Fractures and Dislocations Flashcards
(115 cards)
1
Q
2 ways for fractures to heal
A
Primary bone healing
Secondary bone healing
2
Q
what are features of secondary bone healing
A
fracture gap fills with granulation tissue then cartilage (soft callus) then bone (enchondral ossification, hard callus)
this is used for most cases
3
Q
worries of comminuted breaks
A
high energy usually so watch soft tissue and for compartment syndrome
also left with poor quality bone
4
Q
what are peri articular fractures
A
fractures that occur in or immediately adjacent to a joint
5
Q
if is a high energy break or there is substantial soft tissue swelling what should be avoided
A
ORIF
6
Q
what are intra articular fractures
A
fractures which the break crosses into the surface of a joint. They always result in some degree of cartilage damage
7
Q
how should displaced intra-articular fractures be treated
A
anatomic reduction
rigid internal fixation
prevents post OA
8
Q
what are risks with peri-articular fractures and how can then be treated to avoid this
A
non-union or AVN
Tx – joint replacement
9
Q
Tx for open fractures
A
Antibiotics - normally co-amoxiclav
Tetanus
Early debridement
Operative stabilisation
10
Q
Tx for compartment syndrome
A
Fasciotomy
Operative stabilisation
11
Q
Tx for vascular injury
A
reduction, stabilisation and then reassess circulation
may need revascularisation procedure
12
Q
Tx for nerve injury
A
Open #»_space; explore
Closed #»_space; reduce fracture, hold, recheck and observe
13
Q
extra-articular distal femur fractures Tx
A
Unstable - pull of muscles causes flexion at #
Thomas splint
Can nail/plate it
14
Q
intra-articular distal femur fractures Tx
A
anatomical reduction, rigid fixation
plate and screws
15
Q
what are extra-articular #
A
fractures that do not involve the joint surface
16
Q
Mx of proximal tibial fractures
A
anatomical reduction
rigid fixation
17
Q
what Ix can be used after x-ray if more info is needed
A
CT scan
18
Q
what is the slowest healing fracture in the body
A
tibial shaft #
16 weeks to union
> 1 year non-union
19
Q
what is poor tolerated in tibial shaft #
A
internal rotation
20
Q
what is an intra-articular distal tibial # called
A
pilon #
fracture of the distal part of the tibia, involving its articular surface at the ankle joint
21
Q
what type of proximal humerus # risk AVN and non-union
A
comminuted #
22
Q
what can be considered in proximal humerus # for head splitting #
A
arthroplasty
will provide pain relief but ROM poor
23
Q
what is at risk in humeral shaft #
A
radial nerve injury
24
Q
when is internal fixation used in humeral shaft #
A
non-union pathological # poly-truama open # high energy
25
intra-articular distal humerus # Tx
ORIF
26
what is responsible for supination/pronation at the elbow
radial head
27
radial head fracture - what is can occur with and treatment
can occur with dislocated elbow
minimally displaced >> treated conservatively
comminuted >> excise +/- replacement
28
what sign seen on an x-ray in radial head fractures
fat pad sign
29
Radius fractured in isolation, suspect a dislocation of the distal RU joint
Galeazzi fracture dislocation
30
Ulna fractured in insolation, suspect a dislocation of the radial head
Monteggia fracture dislocation
31
Tx for Galeazzi/Monteggia
ORIF fractured bone
| then dislocation should be reduced
32
what is nightstick fracture
direct blow to ulna causing isolated ulna fracture
33
Colles fracture
FOOSH
extra-articular # of distal radius
dorsal angulation
dorsal displacement
34
Tx for Colles fracture
Stable, minimally displaced / angulated POP
Displaced simple # MUA
Displaced, comminution MUA & K-wiring, ORIF
35
complications of colles fracture
median nerve compression
EPL rupture
CRPS - Complex regional pain syndrome
loss grip strength
36
appearance of Colles fracture on x-ray
dinner fork deformity
37
fall onto back of hand
| extra-articular, volar displacement and angulation
Smiths #
38
Barton #
Intra-articular, Volar or dorsal rim # of the distal radius >> subluxation carpus
39
what are early local complications of fractures
- compartment syndrome
- vascular injury w/ distal ischaemia
- nerve injury
- skin necrosis
40
3 types of nerve injury
1st degree - Neurapraxia
2nd degree - Axonotmesis
3rd degree - Neurotmesis
41
features of neurapraxia
Temporary conduction block / demyelination
| Should resolve within 28 days
42
features of axonotmesis
Nerve cell axon dies distally from point of injury = Wallerian degeneration
Structure of nerve (endoneurial tubes) intact
Regenerates at 1mm per day
43
what is Wallerian degeneration
when Nerve cell axon dies distally from point of injury
44
features of neurotmesis
Nerve transected – rare with # or dislocation
| No recovery without surgery
45
what are indications for exploration of nerve injury
open fracture
penetrating injury
neuralgic pain >> ongoing compression
46
if no function returns, what can be done for nerve injury
NCS - provides info on recovery potential and prognosis
Nerve grafting
Tendon transfers
47
what are early systemic complications of fractures
```
Hypovolaemia
Fat embolism
Acute Respiratory Distress Syndrome
Systemic Inflammatory Response Syndrome
Multi-Organ Dysfunction Syndrome
```
48
late local complications of fracture
```
stiffness, loss of function
post-trumatic OA
Non union - atrophic/hypertrophic
Malunion
CRPS
AVN
DVT
Osteomyelitis
Volkmann's ischaemic contracture
```
49
what does malunion cause
pain
stiffness
loss of function
deformity
50
what fractures get x-rays to confirm union
diaphyseal fractures of major long bones
51
signs of fracture healing
pain improved
no tenderness
no movement at fracture site
no swelling or oedema
52
what causes atrophic non-union
```
Poor blood supply to fracture site
Fracture gap too big and no movement
Systemic disease
Smoking
Medicines – steroids, NSAIDs, bisphosphonates
```
53
what is difference between atrophic and hypertrophic non-union
atrophic - no callus formed
| hypertrophic - callus formed
54
causes of hypertrophic non-union
too much movement at fracture site
| Abundant callus response but failure union
55
what can cause both type of non-union
infection
56
what is volkmann's ischaemic contracture
permanent shortening of forearm flexor muscles
causes clawlike deformity of the hand, fingers, and wrist.
more common in children
57
causes of volkmann's ischaemic contracture
ischemia to the forearm
| occurs when there is increased pressure due to swelling i.e. compartment syndrome
58
signs/symptoms of volkmann's ischaemic contracture
5 P's
```
Pain (earliest manifestation), especially accentuated by passive stretching
Pallor
Pulselessness
Paresthesias
Paralysis
```
59
what is CRPS and Tx
exaggerated pain response after injury
Tx - pain specialists
60
definition of allodynia
experience of pain from non-painful stimuli
61
late systemic complications of fractures
pulmonary embolus
62
what is the blood supply to femoral head
Intramedullary artery of shaft of femur
Medial & lateral circumflex branches of profunda femoris
Artery of ligamentum teres
63
Hx of proximal femoral fractures
fall
pain
unable to weight bear
64
Signs of proximal femoral fracture
shortening
| external rotation
65
why do children's bones bend before they will snap
periosteum is much thicker
66
what is Wolfs law
Bone in a healthy person or animal will adapt to the loads under which it is placed
67
what is Heuter-Volkmann principle
Compression forces inhibit growth and tensile forces stimulate growth
68
features of Hx indicative of NAI
MOI/Hx does not match nature or severity of injury
Inconsistency in Hx
Delay in seeking help
69
NAI features
Any obvious or suspected fractures in a child under
70
what are the 3 movements that can be done to test nerve supply in the hand
Thumbs up - Radial
Starfish - Ulnar
Ok sign - Median
71
principles of fracture management
Reduce
Retain
Rehabilitate
72
most commonly used treatment in kids
plaster of paris
73
Tx for diaphyseal fracture in kids
immobilize joint above and below to prevent rotation
74
Tx for metaphyseal fractures in kids
rotation not an issue immobilise adjacent joint
75
internal fixation used in kids
less invasive and rigid than in adults
| e.g. Percutaneous K wires, cannulated screws
76
what is used for long bone fixation
flexible nails
| used for femur
77
adv and disadv for flexible nails
ADV
Predictable position rapid healing
Early joint mobilisation and weight bearing
DISADV
Infection risk
Risk of anaesthesia
78
when is fixation usually indicated
Displaced Intra articular fractures
Displaced growth plate injuries
Open fractures
Multiple injuries
79
when is external fixation indicated
Contaminated wounds
Acute vascular injury
Burns
Multiple injuries
80
is dislocations, what must be examined and documented
vascular supply
neurology
so can determine if intervention has helped
81
most common shoulder dislocation
anterior
| humeral head anterior to the glenoid
82
MOI of anterior shoulder dislocation
fall with shoulder with external rotation
83
what is at risk in anterior shoulder dislocations
axillary nerve
84
MOI of posterior shoulder dislocation (humeral head posterior to glenoid)
Fall with shoulder in internal rotation
| Direct blow to anterior shoulder
85
what do people with inferior shoulder dislocations look like
arm held in abduction i.e. above their head
86
what needs to be checked in inferior shoulder dislocations
brachial plexus
| brachial artery
87
x-ray sign of posterior dislocation
light bulb sign
88
Mx of shoulder dislocations
closed reduction under sedation
for locked posterior dislocation - open reduction
chronic - stabilisation and rehabilitation
89
what are some reduction methods for shoulder dislocations
Hippocratic, Kocher’s, in-line traction
90
what does the recurrent instability risk depend on
Related to age,
| risk of recurrence decreases with age
91
MOI for elbow dislocation
fall onto outstretched hand
92
what is at risk in elbow dislocations
Radial head #
| Coronoid process #
93
what is the types of elbow dislocation and what is most common
Posterior (most common)
Anterior
Medial/Lateral
94
special type of dislocation seen in children
Pulled elbow
| lax annular ligament around radial head, radial head has escaped
95
Mx of elbow dislocation
Closed reduction under sedation
Open reduction rarely required
2 weeks in sling & rehabilitation
96
traction methods in elbow dislocation and risk of recurrent instability
Traction in extension +/- pressure over olecranon
| Low
97
MOI of IPJs dislocation
hyperextension injury; direct axial blow
| always posterior
98
possible complications of IPJs dislocations
Head of phalanx button-holes through volar plate
| Recurrent instability due to associated fracture
99
Mx of IPJs dislocations
closed reduction under digital or metacarpal block
2 weeks in neighbour strapping
volar slab in Edinburgh position if unstable
100
MOI of patella dislocations
sudden quads contraction with a flexing knee
always lateral
most common in teens, F > M
101
what is patella dislocations associated with
hypermobility
under developed lateral femoral condyle
increased Q angle (genu vaglum or increased femoral neck ante version)
Weak vastus medialis
102
what is torn in patella dislocations
medial retinaculum
| causes pain
103
what is seen on examination of a patella dislocation
effusion - haemarthrosis
| patella apprehension test is positive
104
Mx of patella dislocation
reduce with knee extensions
aspirate - large effusions of the knee are very uncomfortable
brace
physio
105
Mx of repeat patella dislocations
lateral release/medial reefing
| patella tendon realignment
106
what are the signs suggestive of a spontaneous relocation of a dislocated knee
Lat collateral lig injury + peroneal nerve injury
107
what can be injured in a knee dislocation
popliteal artery/vein
| peroneal nerve
108
Mx of knee dislocation
Reduction under sedation
| Stabilise in splint or External-Fixation
109
Ix of knee dislocation
plain radiography - associated #
| MRI
110
Surgical treatment for the knee
Vascular repair (6hr window)
Nerve repair
Sequential ligamentous repair
111
complications of knee dislocation
Arthrofibrosis (excessive scar tissue, painful restriction of joint movement) and stiffness
Ligament laxity
Nerve or arterial injury
112
Hip dislocation associated #
posterior
posterior acetabular wall #
femoral #
113
presentation of hip dislocation
flexed, internally rotated and adducted knee
114
Mx of Hip dislocation
```
Neurovascular assessment (particularly the Sciaitic nerve)
Radiographs (changes can be subtle)
Urgent reduction
Stabilise in tractions if required
Further imaging (CT)
```
115
complications of hip dislocation
Sciatic nerve palsy
Avascular necrosis of the femoral head
Secondary osteoarthritis of hip
Myositis ossificans
