Long bone fractures Flashcards Preview

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Flashcards in Long bone fractures Deck (98):
1

Define the terms diaphysis, metaphysis, epiphysis and physis

Diaphysis - shaft of long bone
Metaphysis - between the diaphysis and epiphysis
Epiphysis - end of long bone
Physis - growth plate

2

List the main long bones of the body

Tibia & fibula
Femur
Radius & ulna
Humerus
Metatarsals, metacarpals and phalanges
Clavicle

3

What is primary bone healing?

Healing where the gap between two ends of bone is minimal

4

What type of fracture will heal by primary bone healing?

Hairline (after fixation with plate and screws)

5

What is secondary bone healing?

There is a gap between the two ends of the bone which fills with granulation tissue > soft callus > hard callus/bone

6

Which is more common primary or secondary bone healing?

Secondary

7

What is the sequence of fracture healing?

Haematoma >
Soft callus >
Chondral ossification >
Hard callus >
Bone remodelling

8

What are the important steps in an assessment of a fracture?

Closed vs open
Neurovascular status
Soft tissue injury
Compartment syndrome

9

What can and should be immediately given for a fracture?

Analgesia

10

What is a comminuted fracture?

A fracture with more than two segments

11

When do comminuted fractures tend to happen?

High energy injuries
Poor quality bone

12

How can fractures be managed non-operatively?

Cast (plaster of paris, lightweight)
Functional bracing
Traction

13

Which age groups typically get traction?

Young
Elderly

14

What are the different types of internal fixation?

K-wires
Cerclage wires
Onlay devices (plates & screws)
Inlay devices (intramedullary nail)

15

What are the different types of external fixation

Monolateral
Circular

16

What does ORIF stand for?

Open reduction internal fixation

17

How might certain intra/periarticular fractures be managed?

Joint replacement

18

High energy fractures +/- soft tissue swelling should be treated with ORIF. T/F

False - healing poor and non-union rates high, either way until soft tissues settle or use other techniques

19

How should a stable, minimally displaced, extra-articular fracture be managed?

Conservatively - splint

20

When is reduction used?

When fracture position is unacceptable

21

An unstable fracture should be operatively managed under which circumstance?

When the patient is fit and able to undergo operation

22

When might intra-articular fractures be managed non-operatively?

When they are stable and non-displaced

23

How should displaced intra-articular fractures be managed? Why?

Operatively with internal fixation
Prevent post-traumatic osteoarthritis

24

When might joint replacement be used in a peri-articular fracture?

When non-union risk or avascular necrosis risk is high

25

How should open fractures be managed?

Antibiotics
Tetanus Ig if not vaccinated
Debridement
Operative stabilisation

26

How should compartment syndrome be managed?

Fasciotomy and operative stabilisation

27

How should vascular injury be managed?

Reduction, stabilisation, reassess +/- revascularisation

28

How should nerve injury be managed?

Open - explore
Closed - reduce, stabilise, reassess and monitor

29

When should metronidazole be given (in addition to other antibiotics) with an open fracture?

If it has visible dirt in the fracture wound

30

Which antibiotics should be prescribed for an open fracture?

Gentamicin and flucloxacillin/co-trimoxazole

31

Is a femoral shaft fracture usually low or high energy? What is the exception to this?

High. Pathological fracture

32

What are the risks with femoral shaft fracture?

Hypovolaemia (fluid replacement, blood transfusion)
Fat embolism
Acute respiratory distress syndrome

33

What type of analgesia is given in a femoral shaft fracture?

Femoral nerve block

34

How is a femoral shaft fracture treated?

Stable - Thomas splint
Unstable - Intramedullary nailing

35

Are extra-articular distal femur fractures stable or unstable? Why?

Unstable. The muscles cause flexion

36

How is an extra-articular distal femur fracture managed?

Thomas splint
Intermedullary nail if more proximal
Plate and screw if very distal

37

How are intra-articular distal femur fractures managed?

Reduction and rigid fixation with plate and screws

38

Is a proximal tibial fracture high or low energy?

High energy in the young
Low energy in the old

39

What kind of force is usually responsible for proximal tibial fractures? What pattern of fracture does this cause?

Valgus
Lateral tibial plateau fracture with articular disruption

40

How is a proximal tibial fracture managed?

Temporary external fixation if high energy with substantial swelling
Anatomical reduction with rigid fixation +/- bone graft

41

What is a common complication of proximal tibial fractures?

Post traumatic osteoarthritis

42

How is a proximal tibial fracture assessed?

CT scan

43

Are tibial shaft fractures high or low energy?

Either

44

What is a common complication that tibial shaft fractures must be monitored for?

Compartment syndrome

45

How well is 1) angulation and 2) internal rotation tolerated in a tibial shaft fracture?

1 - well tolerated within 5 degrees
2 - poorly tolerated

46

How long does a tibial shaft fracture take to heal and over which time frame indicates non-union?

4 months. 1 year

47

How is a tibial shaft fracture managed?

Conservative - plaster
Surgical - intermedullary nailing, plate, ex-fix

48

How is compartment syndrome diagnosed?

Clinically

49

What is an intra-articular distal tibial fracture called?

Pilon fracture

50

Is an intra-articular tibial fracture high or low energy?

High

51

What are the associated injuries of a distal tibial fracture?

Spine, pelvis, calcaneous

52

How is a distal tibial fracture managed?

Urgent external fixation +/- limited internal fixation >
Soft tissues settle >
Internal fixation

53

How are distal tibial fractures assessed?

CT scan

54

When may ankle fractures be treated conservatively?

Isolated distal fibular fracture
Minimally displaced medial malleolus

55

What are the two causes of talar shift?

Bimalleolar fractures (unstable)
Distal fibular fracture with ruptured deltoid ligament

56

How at risk of post-traumatic OA are ankle fractures?

Most are high risk

57

How is talar shift managed? Why?

ORIF. Change in joint force causes massive increase in OA risk

58

What is the main cause of proximal humerus fractures and in which type of patient?

Osteoporosis. Elderly

59

What are the risks of proximal humerus fractures?

Brachial plexus injury
Axillary artery injury

60

What are the risk in comminuted proximal humerus fractures?

Avascular necrosis
Non-union

61

How are proximal humerus fractures managed?

Elderly - conservative
Head splitting/comminuted fracture - arthroplasty
Young and displaced - internal fixation

62

What are the benefits of arthroplasty in proximal humerus fractures? The drawbacks?

Pain relief. Poor range of movement

63

Why is surgery not chosen for proximal humerus fractures in the elderly?

Stiffness and rotator cuff dysfunction causes poor healing

64

What is the risk with humeral shaft injuries?

Radial nerve injury (neurapraxia)

65

Can angulation be tolerated with humeral shaft injuries?

Yes

66

How is humeral shaft fracture managed?

Bracing

67

When might humeral shaft fractures be managed surgically?

Non-union
Pathological
Polytrauma
Open fracture
High energy
Not tolerating brace

68

How is a distal humerus fracture managed?

Intra-articular - ORIF
Elderly - arthroplasty

69

Most olcranon fractures are avulsion. T/F

True - due to quadriceps contraction

70

How are olcranon fractures managed?

Internal fixation unless elderly with low demand

71

Which fracture often occurs in conjunction with an elbow dislocation?

Radial head fracture

72

How are radial head fractures managed?

Minimally displaced - conservative
Fragment blocking movement/displaced with large fragments - fixation
Comminuted - excise +/- replacement

73

What is a Galeazzi fracture dislocation?

Isolated radial fracture and distal radio-ulnar joint disocation

74

What is a Monteggia fracture dislocation?

Isolated ulnar fracture and dislocation of radial head

75

How is a forearm fracture of both the radius and ulna managed?

ORIF

76

How is a Galeazzi or Monteggia fracture managed?

ORIF (dislocation should reduce)

77

What is a nightstick fracture? How is it managed?

Isolated fracture of the ulna. Conservatively

78

How does a nightstick fracture occur?

Direct blow to the ulna

79

What is a Colle's fracture?

Extra-articular, dorsal angulation and dorsal displacement of the distal radius

80

How is a Colle's fracture managed?

Stabled/minimally displaced - Plaster of paris
Simple displacement - manipulation under anaesthetic
Displaced comminution - manipulation under anaesthetic & k-wires or ORIF

81

What are the complications of Colle's fracture?

Median nerve compression
EPL rupture
Chronic regional pain syndrome
Loss of grip strength

82

What is the typical mechanism by which a Colle's fracture occurs?

Fall onto an outstretched hand

83

What type of fracture can result in a dinner fork deformity?

Colle's fracture

84

What is the typical mechanism by which a Smiths fracture occurs?

Fall onto the back of the hand

85

What is a Smith's fracture?

Extra-articular, volar displacement and angulation of the distal radius

86

How is a Smith's fracture managed?

ORIF

87

What is a Barton's fracture?

Intra-articular, volar or dorsal on lateral +/- carpal subluxation of the distal radius

88

How is a Barton's fracture managed?

ORIF

89

How is a comminuted intra-articular fracture of the distal radius managed?

External fixation +/- k-wires

90

How many x-ray views does a scaphoid fracture required? What else must be done?

4. Must be x-rayed a number of days after to confirm

91

How is a perilunate dislocation of the wrist managed?

Urgent reduction

92

How is polytrauma defined?

More than one major fracture (long bones/pelvis)

93

What are the two worst fractures in terms of blood loss/fat embolism?

Pelvic and femoral shaft fracture

94

What is the risk in terms of inflammatory cascades during polytrauma?

Systemic inflammatory response syndrome
Adult respiratory distress syndrome
Multiple organ dysfunction syndrome

95

What is the lethal triad in relation to blood loss and polytrauma?

Hypothermia, acidosis and coagulopathy

96

How is a pelvic fracture managed?

Pelvic binder

97

What is consumption coagulopathy?

Bleeding uses up all clotting factors

98

What are the most pressing injuries to treat in polytrauma?

Pelvic, tibial or femoral fracture
Vascular compromise
Open fractures
Compartment syndrome

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