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Rheum/MSK > Ortho 1 > Flashcards

Ortho 1 Flashcards

1
Q

How can you describe a fracture?

A

Complexity
Type
Comminution - number of pieces broken into
Location - bone and location = radial shaft
Displacement

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2
Q

What are the different complexities of fracture?

A 
Simple = closed
Compound = open
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3
Q

What are the different types of fractures?

A

FIGTACOS

Fissure
Impaction
Greenstick
Transverse
Avulsion
Comminuted
Oblique
Spiral
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4
Q

What is the displacement mean in terms of fractures?

A

Displacement - degree of movement of bone from normal location

I) translation (sideways movement, as % of bone diameter)

ii) Angulation (bend in degrees)
iii) Shortening (collapse, in cm)

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5
Q

What is emergency management of open fractures?

A

7As

ATLS - ABC fashion, correct shock and give blood if 1.5L is lost

Assessment - neurovascular status, soft tissues and photograph wound

Antisepsis - swab wound, irrigate with sterile 0.9% saline, then cover with large anti-septic soaked dressing

Alignment - aligh fracture and splint

Anti-tetanus - check status and immunize appropriately

Antibiotics - 3rd gen cephalosporin - ceftriaxone + metronidazole

Analgesia

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6
Q

When would a closed reduction not be recommended?

A
  • It has previously failed
  • 2 fractures in one limb
  • bilateral identical fractures
  • intra-articular fractures
  • open fractures
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7
Q

What’s the difference between external fixtation and internal fixation?

A

External - when there is another set of clamps, screws outside the skin (good for burns, loss of skin and bone or an open fracture)

Internal fixation - plates, screws, nails or wires within the skin

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8
Q

How could you estimate fracture healing time?

A

Rule of 3s

Closed, paediatric, metaphyseal, upper lime fracture is the simples = heal in 3 weeks

  • any complicating factors will double healing time
    e. g. adult, diaphyseal, forearm - 12 weeks
    e. g. open, adult, diaphyseal, tibia - 48 weeks
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9
Q

What are methods of reduction?

A

Manipulation

Traction
I) skin 
ii) fixed
iii) skeletal - pin through bone
iv) balanced
v) gallows
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10
Q

What is the Gustillo classification of open fractures?

A

Type I - low energy wounds - <1cm = bone piercing skin

Type II - low energy wounds >1 cm, causing moderate soft tissue damage

Type III - all high energy

a) adequate local soft tissue coverage
b) inadequate local soft tissue coverage
c) arterial injury needing repair

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11
Q

What is the Salter-Harris classification of epiphyseal injury? When would you commonly see each fracture?

A

I - in babies and pathological conditions (scurvy)
II - commonest injury, fracture line above the growth plate
III - there is a displaced fragment, with fracture line through the growth plate
IV - union across the growth plate may interfere with bone growth
V - compression of the epiphysis causes deformity and stunting

SALTER
S - straight across
A - above growth plate
L- lower or below growth plate
T - two or through
ER - ERasure or growth plate or cRush
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12
Q

Where do you see the commonest fractures?

A 
Clavicle
Arm
Wrist (colles')
Hip
Ankle
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13
Q

How can you externally splint a fracture? When would you use internal fixation?

A

Splints/Plaster casts

NOT CIRCUMFERENTIAL - allow swelling to avoid COMPARTMENT SYNDROME

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14
Q

What are the bones of the wrist?

A

Scared Lovers Try Positions That They Can’t Handle

Scaphoid
Lunate
Triquetrum
Pisiform
Trapezium
Trapezoid
Capitate Hamate
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15
Q

What fractures can occur in the wrist?

A

Colles’ (distal radius with dorsal (UP) displacement fragments)

Smith’s (distal radius with volar (DOWN) displacement)

Barton’s (fracture dislocation of radiocarpal joint)(

Scaphoid (vulnerable blood supply - high risk of non-union and avascular necrosis)

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16
Q

What causes scaphoid fracture? How does it present?

A

FOOSH injury (falling on outstretched hand)

  • tenderness in anatomical snuffbox
  • possibly radial nerve sensory damage
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17
Q

What is the cause of a Colles’ fracture? How would you investigate it?

A

Normally a FOOSH injury with forced dorsiflexion (palm to floor) of wrist. Often seen in osteoporotic elderly patients

Can cause median nerve damage

XR - dinner fork on lateral XR

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18
Q

What would you see on XR of Smith’s fracture?

A

Garden spade deformity

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19
Q

What are the types of hip fracture?

A

Intracapsular - femoral neck between edge of femoral head and insertion to capsule

Extracapsular

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20
Q

What are the types of extracapsular fractures?

A

Trochanteric - distal to insertion into pelvis, involving or between trochanters

Subtrochanteric - below lesser trochanter

21
Q

What risk is associated with intracapsular hip fracture?

A

Disruption to medial and lateral circumflex artery = avascular necrosis

22
Q

What are some risk factors for hip fracture?

A 
Post minor trauma
Elderly
Osteoporosis
Metastatic disease
Falls
Gait disturbance
Sensory impairment
23
Q

How does a patient with a hip fracture commonly present?

A

Shortened and externally rotated leg
Entire hip pain
Impacted - outer thigh/groin
Inability to weight bear

24
Q

How would you investigate a hip fracture?

A

XR - Shenton’s line (imaginary line drawn along the inferior border of the superior pubic ramus and along the inferomedial border of the neck of the femur - should be continuous and smooth

MRI

25
Q

How would you grade an intracapsular hip fracture?

A

Garden Classification

I - stable fracture with impaction in valgus

II - complete fracture but undisplaced

III - displaced fracture, usually rotated and angulated but still has boney contact

IV - complete boney distruption

26
Q

How would you manage a hip fracture?

A

ABCDE
Analgesia
Fluids
Femoral block

Intracapsular - surgery within 1 day
Undisplaced - internal fixtation or hemiarthroplasty if unfit

Displaced - open reduction internal fixation (young), femoral head replacement and arthroplasty (Older)

Extracapsular - intramedullary fixation with Nail/Dynamic hip screw

27
Q

What is fracture disease?

A

Muscle atrophy
Stiff joints
osteoporosis

28
Q

What are the bones of the ankle joint?

A

tibia
fibula
talus

29
Q

What are the joints of the ankle?

A

Ankle - tibia and fibula meet talus

Syndesmosis - tibia to fibula

30
Q

What in the presentation would help you distinguish between an ankle sprain and ankle break?

A

Severe sprain - immediate severe pain, swelling, bruising and tenderness

Consider break - obvious deformity, inability to weight bear, bony tenderness

31
Q

What are the Ottawa ankle rules?

A

Guidelines for clinicians to help decide if patient with foot or ankle pain should be offered X-ray

Ankle X-ray = - bone tenderness at the posterior edge or tip of the lateral malleolus

  • bone tenderness at the posterior edge of tip of medial malleolus
  • inability to bear weight both immediately and in the ED for four steps

Foot X-ray =

  • bone tenderness at the base of the fifth metatarsal
  • bone tenderness at the navicular
  • inability to bear weight both immediately and in the ED for 4 steps
32
Q

What is the Danis Weber classification?

A 
Type A (lowest) -fracture of lateral malleolus distal to syndesmosis 
Type B - fracture of fibular at level of the syndesmosis

Type C (highest) - fracture of the fibula proximal to the syndesmosis

  • syndemosis is disrupted
  • unstable (ORIF)
33
Q

What is the Lauge-Hansen classification? How are ankle fractures classified?

A

System of categorizing ankle fractures based on the foot position and the force applied

Weber A - supination adduction

Weber B - supination exorotation

Weber C - pronation exorotation

34
Q

What is a Pott’s fracture?

A

Bimalleolar fracture - lateral and medial malleolus

35
Q

How would you manage ankle fracture?

A

Deformity and assess neurovascular status

XR

Molded cast

Reduction and internal fixation - compression plate

36
Q

What is the most common ankle sprain? What movements would causes this?

A

85% are lateral-inversion and plantar flexion injuries that damage lateral ligament

37
Q

How would you manage an ankle sprain?

A

PRICE
Protection, Rest, Ice, Compression, Elevation

avoid HARM
heat,alcohol, running and massage

38
Q

What are the steps involved in fracture healing?

A 
Haematoma formation (hours)
-leukocytes move to area and begin secreting pro-inflammatory agents

Fibrocartilaginous callus formation - soft callus (days)
- inflammation leads to angiogenesis and increased number of chondrocytes - secrete collagen and proteoglycans (fibrocartilage)

Bony callus formation (weeks)
- endochondral ossification and direct bone formation - soft callus replaced by woven bone

Bone remodelling (months)

39
Q

How would you initially assess neck injury?

A

If cervical spine injury suspected - immobilize the neck with hard collar and sandbags

-main sites of injury C6,7 followed by C2

40
Q

How would you examine neck injury?

A

Posture of neck and bone tenderness

Movements
-flex, extend, rotation (most commonly affcected), lateral flexion

Test for root lesions
- movements of shoulder, elbow and finger abduction

test flexes - biceps, brachioradialis, triceps

41
Q

What is the Nexus criteria for cervical injury?

A

If DOESNT meet all of the criteria –> radiography

  1. no posterior midline cervical-spine tenderness
  2. no evidence of intoxication
  3. normal level of alertness
  4. no focal neurologic deficit
  5. no painful distracting injuries
42
Q

How would you use the Canadian c spine rule for neck injury?

A
  1. Any high risk factors
    - age >/ 65
    - dangerous mechanism
    - paraesthesis in extremities
2. simple rear end MVC
sitting position in ED
Ambulatory at any time
delayed onset neck pain
absence of midline c-spine tenderness
  1. able to rotate neck actively?
43
Q

What is SCIWORA?

A

Spinal cord injurt without radiological abnormality

  • neurological deficit in the absence of lesion on plain radiographs (may be visible on MRI)
  • most commonly paeds cervical spine injuries
44
Q

What is cervical spondylosis? How does it present?

A

Degenerative changes of the cervical spine, degeneration of the annulus fibrosus and bony spurs - narrow the spinal canal and intervertebral foramina

Asymp
Neck and arm pain with paraesthesiae
Myelopathy (spastic weakness and later incontinence)

45
Q

How would you treat cervical spondylosis?

A

Physio
NSAIDs - naproxen
Muscle relaxants - diazepam
Facet joint injections - dexamethasone

46
Q

What is cervical spondylolisthesis? Causes?

A

Displacement of one vertebra upon the one below - most impt. consequence is poss. of spinal cord injury

  • Congenital failure fusion of the odontoid process with the axis or fracture of the odontoid process (skull, atlas, odotoid process slip forward on axis)

Inflammation softens the transverse ligament of the atlas

Instability after injuries

47
Q

How can you treat cervical spondylolisthesis?

A

Traction
Immobilization in plaster jackets
Spinal fusion

48
Q

What are some red flag symptoms assoc. with cervical injury?

A

<20/>55
Weakness/loss of sensation and intractable pain –> MRI

Myelopathy is suggested by Lhermitte’s sign, insidious progression, gait disturbance, UMN/LMN signs, fine motor issue - dexterity, bowel and urinary problems –> MRI

49
Q

How does acute whiplash occur?

A

excessive hyperextension

hyperflexion

rotation of the neck

Rheum/MSK (5 decks)

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