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MBChB IV Orthopaedics > Fractures (toronto) > Flashcards

Fractures (toronto) Flashcards

(57 cards)

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1
Q

How do you describe a fracture?

A
  1. Name of injured bone
  2. Integrity of skin/soft tissue
  3. Location
  4. Orientation/fracture pattern
  5. Alignment of fracture fragments
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2
Q

Name fracture locations

A

Epiphyseal (end of bone)
Metaphyseal (flared end)
Diaphyseal (shaft)
Physis (growth plate)

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3
Q

Name fracture patterns

A 
Transverse
Oblique
Butterfly
Segmental
Spiral
Comminuted
Intra-articular
Compression
Torus
Greenstick
Pathological
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4
Q

Define a transverse fracture

A

Fracture line perpendicular (<30 of angulation) to long axis of bone due to direct high energy force

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5
Q

Define an oblique fracture

A

Angular fracture (30-60) line due to angulation and high energy compressive force

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6
Q

Define a butterfly fracture

A

Triangular/wedge-shaped fragment commonly between two main fracture fragments in comminuted long bone fractures

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7
Q

Define a segmental fracture

A

A separate segment of bone bordered by fracture lines

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8
Q

Define a spiral fracture

A

Complex, multi-planar fracture line due to low energy rotational force

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9
Q

Define a comminuted fracture

A

> 2 fracture fragments

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10
Q

Define an intra-articular fracture

A

Fracture line crosses articular cartilage and enters joint

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11
Q

Define a compression fracture

A

Impaction of bone

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12
Q

Name typical sites of compression fractures

A

Vertebrae

Proximal tibia

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13
Q

Define a torus fracture

A

Compression of bony cortex on one side while the other remains intact

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14
Q

Define a greenstick fracture

A

Compression of one side with fracture of the opposite cortex

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15
Q

Name alignments of fracture fragments

A 
Non-displaced
Displaced
Distracted
Translated
Angulated
Rotated
Shortened
Avulsion
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16
Q

What is the rule of 2s with orthopedic XR?

A

2 sides
2 views
2 joints
2 times

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17
Q

Name advantages to closed reduction and splinting

A 
Pain control
Reduces further neurovascular damage
Reduces point loading on articular surfaces
Decreased risk of converting to open 
Facilitates patient transport
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18
Q

Give the mnemonic for indications for open reduction

A 
NO CAST
Non-union
Open 
Neurovascular compromise
Displaced intra-articular 
Salter-harris 3,4, 5
Polytrauma
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19
Q

What is Buck’s skin traction?

A

A system of weights, pulleys and ropes attached to end of patient’s bed exerting longitudinal force on distal end of the fracture
Improves length, alignment and rotation temporarily while awaiting fixation

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20
Q

Describe your approach to fractures

A
  1. Clinical assessment
  2. Analgesia
  3. Imaging
  4. Reduction
    - recheck NVS
    - post-reduction XR
  5. Immobilization
  6. Follow-up
  7. Rehabilitation
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21
Q

What are methods of external stabilization?

A

Splints
Casts
Traction
External fixator

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22
Q

What are methods of internal stabilization?

A 
Percutaneous pinning
Extramedullary fixation (screws, plates, wires)
Intramedullary fixation (rods)
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23
Q

What is Wolff’s Law?

Study These Flashcards
A

Bone adapts to the amount of force applied by increasing or decreasing its mass to resist the applied stress

24
Q

Describe normal healing of bone

Study These Flashcards
A
  1. 0-3w
    - hematoma
    - macrophages surround fracture site
  2. 3-6w
    - osteoclasts remove sharp edges
    - callus forms within hematoma
  3. 6-12w
    - bone forms within the the callus to bind fragments
  4. 6-12m
    - cortical gap bridged by bone
  5. 1-2y
    - normal architecture via remodelling
25
What is a fracture blister?
Formation of vesicles/bullae that occur on edematous skin overlying a fractured bone
26
What is heterotopic ossification?
The formation of bone in abnormal sites secondary to pathology
27
What is CRPS?
Complex regional pain syndrome Exaggerated response to an insult in the extremities characterised by symptoms of hyperalgesia and allodynia with signs of autonomic dysfunction (temperature assymetry, mottling, hair/nail changes)
28
What was CRPS originally called?
RSD (reflex sympathetic dystrophy)
29
How do you evaluate union?
``` Clinically - non-tender to palpation XR - trabeculae cross fracture site - visible callus bridging site on >2/4 cortices ```
30
Name early local complications of fractures
``` Compartment syndrome Neurological injury Vascular injury Infection Implant failure Fracture blisters ```
31
Name late local complications of fractures
``` Malunion Non-union AVN Osteomyelitis Heterotopic ossification Post-traumatic OA Joint stiffness CRPS ```
32
Name systemic complications of fractures
``` Sepsis DVT PE ARDS Hemorrhagic shock ```
33
Define avascular necrosis
Ischemic of bone due to disrupted blood supply
34
Which sites are most commonly affected by avascular necrosis?
Femoral head Talus Proximal scaphoid
35
What is osteochondritis dissecans?
Avascular necrosis of subchondral bone usually in children/adolescent and causing pain and decreased ROM
36
What are the properties of articular cartilage?
``` Hyaline cartilage 2-4mm layer Avascular Aneural Alymphatic ```
37
Name causes of articular cartilage defects
Overt trauma Repetitive minor trauma Degenerative conditions
38
Name predisposing factors to articular cartilage defects
``` Ligament injury Joint malalignment Obesity Avascular necrosis Inflammatory arthropathy ```
39
How are chondral defects classified?
Outerbridge classification
40
Discuss the Outerbridge Classification of Chondral Defects
Grade 1 - softening and swelling of cartilage Grade 2 - fragmentation and fissuring <1.3cm in diameter Grade 3 - fragmentation and fissuring >1.3cm in diameter Grade 4 - erosion of cartilage down to bone
41
What is the treatment of articular cartilage defects?
``` Individualised Non-operative - rest - NSAIDs - bracing - PT Operative ```
42
Name XR views that should be requested in shoulder injuries
AP Axillary w/wo stress Trans-scapular Zanca
43
Name XR views requested in arm injuries
AP | Lateral
44
Name XR views requested in forearm injuries
AP | Lateral
45
Name XR views requested in wrist injuries
AP Lateral Clenched fist
46
Name XR views requested in pelvis injuries
AP Inlet Outlet Judet
47
Name XR views requested in hip injuries
AP Lateral Frog-leg lateral Dunn
48
Name XR views requested in knee injuries
AP Lateral Skyline
49
Name XR views requested in leg injuries
AP | Lateral
50
Name XR views requested in ankle injuries
AP Lateral Mortise
51
What is a Judet view?
For acetabular fractureres Obturator oblique Iliac oblique
52
What is a clench fist view for?
Scapholunate dissociation
53
What is a Skyline view?
Tangential view with knees flexed at 45 to see patellofemoral joint
54
What is a Mortise view?
Ankle at 15 degrees internal rotation
55
Name XR views requested in foot injuries
AP Lateral Oblique Lateral Harris axial
56
Name XR views requested in spinal injuries
``` AP spine AP odontoid Lateral Oblique Swimmer's Lateral flexion Lateral extension ```
57
What is a Swimmer's view?
Lateral view with arm abducted 180 degrees to evaluate C7-T1 junction

MBChB IV Orthopaedics (15 decks)

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