Fractures and dislocations Flashcards
(78 cards)
1
Q
What are the most common dislocations?
A
- Hip
- Knee
- Shoulder
2
Q
Name the two main types of shoulder dislocation
A
- Glenohumeral - usually caused by a fall on a abducted arm (often during sports)
2. Acromioclavicular- dislocation between the joint at the top of the shoulder blade (acromion) and the far end of the collar bone (clavicle)
3
Q
What specific part of the knee is usually involved in a knee dislocation?
A
- The patella
4
Q
What is the main treatment for a knee dislocation
A
- Reduction
- If dislocation becomes recurrent, surgery will be considered.
5
Q
Name 3 measures used in infection prevention and control institutions
A
- Handling, storage and disposal of clinical waste
- Containment and safe removal of spilled blood and body fluids
- Cleanliness of environment and medical equipment
- Specialised ventilation
- Sterilisation and disinfection of instruments and equipment
- Food hygiene
- Laundry management
6
Q
What are the response to infections in a hospital?
A
- Surveillance to detect alert organism
- Antibiotic chemoprophylaxis in infectious disease contacts
- Isolation
- Vector control
- Reservoir control
7
Q
What are the main transmission routes in a hospital
A
- Haematogenous
- Air
- Droplet
- Direct contact
8
Q
Name the different cells of the immune system
A
- Macrophages
- Neutrophils
- Monocytes
- Dendritic cells
9
Q
What do monocytes differentiate into?
A
Macrophages
10
Q
Where are macrophages found?
A
The liver and lungs
11
Q
What are neutrophils
A
They are granulocytes that kill pathogens by phagocytosis
12
Q
What is the cytoplasm of neutrophils packed with
A
- Granules e.g granules that contain enzymes (catalase) that generate toxic material (h2O2) or enzymes that lyse and digest pathogens (lysozyme)
13
Q
Dendritic cells
A
Cycle through the bloodstream, tissues and lymphoid organs
14
Q
What are eosinophils and basophils?
A
- eosinophils: have a similar structure, function and origin to neutrophils
- associated with allergic reactions and defence against parasites
- basophils: when they enter tissues they become mast cells that are involved in the recruitment of other inflammatory cells to sites of infections
15
Q
What is compartment syndrome?
A
- caused by a build up of fluid in the fascial compartments which results in increased pressure within the compartments
- could lead to necrosis due to ischaemia
16
Q
What is the epidemiology of compartment syndrome?
A
- most commonly seen after lower leg fractures followed by forearm fractures
- Tibial fractures account for 1-10% of all acute compartment syndrome cases
17
Q
Name some symptoms of compartment syndrome
A
- Muscles feel tight and stiff
- Tenderness in affected area
- Pain is disproportionate to their injury and gets worse by stretching the muscle
- Numbness/weakness can indicate permanent damage
18
Q
Name some investigations of compartment syndrome
A
- Physical exam of the affected area & checking for symptoms
- If compartment syndrome is suspected > measure intercompartmental pressure by inserting a needle that is attached to a pressure monitor
- Compartment syndrome = pressure of 30mmHg
19
Q
How is compartment syndrome managed?
A
- by a fasciotomy: involves making an incision in the limb and then cuts are made in the fascia to relieve pressure
- Wound is usually left open initially and if swelling doesn’t reduce > skin grafting
20
Q
Name the 5 main types of radiological scans
A
- CT scans
- MRI scans
- Ultrasounds
- X-rays
- PET scans (Nuclear Medicine Imaging)
21
Q
Name advantages and disadvantages of CT scans
A
Advantages: - lasts for a short time - faster results - painless and non - invasive Disadvantages: - Exposure to radiation - Allergic reaction due to dye can occur
22
Q
Name advantages and disadvantages of PET scans
A
Advantage: - doesn't last long - can reveal cell level metabolic changes happening in an organ or tissue Disadvantage: - Exposure to radiation
23
Q
Name advantages and disadvantages of MRI scans
A
Advantage: - painless - no x-ray exposure (can be used on pregnant women) Disadvantages: - Claustrophobia can occur - Metal cannot go into the scanner
24
Q
Name advantages and disadvantages of X-rays scans
A
Advantage: - No claustrophobia - Short duration Disadvantages: - Radiation exposure
25
Name advantages and disadvantages of ultrasound scans
Advantages:
- cheap and safe
- produces real life image
- useful for assessing tendons and joints
Disadvantages:
- deeper structures are more difficult to image with ultrasound as it cannot penetrate through the bone
- allergic reactions to latex can occur
26
Describe an MRI Scan
- Creates a detailed cross -sectional image of the part of the body and shows soft tissues.
- How does it work?
o MRI surrounds the whole body – patient is pushed into a thin tube
o It is the depiction of the anatomical distribution of protons in the body > protons are mainly located in fat and water.
27
Describe X-Rays
o Electromagnetic radiation pass through the body
o Energy is absorbed by different parts of the body at different rates and a detector on the other side of the person will see how much was absorbed and generates an image from this
o Deeper parts such as the bone show up as white > only a few x-rays could pass through
28
Describe Ultrasounds
- Demonstrates musculoskeletal soft tissues by building images from echoes of the ultrasound bean that are reflected at the tissue interfaces.
29
Describe PET scans
- Creates a 3D image of the inside of the body
- Shows how well a part of the body is working
- Usually used on patients that have cancer or dementia
30
Describe CT scans
- Creates a detailed cross – sectional image of the body using x-rays and computers
- Can be used to visualise bones, internal organs and blood vessels
- Usually used to find tumours or to see broken bones
31
Describe the common bone - cartilage tumours
1. Chondrosarcoma - mainly affects the cartilage of the femur, arm, pelvis or knee
2. Osteochondroma is an overgrowth of cartilage and bone that happens at the end of the bone near the growth plate
3. Chondroblastoma is a rare, benign, locally aggressive bone tumour that typically affects the epiphyses or apophyses of long bone
32
What are the main types of abnormal fracture healing
1. Delayed union: when a fracture takes longer to heal
2. Malunion: when the bone heals in the wrong position
3. Non- union: when a bone fails to heal
33
Define a fracture
The loss of continuity of the cortex of a bone
34
What are some causes pathological fractures
1. Tumours
- benign
- malignant
- metastasis
- primary
2. Pagets disease (affects the replacing of old bone with new bone - over time the bones become fragile and misshapen)
3. Lymphoma and Myeloma
4. Rheumatoid arthritis
5. Osteomalacia/rickets
6. Hyperthyroidism
35
What is the initial management of a fracture
1. Control any external bleeding with direct pressure
2. Administer tetanus prophylaxis and antibiotics
3. Immobilize the fractured bone e.g splint, plaster or brace
4. Give appropriate amount of analgesia - often requires intravenous opiates.
36
What is tetanus
serious disease caused by a bacterial toxin that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles
37
Give examples of definite managements of fractures
- Reduction
- Stabilization (e.g external splintage or internal by wires, plates and screws etc.)
- Rehabilitation (If fracture is stable, range of movement exercises can begin which allow mobilisation of the
38
Name some complications of fractures
- Haemorrhage
- Compartment syndrome
- Fat embolism (occurs due to fat entering the circulation and embolizing to the lungs)
- Thromboembolism (deep vein thrombosis
- Infection
- Complex regional pain syndrome
39
What is fat embolism
- occurs after long bone fractures
- occurs because long bones contain fat
- occurs due to fat entering the circulation and embolizing to the lungs
The patient presents with:
- shortness of breath
- sometimes confusion
- haemorrhage
- this condition can be very serious and causes respiratory distress syndrome
40
What is deep vein thrombosis
Clot in the blood vein
41
Name some of the most common fractures
1. Distal radial
2. Hip fractures
3. Ankle fractures
42
When do people usually get fractures (in a lifetime)
- Childhood when their bones are still growing
| - The elderly: when their bones have softened
43
How are hip fractures treated?
- most hip fractures are treated surgically as non -surgical treatments have high mortality rates
- Undisplaced intracapsular fractures have a lower chance of disrupting the blood supply so usually a these fractures are treated my fixation
- Displaced intracapsular fractures are treated with hemiarthroplasty (femoral head is removed but the acetabulum remains
44
Extracapsular fractures are ...... 1...... or ......2......and are treated with internal fixation with either a dynamic hip screw or ......3.......
1. trochanteric
2. sub trochanteric
3. intramedullary nail
45
What is a extracapsular and intracapsular fracture
Intracapsular - the fracture line is between the blood supply and the head, potentially severing the blood supply to the head which can lead to avascular necrosis and non union
Extracapsular- the head is in continuity with its blood supply and therefore the head does nor have a risk of avascular necrosis
46
What are the clinical features of ankle, radial and hip fractures
Hip: - severe pain around the hip and groin
- unable to weight bear
- shortened and externally rotated led on the affected side
- unable to raise the straight leg and tenderness on palpation
Ankle:
- pain and swelling
- unable to weight bear
-ankle deformity
- tenderness over fracture and ligament
-important to check neurological and vascular status of foot
Radial:
-glossly swollen and frequently deformed wrist
- reduced motion and wrist
- altered sensation in hand
- most common fracture is the dorsally translated and dorsally and radially angulated (also called Colles fracture)
47
What treatments are given to patients that fractured their distal radius and ankle
Radial (wrist) - immobilization for 4-6 weeks and in severe cases open reduction
Ankle: External splintage
if medially and lateral sides of the ankle involved = surgical stabilisation
48
What triggers an inflammation
- Infection
- Autoimmune disease
- Blood clots
- Tissue damage (Trauma, surgery)
49
Where are acute phase proteins found?
- Plasma
- Buffy coat
- Red cell pellet - red blood cells
50
What are acute phase reactants?
- C-reactive proteins which increase its concentration in the plasma once it reaches an area of inflammation
- A component of the complement cascade - C3
- Serum amyloid A
- Haptoglobin - arrives when blood cells have been haemolysed, captures iron
- Fibrinogen - binds to receptors on platelets
51
Acute phase reactants:
- C-reactive proteins which increase its .....(1) in the plasma once it reaches an area of inflammation
- A component of the complement cascade - .....(2)
- Serum ...... (3)...... A
- Haptoglobin - arrives when blood cells have been ......(4)..... , captures iron
- Fibrinogen - binds to receptors on platelets
1. Concentration
2. C3
3. Amyloid
4. haemolysed
52
Where do acute phase proteins come from?
- From the liver
- Protein synthesis is constantly in a state of turnover and nearly all proteins in the blood are made by the liver
- IL -1, IL – 6 and TNF- alpha stimulate the hepatocytes to produce the acute phase reactants
- As the production of acute phase proteins increases, albumin levels reduce. (Albumin is partly broken down into CRP, and to maintain osmotic pressure)
53
What are the main functions of CRP?
- binds to the Fc receptors of monocytes and neutrophils to stimulate production of cytokines
- activated complement
- works as an opsonin
54
What is the function of C3 in the process of inflammation?
- dilating arterioles
- stimulating mast cells to release histamine
- cause chemotaxis of phagocytes
- opsonisation of microbes
55
What are chemotaxins
- Chemicals that attract cells to a certain area
| - cells that release cytokines that e.g attract neutrophils with IL-8 etc.
56
What is opsonisation?
- Painting a marker of something and calling the macrophages/neutrophils to come along.
57
What is the downside of CRP?
- It is non specific but it is very sensitive
58
What does it mean have a sensitive test?
It means it is likely to pick up all the cases where there is a disease but you cannot pick up things that are not actually a disease
59
What is the erythrocyte sedimentation rate (esr)
- based on how fast the erythrocytes clump together
- non- specific sickness index
- not diagnostic for any particular disease
- increases with age due to increased serum amyloid a and anaemia
60
What is the definition of illness:
A disease of he body or mind
61
What is the definition of disease?
An illness of people, animals, plants caused by infection or failure of health rather than by accident
62
What is consent?
Consent is where an individual must give permission before they receive any type or medical test, treatment or examination
63
What are the three things that need to take place for consent to be valid?
It has to be:
1. Informed
2. Voluntary
3. They must have capacity
64
Who does the mental capacity act apply to
anyone over the age of 16, and it aims to protect and empower who may not be able to make decisions for themselves
65
What does the mental capacity act assess?
- Understand information given to them to make a particular decision.
- Retain information long enough to make a decision
- Use or weigh up that decision
- Communicate the decision.
66
How does consent work in adults in non - emergency situations
: In some cases, lack of capacity may not be permanent. In these instances where an assessment has shown that the lack of mental capacity is not long term, it is appropriate to wait until capacity is regained and to seek consent before going ahead with treatment
67
How does consent work in adults in emergency situations?
involving an adult, if the patient has capacity, consent must be obtained before treatment is provided.
If the patient lacks capacity, in an emergency situation the doctors should act in the patient’s best interest. However, there may be cases where a patient has an advanced refusal for any treatment, in these cases treatment should not be given.
68
How does consent in children work in non emergency and emergency situations
With children, the key concept is Gillick competence. Children under 16 can consent to their own treatment if they are deemed to have Gillick Competence. When this is not the case, someone with parental responsibility is able to consent for them.
In a non-emergency situation and emergency situation if a child refuses treatment and is deemed as incompetent it can be overruled by an individual with parental responsibility if the doctors decide that it’s in their best interests.
Parental responsibility refers to individual who has rights, responsibilities, duties, power and authority to make decisions for a child. (Consent: giving permission for your child to have treatment, 2020)
In essence, where consent may not be attainable or there are questions around the competence of the individual giving consent, doctors must always act in the best interests of the patient.
69
How are ankle fractures diagnosed?
By X-Rays
However you should not wait for an xray before you reduce an obvious deformed ankle
- if not fracture can be seen at the xray and there is proximal fibular tenderness and a background of an ankle injury, complete a full length tibia and fibula x-ray
70
How is a hip fracture diagnosed?
Film X-rays (AP pelvis and lateral hip views)
| - sometimes occult fractures might not show up on an X-ray so an MRI or isotope bone scan might be needed.
71
When asked to describe an x-ray always state.........(List the steps of describing an x-ray)
1. Name and age of patient and date on X-ray
2. What anatomical region is shown e.g AP X-ray of pelvis
3. Remember ABC:
A: Alignment and adequacy, is the film rotated, too light etc.
B (Bone): State which bone is fractured e.g tibia
- state where the bone fracture is (e.g metaphysis, diaphysis etc.)
- state whether the fracture is comminuted, simple or incomplete
- Fracture pattern: e.g transverse, oblique, spiral etc.
- Displacement of fracture
C: Covering soft tissues - look for air, foreign material, swelling or joint fluid
72
Describe the different types of Salter Harris fractures
1. Type One - through the growth plate only
2. Type Two - fracture travels through physis but part of metaphysis is involved
3. Type Three - epiphyseal segment separated (intra-articular fracture)
4. Type Four - fracture crosses physis and involves joint interface
5. Type Five - crush injury - difficult to diagnose initially becomes obvious later when growth arrest occurs
73
Describe a Type 1 Salter Harris fracture
through the growth plate only
74
Describe a Type 2 Salter Harris fracture
fracture travels through physis but part of metaphysis is involved
75
Describe a Type 3 Salter Harris fracture
epiphyseal segment separated (intra-articular fracture)
76
Describe a Type 4 Salter Harris fracture
fracture crosses physis and involves joint interface
77
Describe a Type 5 Salter Harris fracture
crush injury - difficult to diagnose initially becomes obvious later when growth arrest occurs
78
Why is a neck of femur fracture not as dangerous in children?
Because children have the ligamentum teres which supplies the femoral head itself. Therefore a neck of femur fracture would not cut of the blood supply to the femoral head. Whereas in adults the ligamentum teres is not present, therefore a neck of femur fracture would cut off the blood supply to the femoral head.
