Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Muscluloskeletal Systems > Fractures and Dislocations 2 > Flashcards

Fractures and Dislocations 2 Flashcards

1
Q

What is the other name for open fractures?

A

“Compound fractures”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the definition of an open fracture?

A

Direct communication between fracture and external environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What two important respects differentiate closed and open fractures?

(why are open fractures seen as worse?)

A

Higher risk of infection

Higher energy injury
-In general with consequences for soft tissue and bone healing etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Give two fracture locations that sound odd but still count as open fractures?

A

Facial fractures into the nose

Pelvic fractures into the rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Is a graze on the skin that does not penetrate the dermis over a fracture class as an open fracture?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Give 4 determinants of fracture classification

A

Mechanism and velocity
Degree of soft tissue damage
Fracture configuration
Degree of contamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List the classifications for open fracture Gustilo grading

no need to give a definition of each grade

A 
Type I
Type II
Type III
-IIIA
-IIIB
-IIIC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the definition of Type I Gustilo Grading?

A

Low energy

Wound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the definition of Type II Gustilo grading?

A

Moderate soft tissue damage

Wound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the definition of Type III Gustilo grading?

not covering each division

A

High energy
Extensive soft tissue damage
Severe fracture (comminution displacement)
Wound >10cm

ANY:

  • Gunshot
  • Farm accident
  • Segmental fracture
  • Bone loss
  • Severe crush injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the definition of Type IIIA Gustilo grading?

A

Soft tissue damage +++ but not grossly contaminated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the definition of Type IIIB Gustilo grading?

A

Periosteal stripping
Extensive muscle damage
Heavy contamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the definition of Type IIIC Gustilo grading?

A

Associated neurovascular complication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Fingers and tibial shaft fractures account for what percentage of total fractures?

A

> 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What two specialities are key in managing open fractures particularly severe tibial fractures?

A

Plastic and orthopaedic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the management of open fractures

A

Full ATLS

Tetanus and antibiotics prophylaxis

Photograph, cover and stabilise limb

Surgical emergency (operation within 6hrs)

  • Early and thorough wound excision and toilet
  • DO NOT CLOSE WOUND

Repeat wound review and toilet every 24-48hrs

Early definitive skin cover (5-7 days)

Stabilise fracture definitely

? bone grafting

Fasciotomies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Give some antibiotics you can consider to give prophylactically

A

Cefuroxime
Augmentin
Clindamycin
Gentamycin at time of fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What open fracture patients should be operated on within 6hrs?

(5 marks)

A

Polytraumatised patients

Marine and farmyard environment

Gross contamination

Neurovascular compromise

Compartment syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why do you not need to rush to operate within 6 hours for all open fracture patients?

A

Outcome better if you assemble a proper team including ortho and plastics

Jumping in unprepared is not needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Give some different methods for wound closure

5 marks

A

Split skin graft

Myofasciocutaneous
-Muscle, fat and skin

Fasciocutaneous
-Fat and skin

Rotation

Free flaps
-Muscle group with skin taken and plugs hole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the 4 C’s of surgical debridement?

A

Colour

Contraction (diathermy and twitch)

Consistency

Capacity to bleed

(Tissue should be taken away until thses 4 are met)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the 4 broad criteria for the MESS score?

A

Limb ischaemia

Patient age range

Shock

Injury mechanism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the difference between dislocation and subluxation?

A

Dislocation = complete joint disruption

Subluxation = partial dislocation
-Not fully out of joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Anterior and posterior shoulder dislocations are characterised by which deformity?

A

Anterior
-Squared off

Posterior
-Locked in internal rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Elbow dislocation is characterised by which deformity?
Olecranon prominant posteriorly
26
Posterior hip dislocation is characterised by which deformity?
Leg short Flexed Internal rotation Adduction
27
Knee dislocation is characterised by which deformity?
Loss of normal contour | Extended
28
Ankle dislocation (lateral most common) is charcaterised by which deformity?
Externally rotated | Prominent medial malleolus
29
Subtalar joint dislocation (lateral most common) is characterised by what deformity?
Laterally displaced os calcis
30
Give some other names for Complex Regional Pain Syndrome Type 1
``` Reflex sympathetic dystrophy Causalgia Algodystrophy Sudeck's atrophy Post-traumatic dystrophy Shoulder Hand syndrome Reflex neurovascular dystrophy ```
31
Give 7 aetiologies of Complex regional pain syndrome type 1
Trauma (minor) Surgery Infections Repetitive motion disorders IHD, MI Specific genetic predisposition Nothing at all
32
Describe the epidemiology of CRPS Type 1 | incidence, incidence compared to type II, what do they commonly occur after, M:F, Age
Actual indicence unknown -Higher than CRPS type 2 (causalgia) 1-5% after peripheral nerve injury 15-30% after Colles' fracture Higher incidence in women Rare in children
33
What is CRPS I?
Syndrome characterised by PORT: - Pain - Oedema - Reduced ROM - Temp and colour changes Extremity Disproportionate to the inciting event Aggravated by activity
34
What are the clinical features of CRPS 1?
``` Pain Swollen +++ Skin Shiny Discoloured Hot Very Stiff Bone osteoporotic +++ (rapid) Joints osteoarthritis ++ (rapid) Muscles wasted ```
35
Describe the pain in CRPS I
Severe Constant Worse with touch/ movement Disproportionate Pain occurs as two components: - Spontaneous or continuous pain - Evoked pain = allodynia or hyperalgesia
36
Describe the two stages of CRPS type I and the differences between them
Acute: (6 months) - Cooler - Skin perfusion lower on affected side
37
What is allodynia?
Painful response to a normally innocuous stimulus
38
What is hyperalgesia?
Increased response to a painful stimulus
39
What are the general rules of treatment for CRPS I?
Early active movement +++ -Encourage normal use of limb Regular analgesia: - Minimise pain - Educate patient about therapeutic goals Frequent supervised physiotherapy
40
How successful is treatment in CRPS I? | when should it be given
Better if treated early (6 months PREVENTION
41
Describe the treatment protocol for CRPS 1
MOBILITY OF LIMB Improved pain and function with mobilisation -Conservative care ``` OPTIMISE MEDICATION Series of sympathetic blocks -Physical therapy evaluation -Sympathectomy -Trial of spinal cord stimulator -Trial of strong opioids -Psychological evaluation ```
42
What pharacological therapy can you use for CRPS 1? | 6 marks
- Traditional analgesics - Tricyclic antidepressants - Gabapentin (other anticonvulsants) - Glucocorticoids - Transdermal clonidine - Intravenous bisphosphonates
43
What is crush syndrome also called?
Traumatic rhabdomyolysis
44
What is crush syndrome? | What causes it, what does it lead to?
Crush injury to a large muscle mass (thigh, calf, etc) Direct muscle injury + Muscle ischaemia + Cell death with release of myoglobin ATN (acute tubular necrosis of kidneys) ARF (acute renal failure)
45
What are the clinical features of crush syndrome?
Dark amber urine - tests +ve for Hb - Request specific test for Mb Acute renal failure - Hypovolaemia - Metabolic acidosis - Hyperkalaemia - Hypocalcaemia - DIC
46
How do you manage crush syndrome?
IV FLUIDS +++ Early (protect kidney and prevent ARF) Fluid expansion + osmotic diuresis (to maintain high tubular volume +urine flow - aim: 100mls urine per hour until Mb cleared) Alkalisation of urine with sodium bicarbonate reduce tubular precipitation of myoglobin
47
Give some aetiologies of acute compartment syndrome
Occurs after trauma - Usually with a fracture (70%) - But can be soft tissue trauma alone Also seen in vascular reperfusion of acutely ischaemic limb Burns (circumferential eschar) Crush injuries Haemorrhage -10% on anti-coagulants or have bleeding disorder) Drug injection (plus chronic exertional)
48
What is the definition of acute compartment syndrome?
A compartment syndrome develops when intramuscular pressure is elevated sufficiently to reduce nutritional blood flow significantly to tissues within the involved compartment
49
What sites are at risk from acute compartment syndrome?
``` LOWER LEG Forearm Hand Foot Thigh ``` (NOTE: you can get a compartment syndrome anywhere where there is a compartment -> bum, abdominal wall)
50
What is the effect of acute compartment syndrome? | why can it go unnoticed?
Blood vessels compressed (lowest pressure first) and blood flow stops -Tissue (muscle) becomes ischaemic Smallest vessels = capillaries compress first Foot still pink warm and has pulse
51
Describe the two categories of patients who are at risk of acute compartment syndrome?
Trauma - Young, fit, male - 25% of adolescent tibial fractures have a compartment syndrome No trauma - Older medically unfit patients - Greater Proportion female
52
Is acute compartment syndrome more frequent in high or low energy injuries?
More common in LOW energy tibial fractures as fascial compartments more likely to be intact
53
Can ACS occur in open fractures?
Yes, compartments will often remain intact in open fractures
54
What are the 9 Ps of acute compartent syndrome?
``` PAIN Passive Dorsiflexion Parasthesiae Paresis or Paralysis Pallor Pulselessness Perishing Cold Pressure (Prompt decompression) ```
55
Describe the pain in acute compartment syndrome
Severe (disproportionate) Worsening Out-growing analgesia Deep ache, crushing/tight Made worse by -passive dorsiflexion of the digits of the limb
56
What causes parasthesiae in acute compartment syndrome?
Both direct pressure on nerve + ischaemia of nerve
57
If compartment syndrome goes untreated what can it lead to? | 4 things
Muscle ischaemia and necrosis Muscle contractures Delayed fracture healing May nessecitate limb amputation
58
How can you diagnose acute compartment syndrome?
Threshold for fasciotomy: | (persistent) Delta P
59
When is fat embolism syndrome seen?
Occurs after trauma -Always with a fracture of a long bone (usually 24-72 hrs) Also seen in instrumentation of long bone -e.g. intramedullary nailing
60
What is the difference between fat embolism and fat embolism syndrome?
Fat within the systemic circulation that produces embolic phenomena, with or without clinical sequelae When associated with an identifiable clinical pattern of symptoms and signs, it is known as Fat Embolism Syndrome (FES)
61
How common is fat embolism? How common is fat embolism syndrome?
Evidence of fat embolism (marrow fat + debris from fracture site) in 90% of patients with traumatic injury But only 3-4% of long bone fractures result in "fat embolism syndrome"
62
Give 5 risk factors for fat embolism syndrome
Long bone fractures Conservative management of long bone fractures Multiple trauma Associated abdominal injuries Severe blood loss
63
What is the mechanical theory of fat embolism syndrome?
Bone marrow enters venous circulation and lodges in the lungs, smaller particles penetrate pulmonary capillaries and enter arterial circulation
64
What is the biochemical theory of fat embolism syndrome?
Circulating fatty acids directly affect pneumocytes altering gas exchange
65
How do you diagnose fat embolism syndrome?
Clinical Blood investigations: - Hypoxia on ABGs - Fall in haemoglobin - Thrombocytopaenia - Fat droplets within blood clots CXR
66
What are the clinical features of fat embolism syndrome?
24-72 hours post insult HYPOXIA!! (PaO2
67
What is the organ most sensitive to hypoxia?
Brain
68
What is the classic triad of fat embolism syndrome?
``` Hypoxia (Pulmonary) Cerebral disfunction (Brain) Petechial rash (Cutaneous) ```
69
Describe the skin rash of fat embolism syndrome
60% Petechial Only in distribution of SVC (chest/neck/axillae/eyes/mouth) Fleeting - gone within 12-24h
70
What is the treatment for fat embolism syndrome?
No current "treatment" (i.e. cure) | ``` Only supportive -Steroids -Dextran -Heparin -Ethanol limited evidence ```
71
How do you manage fat embolism syndrome?
Aim: Maintain cerebral and pulmonary perfusion Oxygen! May require intensive gas and circulatory monitoring -> seen by ITU staff If necessary: - mechanical ventilation - advanced circulatory support
72
How do you prevent fat embolism syndrome?
Immobilisation/fixation of long bone fractures Possible role for prophylaxis with steroids? Monitoring with pulse oximetry

Muscluloskeletal Systems (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions