Orthopaedics VII Flashcards
(81 cards)
Which bones are typically broken during a Colles’ fracture? [2]
What is meant by a Colles fracture [1]
Colles:
- Distal radius fracture
- There is an associated fracture of the ulna styloid in around 50% of cases.
Typically occurs due to FOOSH impaction with the forarm in dorsiflexion.
Explain the typical presentation of a Colles fracture [3]
Wrist pain and swelling
* Pain and swelling usually occur immediately after the fracture is sustained
* Movement at the wrist is painful
Wrist deformity
* Colles’ fractures typically cause a ‘dinner-fork’ deformity of the wrist, caused by dorsal displacement of the distal fragment of the radius.
Paresthesia and weakness
* If the fracture causes neurological damage this may result in paraesthesia and weakness of the wrist and/or fingers
* The median nerve is the most common nerve to be damaged by a Colles’ fracture, affecting up to 12% of cases caused by low-energy trauma and up to 30% of cases caused by high-energy trauma
What is the gold standard investigation for a Colles’ fracture? [1]
How does it appear ^? [1]
Plain radiograph using 2 views:
- AP (anteroposterior) and lateral view are sufficient for diagnosis although oblique views are sometimes included.
- Transverse fracture fracture is typically 2.5cm proximal to the radio-carpal (wrist) joint.
How do you manage a Colles’ fracture? [4]
Choice of management of a Colles’ fracture depends on the severity of the fracture. The most common treatment method is closed reduction with immobilisation with a plaster cast
open reduction and internal fixation (ORIF) used if:
* Unstable fracture
* Significant angulation of the distal fragment of the radius
* Usually defined as >10 degrees dorsal angulation
* Closed reduction is unsuccessful
* Comminuted fracture
Describe some complications of a Colles’ fracture [3]
Malunion
- Lead to dinner-fork deformity
Median nerve damage
- May lead to post-traumatic carpal tunnel syndrome
Rupture of EPL tendon
- Clinical features of an EPL tendon rupture include the inability to extend the interphalangeal joint of the thumb
Describe what is meant by a Galeazzi fracture [1]
How does a Galeazzi fracture typically occur? [1]
Galeazzi fracture
- This is a fracture of the radius which usually occurs at the junction of the middle and distal third of the radial shaft
- This injury is typically caused by a FOOSH with the elbow in flexion
Describe what is meant by a Smith’s fracture? [1]
Fracture of the distal radius with volar angulation of the distal fragment
Often described as a reverse Colles’
Describe what is meant by a Barton fracture [1]
Barton Fracture:
- Distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation
- Fall onto extended and pronated wrist
What are the signs of a scaphoid fracture? [5]
Point of maximal tenderness over the anatomical snuffbox
This is a highly sensitive (around 90-95%), - - but poorly specific test (< 40%) in isolation
Wrist joint effusion
- Hyperacute injuries (< 4hrs old), and delayed presentations (>4days old) may not present with joint effusions.
Pain elicited by telescoping of the thumb (pain on longitudinal compression)
Tenderness of the scaphoid tubercle (on the volar aspect of the wrist)
Pain on ulnar deviation of the wrist
Describe the management for a scaphoid fracture
Initial management
* immobilisation with a Futuro splint or standard below-elbow backslab
* referral to orthopaedics: clinical review with further imaging should be arranged for7-10 days later when initial radiographs are inconclusive
Orthopaedic management:
* undisplaced fractures of the scaphoid waist: cast for 6-8 weeks
* displaced scaphoid waist fractures: requires surgical fixation
* proximal scaphoid pole fractures: require surgical fixation
Name and describe the classification system used for ankle fractures
Weber classification:
A
- Fracture below the level of the syndesmosis; typically from an inversion injury of the ankle.
B
- Fracture begins at the level of the syndesmosis and extends proximally in an oblique fashion.
- When accompanied by a fracture of the medial malleolus or rupture of the deltoid ligament, the ankle is considered unstable. Typically from an eversion injury of the ankle.
C
- Fractures above the syndesmosis, generally associated with syndesmotic injury.
- May be associated with an avulsion fracture of the medial malleolus or rupture of the deltoid ligament.
- Always unstable, requiring fixation.
Describe what is meant by a Maisonneuve fracture [1]
A Maisonneuve fracture describes a fracture of the proximal fibula combined with an unstable ankle injury.
- Sometimes considered a high Weber C
- On occasion the energy from an ankle injury will pass through the ankle and syndesmosis and exit at the proximal fibula
Describe what is meant by the Ottawa ankle rules [1]
The Ottawa ankle rules help differentiate ankle injuries that require radiographic assessment from those that do not: only required if there is pain in the malleolar zone AND one or more of the following is found:
* Boney tenderness at the posterior edge or tip of the lateral malleolus OR
* Boney tenderness at the posterior edge or tip of the medial malleolus OR
* Inability to weight bear immediately and in the A+E department for four steps
Describe a very basic overview for Weber A-C fracture management [3]
Weber A fractures:
- Generally stable so surgical management is rarely indicated and they can be discharged from A&E in a walking boot with analgesia
- Full weight bearing
- 6 weeks
Weber B & C:
- Require open reduction and internal fixation and likely to need syndesmosis repair
- Non-weight bearing following surgery
- Immobilisation in cast following surgery until bony healing has occurred (usually 6-8 weeks)
Describe the managment plan for an open ankle fracture [3]
Debridement and washout and intravenous antibiotics
Open reduction and internal fixation if the wounds are small and there is a low risk of infection
External fixation if the wounds are significant or likely to need subsequent skin grafting or there is a high risk of soft tissue infection
Then:
- Non-weight bearing except if an intramedullary nail is used; 6-8 weeks
Describe the management plan for a tibial plafond (pilon) fracture [3]
- Open reduction and internal fixation if affecting the articular surface or stability compromised
- Conservative if position maintained and joint stable and articular surface intact
- 6-8 weeks non-weight bearing and subsequent weight-bearing immobilisation up to further 6 weeks
Describe the management plan for a talus fracture [3]
- Conservative if position adequate and articular surfaces of ankle and subtalar joints are preserved
- Open reduction and internal fixation or external fixation if position is not maintained, articular surface affected or significant comminution indicating significant instability
- Non-weight bearing for 6-8 weeks
What is meant by a pilon fracture? [1]
Pilon fractures: Involve the distal end of the tibia and may extend into the ankle joint.
What is the most commonly involved ligament in ankle sprains? [1]
Quesmed flaschards
Anterior talofibular ligament.
Which bones are typically broken during a Colles’ fracture? [2]
What is meant by a Colles fracture [1]
Colles:
- Distal radius fracture
- There is an associated fracture of the ulna styloid in around 50% of cases.
Typically occurs due to FOOSH impaction with the forarm in dorsiflexion.
The major risk of scaphoid fracture is avascular necrosis, which would present with [2]
The major risk of scaphoid fracture is avascular necrosis, which would present with pain and stiffness at the wrist.
What is a Jones’ fracture? [1]
What is the main complication of Jones’ fracture? [1]
A Jones fracture is a fracture of the proximal metadiaphyseal junction of the fifth metatarsal bone that involves the 4th-5th metatarsal articulation.
- High risk of non-union for that reason (15-30%).
Explain the typical presentation of a Colles fracture [3]
Wrist pain and swelling
* Pain and swelling usually occur immediately after the fracture is sustained
* Movement at the wrist is painful
Wrist deformity
* Colles’ fractures typically cause a ‘dinner-fork’ deformity of the wrist, caused by dorsal displacement of the distal fragment of the radius.
Paresthesia and weakness
* If the fracture causes neurological damage this may result in paraesthesia and weakness of the wrist and/or fingers
* The median nerve is the most common nerve to be damaged by a Colles’ fracture, affecting up to 12% of cases caused by low-energy trauma and up to 30% of cases caused by high-energy trauma
