Fractures & Dislocations Flashcards by Eilidh Gilchrist

what are the possible early local complications of fractures?

compartment syndrome
vascular injury with distal ischaemia
nerve injury
skin necrosis

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what is 1st degree nerve injury

neurapraxia, temporary conduction block / demyelination

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what is 2nd degree nerve injury

axonotmesis, nerve cell axon dies distally from point of injury (= Wallerian degeneration)

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what is 3rd degree nerve injury

neurotmesis, nerve transected

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what are the possible early systemic complications of fractures?

Hypovolaemia
 Fat embolism
 Acute Respiratory Distress Syndrome
 Systemic Inflammatory Response Syndrome
 Multi-Organ Dysfunction Syndrome

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what are the possible late local complications?

Stiffness, loss of function, “fracture disease”
Post-traumatic arthritis
Non-union: Atrophic non union or Hypertrophic non-union
Malunion
Volkmann’s ischaemic contracture
Chronic Regional Pain Syndrome
Osteomyelitis
Avascular necrosis
DVT

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malunion

fracture has healed in a non-atnatomic position sufficient to cause symptoms

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atrophic non-union causes

Poor blood supply to fracture site
Fracture gap too big &amp; no movement
Systemic disease
Smoking
Medicines – steroids, NSAIDs, bisphosphonates

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hypertrophic non-union causes

Too much movement at fracture site
Abundant callus response but failure union
Infection

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what are the possible late systemic complications of a fracture?

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femoral shaft fracture

high energy
lots of blood loss
other injuries

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what’s the management of a femoral shaft fracture?

Resuscitation
Analgesia – femoral nerve block
Splintage – Thomas splint

Unstable  IM Nailing

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what’s the management of an extra-articular distal femur fracture?

Unstable - pull of muscles causes flexion at fracture
Can use Thomas splint
If not too distal can nail
Distal plating

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what’s the management of an intra-articular distal femur fracture?

Anatomical reduction, rigid fixation

Plate & screws

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proximal tibial fractures

high energy in young, low energy in old

- usually values stress

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tibial shaft fracture

higher risk of compartment syndrome

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management of compartment syndrome

urgent, surgical emergency

FASCIOTOMY

distal tibial fracture

high energy
associated injuries spine, pelvic, calcaneus
soft tissue injury
surgical emergency

intra-articular distal tibial fracture

pilon fracture

proximal humerus fracture

elderly osteoporotic
nerve & vascular injuries
AVN & non-union risks

humeral shaft fracture

radial nerve injury in spiral groove

intra-articular distal humerus fracture treatment

ORIF

geleazzi fracture dislocation

If the radius is fractured in isolation, suspect a dislocation of the ulna at the DRUJ

monteggia fracture dislocation

If the ulna is fractured in isolation, suspect a dislocation of the radial head at the elbow

Colles fracture

- fall onto outstretched hand | - extra-articular #, dorsal angulation, dorsal displacement

Smiths fracture

- fall onto back of hand - extra-articular, volar displacement & angulation - ORIF

Barton fracture

- intra-articular, volar/dorsal rim fracture on lateral can lead to subluxation carpus - ORIF

blood supply to femoral head

- intramedullary artery of shaft of femur - medial & lateral circumflex branches of profunda femurs - artery of ligamentum teres

what blood vessels does an intracapsular fracture of the proximal femur affect?

all but ligamentum teres

what would a fall with should in external rotation do to the joint?

humeral head move anterior to the glenoid | - badge area sensory assessment to check axillary nerve

what would a fall with should in internal rotation or a direct blow to anterior shoulder do to the joint?

humeral head move posterior to the glenoid

what would the arm being held in abduction do to the joint?

humeral head move inferior to the glenoid | - promp neurovascular assessment & reduction

what's the commonest mechanism of injury causing elbow dislocation?

fall onto outstretched hand

what's the commonest mechanism of injury causing IPJ dislocation?

hyperextension injury or direct axial blow

what direction is an IPJ dislocation normally in?

posterior

what's the commonest mechanism of injury causing patella dislocation?

sudden quads contraction with a flying knee

what direction is a patella dislocation normally in?

lateral

lateral collateral ligament injury + peroneal nerve injury

knee dislocation

what's the commonest mechanism of injury causing hip dislocation?

high velocity: RTA dashboard injury, fall from height

what direction is a hip dislocation normally in?

posterior