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Fractures Flashcards

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1
Q

what are the acute complications of fractures

A

Compartment syndrome

visceral injury

Vascular Injury

Nerve Injury

Infection

Rhabdomyolysis

Bleeding

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2
Q

what is compartment syndrome

A

increased pressure in osteofascial compartment leading to ischaemia and necrosis due to a viscous cycle of increased pressure forcing fluid out of capillaries which causes increased pressure forcing out further fluid and so on

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3
Q

when does damage tend to occur in compartment syndrome

A

6 hours

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4
Q

what compartments are usually affected with compartment syndrome

A

forearm/leg flexor

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5
Q

what are the clinical features of compartment syndrome

A

worst pain ever - described as bursting

not relieved by strong opioid analgesia

still a pulse and limb is warm and red

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6
Q

how do you diagnose compartment syndrome

A

lot done clinically but if there is doubt compartment pressure can be done

> 30 over diastolic blood pressure means immediate fasciotomy is required

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7
Q

what is the management for compartment syndrome

A

Remove cast/bandage/dressing
Elevate limb
Immediate fasciotomy if high clinical suspicion or positive pressure readings
Debridement if any necrosis present
Aggressive IV fluids due to risk of myoglobinuria and AKI
Leave wound open and inspect in 2 days for potential closure

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8
Q

what suggests vascular injury in a fracture

A

6 Ps

pain
pulseless
perishingly cold
parasthesia
paralysis
pale
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9
Q

what are chronic complications of fractures

A

Infection

DVT/PE

Pressure sores

Delayed union

non-union

mal-union

avascular necrosis

joint instability

OA

complex regional pain syndrome

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10
Q

what are local risk factors for delayed union of a fracture

A

poor blood supply

infection

poor apposition of bone ends

presence of foreign bodies

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11
Q

what are systemic risk factors for delayed union of a fracture

A

poor nutritional status

smoking

corticosteroid therapy

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12
Q

what are clinical features of delayed union of a fracture

A

persisting fracture tenderness

on XR - very little callous formation, fracture line still visible

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13
Q

what’s the treatment for delayed union of a fracture

A

elimiate any local or systemic cause

immobilise bone in plaster

promote muscular exercise within the cast to encourage union

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14
Q

when is fracture non-union diagnosed

A

when the fracture hasn’t healed over 2x the time expected

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15
Q

clinical features on non-union of a fracture

A

Movement can be elicited at the site
Pain dimishes as the site gap becomes a pseudoarthritis
XR – fracture is clearly visible

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16
Q

what are the subtypes of non-union of a fracture

A

hypertrophic non-union where the fracture ends are enlarged

atrophic non union where there is no evidence of bone growth and the ends are tapered

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17
Q

how do you treat non union of a fracture

A

Conservative
Splinting
Functional bracing

Surgical
Rigid fixation +/- bone graft

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18
Q

what is mal-union of a fracture

A

bones unite in the wrong position

usually due to inadequate reduction or immobilisation

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19
Q

what are the treatments for mal-union of a fracture

A

remanipulation

osteotomy

internal fixation

limb lengthening procedures

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20
Q

what is a colles fracture

A

fracture of distal radius with dorsal displacement of the distal fracture

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21
Q

what mechanism of injury causes a colles fracture

A

FOOSH (fall on outstretched hand)

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22
Q

what patient group is most commonly associated with colles fracture

A

elderly women with osteoporosis

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23
Q

what physical change change is seen in colles fracture

A

Dorsal displacement of radius and radial impaction leading to a shortened radius compared to the ulna

Classically called a dinner fork deformity

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24
Q

whats the treatment for a colles fracture

A

initial manipulation and traction

application of a plaster to maintain traction

if good position = XR 1 + 2 weeks after to assess

if not positioned well or is a communated fracture = open reduction/internal fixation via a plate

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25
what are common complications of colles fracture
median nerve damage/post traumatic carpal tunnel syndrome
26
what is a smiths fracture
opposite of colles - FOOSH but with back of hand striking floor first distal radial fracture with volar displacement of the distal fragment
27
how do you treat a smiths fracture
generally more unstable so open reduction + internal fixation
28
what is the most commonly fractured carpal bone
scaphoid fracture
29
what mechanism of injury causes a scaphoid fracture
similar to colles - FOOSH, usually hyperextension of wrist
30
where is the pain worse in scaphoid fractures and what movements are weak
anatomical snuffbox weak pinch grip
31
how is a ?scaphoid fracture investigated
scaphoid series of x rays AP, lateral, + 2 oblique views
32
what should be done if you suspect a patient has had a scaphoid fracture but initial investigations are normal
treat as a fracture patient with repeat XRs out of plaster at 2 weeks and repeat clinical exam
33
what is the treatment of scaphoid fracture
plaster + thumb immobilisation
34
what time period is a scaphoid fracture expected to get better for
6-8 weeks
35
what are the risks of scaphoid fractures
10% non union avascular necrosis
36
what is the monteggia fracture
proximal ulnar fracture with associated dislocation of the proximal radial head (MUrderous)
37
what is the galaezzi fracture
proximal radial fracture with asociated dislocation of the proximal ulnar head
38
what is more common between the monteggia and galeazzi fracture
monteggia
39
what is a complication of monteggia and galeazzi fractures
anterior interosseus nerve injury
40
what would an anterior interosseus nerve injury cause
loss of pinch grip between thumb and forefinger due to flexor digitorum profundus and flexor pollicus longus
41
what is a barton's fracture
distal radius fracture involving the articular surface with dislocation of the radiocarpal joint
42
what is a bennets fracture
intra-articular fracture of base of thumb metacarpal
43
what would you expect to find on examination in a femoral neck fracture
hip pain on passive movements if fracture displaced: shortened, externally rotated leg
44
what arterys supply the femoral head
intramedullary vessels medial/lateral circumflex artery artery of ligamentum teres
45
what blood supply is interrupted in displaced femur fractures
circumflex blood supply intermedullary remaining artery of ligamentum teres is not enough
46
what blood supply if interrupted in non displaced femur fractures
intermedullary
47
what are the 3 subtypes of femur fractures
intracapsular intertrochanteric subtrochanteric
48
what is defined as an intracapsular fracture of the femur
NOF fractures proximal to capsular insertion of the femoral head just above intertrochanteric line
49
what is the garden criteria and what is each subheading in the criteria
criteria used when assessing intracapsular femur fractures 1 = incomplete impacted fracture 2= complete fracture across neck but not displaced 3 = complete fracture, partial dislocation with some continuity between heads 4 = complete fracture, no continuity between heads
50
how do you manage garden 1-2 intracapsular fractures of the femur
Open reduction and internal fixation | Low risk of AVN so with cannulated hip screws
51
how do you manage garden 3-4 intracapsular fracture of the femur + why is it different to garden 1-2
hemiarthoplasty if not that mobile or independent, total hip replacement if patient is mobile and competent with ADLs however in younger patients open reduction and internal fixation generally done due to better prognosis high risk of avascular necrosis
52
what is defined as an intertrochanteric fracture of the hip
fracture line is between trochanters and is therefore extracapsular
53
how do you manage intertrochanteric fractures
dynamic hip screw
54
how do you manage subtrochanteric fractures
intermedullary nail and hip screw
55
what is defined as a subtrochanteric fracture
fracture line is below the trochanters
56
what vertebral fractures are common
wedge fractures from osteoporosis otherwise mainly trauma
57
how does a vertebral wedge fracture present
marked pain - worse on movement spine kyphosis
58
what investigations should be done if you suspect osteoporitic fractures
AP + lateral x rays of spine
59
whats the treatment of osteoporotic fractures
Bed rest 1-2 weeks until pain subsides Conservative Mobilisation and muscle strengthening exercises Marked wedging (>25% anterior height reduction) then a thoraco-columnar brace for 3 months may be used Surgical Kyphoplasty Cement is injected into the collapsed vertebrae Indicated in patients with ongoing pain that is confirmed to be at the level of the fracture
60
what's a jeffersons fracture
C1 spinal fracture due to axial compression forces
61
how do you diagnose a jeffersons fracture
open mouth XR
62
whats a hangmans fracture
C2 fracture due to hyperextension of the neck
63
whats highly associated with an odontoid fracture
spinal cord injury
64
what is the most common fracture in adults
tibial
65
how do you treat tibial fractures
undisplaced/minimally undisplaced = full length cast displaced fracture = reduction under anaethesia with XR guidance before cast application limb is elevated and observed for 48 hours to assess for compartment syndrome check with XR at 2 weeks at 4 weeks change to below knees to allow weight bearing
66
what patients tend to get ankle fractures
young athletes, osteoporitic older women
67
how is a lateral ankle fracture classified
Weber classification Weber A Fracture is below the level of syndesmosis (tibulofibular joint) Syndesmosis intact Weber B Fracture at the level of the syndesmosis Syndesmosis partially intact Weber C Fracture above the level of the syndesmosis Syndesmosis non-intact
68
what is a sign of ankle instability
talar shift
69
how do you manage a Weber A ankle fracture
Generally stable and therefore rarely requires operative management 6 weeks plaster usually sufficient
70
how do you manage a Weber B ankle fracture
Trial of conservative management if only one malleoli affected Repeat XR at weeks 1,2+3 if any doubt remains about displacement More than one malleoli fractures are never stable and therefore should be treated surgically (open reduction/internal fixation)
71
How do you manage a Weber C fracture
Never stable Open reduction/internal fixation If patient is able to tolerate
72
what are the ottowa rules for scanning an ankle fracture
XR of ankle only required if the patient is unable to weight bear, has pain and bony tenderness at the lateral/medial malleoli XR of foot only required if if patient is unable to weight bear and has bony tenderness over navicular or base of 5th metatarsal
73
what are the salter harris classifications
I - Straight across the epiphyseal plate II - part of it is above III - part of it is below IV - fracture is above + below (or through) V - crush injury (erasure of the growth plate)
74
what is the general management of a closed long bone fracture
A to E resus Pain relief Imaging of whole bone, with joint above and below Manipulation and stabilisation in a cast Ensure ankle at 90 degrees dorsiflexion Reimage to check positioning Check for complications Distal neurovascular status Further management depends on the positioning post-manipulation If fracture is well reduced conservative management may be used with long term immobilisation and prolonged follow up If it has not, surgical management indicated
75
what is the general management of open long bone fractures
A-E resus Pain relief Checking of neurovascular status Assess degree of soft tissue injury IV ABx +/- tetanus prophylaxis Imaging + theatre within 6 hours for definitive management and irrigation Plastic surgery input may be required
76
what is the gustilo + anderson criteria
Gustilo + anderson criteria used 1 - Simple fracture, wound <1cm 2 – simple fracture, wound >2cm 3 – multifragmented fracture 3A: with adequate soft tissue cover 3B: requiring plastics input 3C: associated with vascular injury
77
what is the general management of every hip fracture patient
Full falls history should be done Any previous fractures/bone pain before fall Malignancy/osteoporosis How long patient was on floor ``` Bloods Coagulation G+S FBC U+E CK if long lie ``` ECG CXR AP pelvis/lateral Xray Whole femur should be imaged if a pathological fracture is suspected
78
whats the prognosis of hip fractures
10-20% of patients require a change to a more dependent residental status 10-50% die within a year of a hip fracture Mobilisation within 24 hours of treatment gives best outcomes

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