fractures Flashcards

Question

limping child

Answer 1

Compressive force in children

Answer 2

Force to one side of bone may cause break in only one cortex in children

Answer 3

In very young children, neither cortex may break

Answer 4

higher grade fractures are more likely to cause growth disturbance I. Fracture passes transversely through physis separating epiphysis from metaphysis II Transversely through physis but exits through metaphysis – Triangular fragment III. Crosses physis and exits through epiphysis at joint space IV. Extends upwards from the joint line, through the physis and out the metaphysis V. Crush injury to growth plate

Answer 5

supracondylar Weakest part of the elbow joint where humerus flattens and flares – Most are extension type (98%) - Classified by Gartland – I, IIa, IIb, III Potential for vascular compromise – Check pulse!!! Reduce fracture if pulse compromised – Check nerve function in hand

Answer 6

Gartland Classification (Extension Type): I – Undisplaced (treat conservatively) IIa – Displaced posteriorly but intact posterior periosteal hinge and anterior humeral line transects capitellum (normally treat conservatively) IIb - Displaced posteriorly but intact posterior periosteal hinge. Anterior humeral line does not transect capitellum (needs MUA +/- wires) III - Displaced posteriorly. No posterior periosteal hinge (needs MUA +/- wires)

Answer 7

Children younger than 2 years old learning to walk  No specific injury notable most of the time  Child refuses to bear weight on leg – Examine hip, thigh and knee to r/o other causes of limping  Often undisplaced spiral fracture of tibia with no fibular fracture  Initial x-ray often normal- diagnosis on f/u films with lucent line or periosteal reaction

Answer 8

Majority of fractures in child \< 1 year are from abuse Greater risk of abuse: – first-born – premature infants – stepchildren – children with learning or physical disabilities  Most common sites: femur, humerus, tibia Unexplained fractures in different stages of healing Femoral fracture in child \< 1 year  Scapular fracture in child  Epiphyseal and metaphyseal fractures of the long bones

Answer 9

Localised bony (marked) tenderness - not diffuse mild tenderness Swelling deformity Crepitus - from bone ends grating with an unstable fracture \*not all MSK injuries require X-ray to exclude fratures. Most are done on clincial judgement. Guidelibes e.g. ottawa for ankle injury exist. General rule - if a patient cannot weight bear, X-ray.

Answer 10

- open or closed - distal neurovascular status - compartment syndrome? - status of the skin and soft tissue envelope

Answer 11

- X-ray - usually AP and lateral. TWO VIEWS ALWAYS REQUIRED. - CT can be used for complex fractures and can help determine the degree of articular damage and help surgical planning for complex intra-articular fractures - MRI can be used for occult fractures where there is clinical suspicion but normal X-ray - Technetium bone scans can be useful to detect stress fractures (e.g. hip, femur, tibia, fibula, 2nd metatarsal) as these fail to show up on x-ray until hard callus begins to form

Answer 12

Assessment & analgesia splintage/immobilization of the limb (temporary plaster slab, sling, orthosis, thomas splint if femoral shaft) investigations If fracture is grossly displaced, if there is obvious dislocation, if there is risk of skin damage from excessive pressure, reduction of the fracture shoul dbe perfoemed before waiting for x-rays. xray post reduction should still demonstrate ay fracture adequately.

Answer 13

non-operatively with a period of splintage or immobilization and then rehabilitation

Answer 14

require reduction under anesthetic. They may perform closed reduction and cast application with serial X-rays to ensure no loss of position.

Answer 15

surgical stabilisation which mau involve the use of small percutaneous pins (K-wires) for small fragments, cerclage wires, screws, plates & screws, intramedullary nails or external fixation

Answer 16

open reduction and internal fixation (ORIF) using plates and screws with the aim of anatomic reduction and rigid fixation leading to primary bone healing It may be preferable to avoid ORIF particularly where the soft tissues are too swollen, where the blood supply to the fracture site is tenuous (high energy), where ORIF may cause extensive blood loss (eg femoral shaft) or plate fixation may be prominent (eg tibia). In this case closed reduction and indirect internal fixation with an intramedullary nail with dissection distant to the fracture site may be used with the aim of a functional reduction and stable fixation allowing micromotion required for secondary bone healing. Another alternative for extra‐articular diaphyseal fractures is external fixation which again aims for secondary bone healing however carries the risk of pin site infection and loosening.

Answer 17

anatomic reductoin and rigid fixation by ORIF using wires, screws and plates. Fractures involving a joint with predictable poor outcome may be treated with joint replacement or arthodesis

Answer 18

Early local: compartment syndrome, vascular injury with ischaemia, nerve compression or injury, and skin necrosis Early systemic: hypovolaemia, fat embolism, shock, ARDS, acute renal failure, SIRS, multi-organ dysfunction syndrome, death Late local: stiffnessm loss of function, chronic regional pain syndrome, infection, non-union, malunion, Volkmann's ischaemic contacture, post traumatic Oa and DVT late systemic: PE (tends to be several days to weeks but can occur much sooner)

Answer 19

ABx prompt surgery - debridement + internal or external fixation (list 3 reasons why) May just need closed primarily if not contamined and skin and muscle is viable and can be closed without tension (resulting in skin necrosis and wound breakdown)

Answer 20

Any dislocation should be reduced as soon as possible. Most dislocations can be reduced by closed manipulation under sedation and analgesia or occasionally general or regional anaesthetic. Delayed presentation of a dislocation (eg in alcoholics) increases the risk of requiring an open reduction and recurrent insatbility. Dislocations may occur after significant trauma however people with hypermobility (including Ehlers Danlos and Marfan’s) may sustain a dislocation with a seemingly innocuous injury and some can voluntarily dislocate joints (eg shoulder). Dislocations can occur with associated injuries including tendon tears, nerve injury, vascular injury and compartment syndrome. Recurrent dislocation may require soft tissue repair / reconstruction or occasionally bony surgical prcedures. Fractures can occur with dislocations (known as fracture‐dislocation) and these may reduce with closed reduction however ORIF may be required if reduction cannot be achieved, if a bony fragment prevents congruent reduction or if the joint is very unstable.

Answer 21

Complete spinal cord injury results in no sensory or voluntary motor function below the level of the injury (reflexes should return). The level of the injury is determined by the most distal spinal level with partial function (after spinal shock has resolved) as determined by the presence of dermatomal sensation and myotomal skeletal muscle voluntary contraction. The prognosis for recovery from complete cord injuries is poor.

Answer 22

With incomplete spinal injuries, some neurologic function (sensory and/or motor) is present distal to the level of injury. In general, the greater the function present,the faster the recovery is and the better the prognosis. Sacral sparing with preservation of perianal sensation, voluntary anal sphincter contraction and big toe flexion(FHL muscle, S1/2) indicates some continuity of the corticospinal (motor) and spinothalamic (course touch, pain, temperature) tracts. The presence of sacral sparingindicates an incomplete cord injury with a better prognosis than a complete injury.

fractures Flashcards

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