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Orthopedics > Lecture 1 - general principles of fractures > Flashcards

Lecture 1 - general principles of fractures Flashcards

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1
Q

explain the foundational cause for bone fractures?

A

occurs when the force of impact exceeds the mechanical resistance of a bony structure

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2
Q

what are the two general type of causes of bone fractures ?

A

Direct trauma - the force hits the bone directly at the point of trauma
and
indirect trauma - the force hits away from the point of trauma

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3
Q

what are the 4 types of forces that causes indirect bone fractures ?

A
  1. Torsion (twisting) - rotational force, spiral fracture
  2. bending (flexion) - transver or wedge fractures
  3. compression - bone are crushed by opposing forces
  4. traction/avulsion - violent pulling of ligament or tendon
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4
Q

what is the classifciation accoding to the skin involved in fractures ?

A

open
closed

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5
Q

explain the 4 types of bone fractures, we can observe on X ray and the relation/positon of the bone fracture

A
  1. Angulation
  2. rotation
  3. overlapping
    translation - side way shifting
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6
Q

what are the classifcaitons of bone fractures according to the location of thee bone ?

A
  1. diaphysis
  2. metaphysis
  3. epiphysis
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7
Q

explain the simple classification of the actual fractures on the site of trauma ?

A
  1. transverse
  2. Oblique
  3. spiral
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8
Q

explain the complex classificsation of the acutal fractues on the site of trauma ?

A
  1. 3rd fragment - wedge fragment
  2. comminuted - more than 3 fractures
  3. segmental
  4. burst, irregular
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9
Q

explain the mechanical force requried to break bones in bone pathology

A

In bone pathology the fractures requires minimal force, since the bone is weak compared to nonpathological bones

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10
Q

what bone pathologies cause fragile bones?

A

ecrease in resistance in metabolic diseases (Paget)
Periosteal dysplasia Lobstein
Primary/secondary malignancies
Neuropathies - polio
Senile osteoporosis
Infections - osteitis

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11
Q

what are the 3 types of cancers that can cause bone consolidation?

A

breast cancer
prostate cancer
Kahler disease (multiple myeloma)

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12
Q

what are the treatment for fractures in bone pathologies ?

A

Osteosynthesis
Conventional palliative cement, mega prosthesis
Prevention = risk of fracture

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13
Q

what type of cancers do not cause bone consolidations ?

A

Lung
Kidney
Digestive

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14
Q

what parts of the bone MUST be included in image diagnostics ?

A

entire segment of interst + the joints inferior and posterior to the fracture
comparative image of the bilateral limb

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15
Q

explain the typical clinical setting for bone fractures

A

pain
swelling
deformities
loss of function
crepitation
ecchymosis

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16
Q

what are the position of the bone in radioligcal imageing ?

A

anteroposterior postion
lateral position

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17
Q

what can CT tell us ?

A

details about smaller fractures

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18
Q

waht are the indications of CT ?

A

spine
acetabulum
calcaneus
tibial plateau

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19
Q

explain Doppler US and why is it used in the diagnosis of bone fractures ?

Study These Flashcards
A

it is used to diagnose damage to blood vessels, in case of compressed vessel at the site of injury

20
Q

what are the 3 ways in which neurovascular injuries can occur ?

Study These Flashcards
A
  1. contusion
  2. elongation
  3. compression
21
Q

explain the immidate complications of fractures

Study These Flashcards
A

neuro-vascular lesions
intimal lesions - thrombosis

22
Q

explain Seddons classifications of nerve damage

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A

Neuropraxia - mild damage, recoverable (days or weeks)
Axontomesis - damgae to axons, recoverable (weeks, months)
neruotmesis - complete nerve severance including the sheath, requires surgical treatment

23
Q

what other local complications may occur ?

Study These Flashcards
A
  1. skin distruption
  2. visicral diruption
  3. infections
24
Q

sign of propability

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A
  • Local pain
  • Swelling
  • Inability to walk
  • Deformities
  • Late ecchimosis (Hennequin)
    Crepitation
25
sign of certinity
* Loss of bone continuity * Abnormal mobility * Lack of motion transmission Crepitation
26
what other general complications may occur ?
1. fat empolisim 2. hypovolmeic/traumatic shock
27
what is the definiton of compartment syndrome ?
Compartment syndrome is a condition where increased pressure within a closed muscle compartment compromises circulation and tissue function within that space. Can lead to ischemia → necrosis → permanent dysfunction if not treated promptly.
28
explain the pathophysiology of compartment syndrome
Normal compartment pressure: 0–10 mmHg Critical threshold: usually >30 mmHg, or ΔP < 30 mmHg (ΔP = diastolic BP – compartment pressure) Increased intracompartmental pressure → ↓ capillary perfusion → muscle and nerve ischemia.
29
what are the etiologies causing compartment syndrome ?
Fractures (most common) — esp. tibial shaft fractures Crush injuries Burns Tight casts or dressings Reperfusion injury Prolonged limb compression (e.g. during surgery or unconscious state) Vigorous exercise (rare) — exertional compartment syndrome
30
how is compartment syndrome diagnosed ?
Primarily clinical. Confirmatory: measure compartment pressure (Stryker device). ○ Absolute pressure >30 mmHg ΔP (diastolic – compartment) < 30 mmHg
31
what is the investigative methods for compartment syndrome ?
Mainly used to rule out other causes. Labs: CK, myoglobin if suspect rhabdomyolysis. Imaging: rarely helpful, but can assess fractures or soft tissue injury. angiography doppler US
32
treatment of compartment syndrome ?
Emergent fasciotomy — definitive treatment. Remove constrictive dressings immediately. Supportive care: fluids (prevent AKI if rhabdo present).
33
complications of compartment syndrome ?
Muscle necrosis → contractures Nerve injury → permanent weakness or sensory loss Volkmann contracture (esp. forearm) Renal failure from rhabdomyolysis
34
plaster complications ?
Nervous/vascular compression Pressure sores Joint stiffness
35
risk factors that may cause compartment syndrome ?
Proximal 3rd tibial facture Important fracture displacement Muscles contusion Circular cast immobilization
36
what are the treatmen methods of the conservative way ?
reduction immobilization rehabilitation
37
how is conservative reduction performed ?
Following the opposite sense of the fracture displacement main manuver = axial traction device = skeletal traction
38
what are the goals of skelete traction ?
Fights muscle contraction Fragments alignment Restore length
39
how is immobilization performed ?
Casts/splints (plaster/reisins) Bandages Orthosis
40
contraindications of plasters ?
Diabetes Arterial insufficiency Blisters Skin conditions
41
surgical reduction has two pathways ?
open closed (orthopedic table traction)
42
what are the advanges of surgical reduction ?
anatomical reduction osteoplasty
43
what are the disadvanges of surgical reduction ?
higher chance of infection bleeding delayed/nonunion Soft Tissue Stripping ➔ Devascularisation
44
what are the tools used in internal fixation ?
scews and plates tension band wiring K wires dynamic hip screws
45
what are the complications of internal fixation ?
Infection (0.5 - 1.5 %) Second displacement Device failure Delayed/nonunion
46
what are the internal fixation indications?
Open fractures - grade II-III G.A Comminuted fractures Pelvic fractures
47
Gustilo Anderson classification
* Type 1 ○ Low energy ○ Wound - 1 cm ○ Minimal contamination * Type 2 ○ Medium energy ○ Wound larger than 2 cm ○ No devitalized tissues ○ Medium contamination * Type 2a ○ High energy ○ Extensive lacerations and soft tissue devitalization ○ Possible coverage of the fracture site ○ Important contamination * Type 3B ○ Fracture site exposrue ○ Periostal stripping ○ Gros contamination * Type 3C ○ Type 3B + arterial lesions Limb salvage procedures or amputation

Orthopedics (5 decks)

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