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MSK 2 > Management of specific fractures > Flashcards

Management of specific fractures Flashcards

1
Q

How do we assess in orthopaedics?

A

Look
Feel
Move
X-Ray

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2
Q

How do we assess in trauma?

A

Reduce
Hold= plaster, external fixation, internal fixation
Rehabilitate (normally six weeks later)

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3
Q

What is the most important step during trauma?

A

Keeping the patient alive

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4
Q

How do you assess a fracture?

A

Pain
Swelling
Crepitus
Deformity
Collateral damage= nerve, vessel

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5
Q

What are the investigations done for fractures?

A

X-Ray
CT (diagnosis + assess patterns)
MRI (if unsure)

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6
Q

How do you describe a fracture radiograph?

A

Name, date, projection
Location (which bone, which side, which part of bone)
Pieces (simple/multifragmentary)
Pattern (transverse/oblique/spiral)
Displaced/undisplaced/minimally displaced (translated/angulated- what plane)

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7
Q

What are the directions of angulation of the bone?

A

-Varus/vagus movement= corral plane towards and away from the midline
-Dorsal/volar movement= sagittal plane
-Internal/external rotation= axial plane

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8
Q

What are the 2 types of fracture healing?

A

-Direct fracture healing
-Indirect fracture healing

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9
Q

How does direct fracture healing work?

A

-Anatomical reduction
-Absolute stability/compression
-No callus

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10
Q

How does indirect fracture healing work?

A
  1. Haematoma formation
  2. Release of cytokines
  3. Granulation tissue and blood vessel formation
  4. Soft callus formation (type 2 collagen)
  5. Converted to hard callus (type 1 collagen=bone)
  6. Callus responds to activity, external forces, functional demands and growth
  7. Excess bones is removed
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11
Q

How do you manage fractures?

A
  1. Reduce
  2. Hold
  3. Rehabilitate
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12
Q

How can you reduce a fracture?

A

-Closed
-Open

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13
Q

How can you hold a fracture?

A

-Plaster/splint
-External fixation
-Internal fixation

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14
Q

How can you rehabilitate a fracture?

A

-Early/late
-Weight bearing
-Physiotherapy

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15
Q

What are general complications of fractures?

A

-Fat embolus
-Deep vein thrombosis
-Infection
-Prolonged immobility

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16
Q

What are more specific complications?

A

-Neurovascular injury
-Muscle/tendon injury
-Non union (failure of a fractured bone to heal)
-Local infection
-Degenerative change (interarticular)
-Reflex sympathetic dystrophy

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17
Q

What are examples of specific fractures? (4)

A

1) Neck of femur fractures (NOF)
2) Shoulder dislocation
3) Distal radial fracture (DR)
4) Tibial plateau fractures (TP)

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18
Q

What is the main cause of NOF fractures in older patients?

A

Osteoporosis

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19
Q

What is the main cause of NOF fractures in younger patients?

A

Trauma

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20
Q

What are key parts of a patient’s history for a fracture?

A

-Age
-Comorbidities
-Pre-injury mobility
-Social history (relatives, stairs at home, alcohol)

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21
Q

What is the femur divided into?

A

Intracapsular and extracapsular
(determined by the joint capsule)

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22
Q

What are the different types of NOF fractures by location?

A

-Subcapital (intracapsular)
-Transcervical (extracapsular)
-Intertrochanteric (extracapsular)
-Subtrochanteric

23
Q

How does a sub capital fracture look like?

A

Fracture just below the head of the femur

24
Q

How does a transcervical fracture look like?

A

Fracture on the neck of the femur and is inferior to the location of a sub capital fracture

25
Q

How does a intertrochanteric fracture look like?

A

A fracture in the intertrochanteric region (between greater and lesser trochanters)

26
Q

How do you determine whether to fix or replace a fracture?

A

-The location of the fracture
-The degree of displacement

27
Q

How would you treat an extracapsular fracture?

A

-Dynamic hip screw (plate and screws)
-Blood supply to femur likely preserved so HOF likely to survive

28
Q

How would you treat a patient with a fracture where the fragments have not moved apart?

A

-Screws
-Bone fragments not moved apart so most likely blood supply is intact

29
Q

How would you treat a patient with a fracture where the fragments have moved apart?

A

-Replace head of femur
-25-30% avascular necrosis so HOF might die

30
Q

What are the 2 potential ways of replacing HOF?

A

-Total hip replacement
-Hemiarthroplasty

31
Q

What is the criteria for a total hip replacement?

A

-Walks more than a mile a day
- Independent
- Minimal comorbidities

32
Q

What is a hemiarthroplasty?

A

Leave acetabulum as bone but replace head and neck of femur

33
Q

What is the criteria for a hemiarthroplasty?

A

-Lower mobility
-Multiple comorbidities

34
Q

How do patients with a dislocated shoulder present?

A

-Direct trauma (mostly)
-Pain
-Restricted movement
-Loss of normal shoulder contour

35
Q

What is the clinical exam that is done for shoulder dislocation?

A

Assess neuromuscular status- auxiliary nerve

36
Q

How do we investigate a shoulder dislocation?

A

-X-ray prior to any manipulation to identify the fracture
-Scapular- Y view and AP

37
Q

How do you manage a shoulder dislocation?

A

-Ensure adequate patient relaxation (entonox/benzodiazepines)
-Ensure environment is safe
-Traction-counter traction
-If alone can use Stimson method

38
Q

How does the traction-counter traction method work?

A

Gentle internal rotation to disimpact humeral head

39
Q

How does the Stimson’s method work?

A

Patient lies prone and arm hangs off and gravity slowly pulls the shoulder back into position

40
Q

What is a complication of shoulder dislocation?

A

Hill-Sachs defect

41
Q

What is Hills-Sachs defect?

A

Bankart lesion= as humerus comes out, it bangs on glenoid fossa of the scapula and a fleck of bone comes off

42
Q

What does Bankart lesion lead to?

A

Recurrent shoulder dislocation

43
Q

What are the 3 ways of managing a distal radial fracture?

A

1) Cast/splint
2) Manipulation under anaesthesia (MUA) and K-wire
3) Open reduction and internal fixation (ORIF)

44
Q

When is a cast/splint used?

A

-Temporary treatment for any distal radial fracture= reduction of fracture and placement into cast. until definitive fixation
-Definitive if minimally displaced, extra-articular fracture

45
Q

When is MUA and K wire used?

A

-For fractures that are extra-articular that have instability (particularly in children)
-In theatre
-Wires removed during post operation clinic

46
Q

When is ORIF used?

A

-For any displaced, unstable fractures not suitable for K-wires or with intra-articular involvement
-Uses plates and screws

47
Q

What is a lipohaemarthrosis?

A

Fat floating to surface when patient is lying down

48
Q

What is lipohaemarthrosis pathognomonic of?

A

Fracture within a joint

49
Q

What is the tibial plateau?

A

The flat, weight bearing part of the tibia

50
Q

How is a tibial plateau fracture caused?

A

Extreme valgus/varus force OR axial loading across the knee causing tibial plateau to depress/split

51
Q

What is the non operative management of ankle fractures?

A

-Non weight bearing below the knee cast for 6-8 weeks
-Transfer into walking boot
-Physiotherapy to improve range of motion/stiffness from joint isolation

52
Q

What is operative management of ankle fractures?

A

-Soft tissue dependent= patient need strict elevation as injuries often swell
-Open reduction internal fixation +/- syndesmosis repair using screw/tightrope technique

53
Q

What is syndesmosis?

A

Fibrous joint where 2 adjacent bones are linked by a strong membrane/ligaments

MSK 2 (5 decks)

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