Comminuted (>3pieces) Open Closed
How does a femoral shaft # present?
Severe pain Tense, swollen, tender thigh Unable to weight bear Hip externally rotated + abducted + shortened Clear deformity usually
