Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MSK > Mini Symposium - Fractures > Flashcards

Mini Symposium - Fractures Flashcards

(62 cards)

Start Studying
1
Q

Define an open fracture?

A

One with direct communication from the fracture to the outside

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the Gustilo grading

Based on energy, wound size, soft tissue damage

A

Type 1 - low energy, wound <1cm, clean
Type 2 - moderate soft tissue damage, <10cm, no soft tissue flap or avulsion
Type 3 - high energy, wound >10cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do we initially manage a open fracture? [3]

A

ABCDE

Remove gross contaminents, photograph, cover with saline swabs and stabilize the limb

Also tetanus and Abx prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What would indicate you should do emergency (<6hrs) surgery for an open fracture? [4]

A

If:

  • Patient is polytraumatised
  • Occurred in a marine or farmyard environment (infection risk), gross contamination
  • Neurovascular compromsie
  • Compartment syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do we surgically manage an open fracture? [3]

A
  • Debridement and fixation if viable or
  • Amputate
    + Plasic surgery for skin coverage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do we determine if muscle is viable for debridement and fixation? [4]

A

Check the 4 Cs:

  • Colour
  • Contraction
  • Consistency
  • Capacity to Bleed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Need for an amputation is scored by what factors? [4]

NB Its a dual consultant decision

A
  • Limb Ischaemia
  • Age
  • Shock
  • Injury mechanism (contamination/energy/complexity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do we manage a dislocation? [3]

A

Initial - Reduce and treat associated injuries
Surgery
Followed by physiotherapy for recurrent instability/stiffness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the most common shoulder dislocations?

A

Anterior mostly

Posterior is rarer but associated iwth fits and electric shocks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the most common elbow dislocations?

How would it appear?

A

Posterior, look for a very prominent olecranon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Whats the most common hip dislocations?

How would it appear?

A

Posterior

Leg short, flexed, internally rotated and adducted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Whats the most common knee dislocation?

How would it appear?

A

Anterior

look for extended knee and loss of normal contour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Whats the most common ankle dislocation?

How would it appear?

A

Lateral

Look for externally rotated ankle and prominent medial malleolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Whats the most common way for the subtalar joint to dislocate?
How would it appear?

A

Laterally, look for the laterally displaced calcaneus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe 3 sub-stages of Type III open fracture according to Gustilo grading

A

IIIA - soft tissue damage but not grossly contaminated
IIIB - periosteal stripping, extensive muscle damage, heavy contamination
IIIC - associated neuromuscular complication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Reasons for fractures [3]

A

High energy transfer
Repetitive stress
Low energy transfer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Delayed union

A

Definition: failure to heal in expected time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Factors that turn off bone healing [4]

A

Infection
Steroids
Immunosuppressed
Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Causes of delayed union [5]

A 
Distraction osteogenesis
Instability
Warfarin
NSAID
Ciprofloxacin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

3 ways to deal with delayed unions

A

Different fixation
Dynamisation
Bone grafting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Stress fracture

A

Small linear fractures as a result of repeated stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Complex fracture

A

multiple types of fractures occurring at one site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Features of non-union (failure to heal) [6]

A 
Pain and tenderness
Failure of calcification of fibrocartilage
Instability
Abundant callus formation
Persistent fracture line
Sclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

2 aims in treating fractures

A

Relieving pain

Restoring function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
3 phases of bone healing
Inflammation Reparative Remodelling
26
Modes of treatment of fracture Conservative pros and cons Surgery [2] Risk: conservative vs surgery
Conservative management - rapid process, rehabilitation slow Surgery - ORIF + compression - nailing/external fixation Conservative low risk Surgery high risk
27
Measurement of fracture healing Clinical examination Radiological measurement [2]
Radiological measurement: - Bridging callus formation - Remodeling
28
Early systemic problems [4], complications [2]
Problems - hypovolemia, crush syndrome, fat embolism, ARDS | Complications - bed rest complications DVT/PE, tetanus
29
Early local problems [3], 1 complication
Early local problems - neuromuscular damage - skin wound problems - compartment syndrome Complications - infection
30
Late local problems [3], complications [4]
Problems- delayed union Non-union avascular necrosis ``` Complications malunion CRPS type 1 implant failure joint stiffness ```
31
Malunion
Fracture that has healed but not in an anatomically correct position
32
Infected non-union What is one cause? [3] Vulnerable group 3 modes of tx
Usually introduced at time of operation Unstable fixation Metastatic sepsis on foreign body implant Vulnerable group - immunologically compromised Tx - Suspect - Diagnose - Debridement
33
Wrist Fractures Focused history questions [3] Examination [5] important aspects
Hand dominance, occupation, mechanism of injury Ex: deformity, skin breaks - open fracture, vascular status, neurological status Examine above and below
34
Wrist fractures | X-ray - how to interpret 5 steps
1. Patient's details, type of x-ray 2. Which bones are fractures - Distal radius - Distal ulna - Ulna styloid 3. Is the fracture intra/extra-articular 4. Comment on radial length - evidence of shortening 5. Describe displacement and angulation of distal fragment
35
Eponymous fractures Colle's fracture - what deformity is this associated with Ax
Dinner fork | Ax: FOOSH
36
Eponymous fractures Smiths fractures - what relationship do these have to Colle's Ax
Reverse Colles fracture | Ax: falling backwards onto the palm of an outstretched hand or falling with wrist flexed
37
Eponymous fractures | Barton fractures - mechanism of injury [2]
Shearing force, fall onto extended and pronated wrist
38
Eponymous fractures | Chauffeurs fracture - associated injury?
``` Scapholunate ligament # of radial styloid ```
39
Wrist fracture Mx Options for anaesthesia [6] Indicate which are typically used * [2]
``` Reduction without anaesthesia Oral/IV analgesia* Hematoma block* Bier block Conscious sedation GA ```
40
Wrist fracture Mx for non-operative distal radius fractures [2]
Closed reduction | Casting in ED
41
Wrist fracture Mx | Surgical interventions [2]
ORIF with volar or dorsal plate | External fixation
42
Compartment syndrome definition [2]
Raised pressure within a closed compartment [1] resulting in tissue ischemia [1]
43
Compartment syndrome - sequelae [3]
If untreated, necrosis > fibrosis > muscle contracture
44
Compartment syndrome | Epidemiology [3]
M>F <35yo Leg then forearm - common sites
45
Compartment syndrome | Causes - 2 mechanisms
Decreases in compartment size | Increase in compartment content
46
Compartment syndrome | Causes by decrease in compartment size [4]
Closure of fascial defects Tight plaster casts/bandages Localised external pressure eg lying on limb Pneumatic antishock garments
47
Compartment syndrome | Causes by increase in compartment content [3]
Hemorrhage following soft tissue injury # Post-op swelling and edema Post-ischemic swelling eg after tourniquet use intra-operatively
48
Compartment syndrome | Symptoms [3] + 6 P's
Pain out of proportion [1] to the injury not improving with suitable opioids [1] IN AN ALERT PATIENT [1] Pain, pallor, pressure, paresthesia, paralysis, pulselessness
49
Compartment syndrome | Examination - what would you see that would point to this diagnosis and why? [3]
Severe pain on passive stretching [1] of involved limbs digits ie fingers or toes [1] as this stretches the muscles within the affected compartment [1]
50
Compartment syndrome | Diagnosis in a suspected patient who is sedated or unconscious - what investigation [1]
Pressure monitor inserted into compartments of affected limb
51
What is the delta pressure [2]
A difference between the patients compartment pressure and their diastolic blood pressure [1] of less than 30mmHg [1] is suggestive of compartment syndrome
52
Compartment syndrome | Initial management [2]
TIME IS MUSCLE Remove any constrictive dressings or split them down to the skin Hold limb at level of heart not above to promote arterial inflow
53
Compartment syndrome | Gold standard management
Urgent fasciotomy - release of restrictive fascial compartment
54
Fat embolism | Clinical features split into 3 groups
Respiratory Dermatological CNS
55
Fat embolism: clinical features Respiratory [3] Dermatological [2] CNS [2]
Respiratory - Early persistent tachycardia - Tachypnoea, dyspnoea, hypoxia usually 72 hours following injury - Pyrexia Dermatological - Red/ brown impalpable petechial rash (usually only in 25-50%) - Subconjunctival and oral haemorrhage/ petechiae CNS - Confusion and agitation - Retinal haemorrhages and intra-arterial fat globules on fundoscopy
56
Fat embolism: imaging
CTPA - Tend to lodge distally so may not show any vascular occlusion - Ground glass appearance at periphery
57
Fat embolism: treatment [3]
Prompt fixation of long bone fractures DVT prophylaxis General supportive care
58
Complex regional pain syndrome (CRPS) Ep [3] Clinical features
1-5% after peripheral nerve injury 15-30% after Colles’ fracture Higher incidence in women PORT - Pain disproportionate to inciting event - Oedema + sudomotor - Reduced ROM but passive normal - Temperature + cooler changes
59
CRPS Describe the characteristic of pain [3] What is sudomotor? Mx
Continuous pain (hyperalgesia) Allodynia Aggravated by activity Sudomotor: stimulation of sweat glands Mx: early physiotherapy, neuropathic analgesia, refer to pain clinic
60
What is CRPS? | Describe the 2 types of CRPS
Umbrella term for a number of conditions such as reflex sympathetic dystrophy and causalgia It describes a number of neurological and related symptoms which typically occur following surgery or a minor injury. Type 1* no demonstrable lesion to major nerve Type 2: lesion present to major nerve
61
Crush syndrome definition [2] | Pathophys [2]
Crush injury to large muscle mass like thigh or calf Traumatic rhabdomyolysis Pathophys: Muscle ischemia > cell death with release of myoglobin > acute tubular necrosis > acute renal failure
62
Crush syndrome Clinical features [2] | Management
Dark amber urine positive for Hb Acute renal failure signs (hypovolemia, metabolic acidosis, hyperkalemia, hypocalcemia, DIC) Mx: IV fluids

MSK (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions