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Block 12 > Principles Of Diagnosis And Management Of Fractures And Soft Tissue Injuries > Flashcards

Principles Of Diagnosis And Management Of Fractures And Soft Tissue Injuries Flashcards

1
Q

what is a pathological fracture

A

occurs through abnormal bone in which disease causes structural weakness thus predisposing the individual to injury

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2
Q

what is a stress fracture

A

repeated low stress forces cause bone weakness which increases likelihood of a fracture when injury occurs

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3
Q

injuries can be predicted by knowing what 4 factors

A

chief complaint

age of the patient

mechanism of the injury

estimation of the amount of energy delivered

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4
Q

what is a fracture

A

break in the continuity of bone or cartilage

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5
Q

what are the clinical presentations of a fracture

A

loss of function
pain
tenderness
swelling
abnormal motion
deformity

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6
Q

what does it mean when a fracture is closed or open

A

closed fracture = the skin and soft tissues overlying the fracture sites are intact

open = if fracture site is exposed to outside environment in any manner

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7
Q

how should all fractures be identified and classified

A

open vs closed

exact anatomical position

direction of fracture line

simple or comminuted

position ( displacement, alignment)

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8
Q

how can direction of fracture line be described

A

this is comparison to the long axis of the bone in question

transverse = occurs at a right angle to the long axis of the bone

spiral fracture = results from rotational force and encircles shaft of a long bone in a spiral fashion

Oblique = runs oblique to long axis of bone

comminuted = fracture with more than 2 fragments

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9
Q

what is displacement

A

fracture fragments that have deviated from their normal position

can in mm or as a % of bone width

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10
Q

what is alignment

A

relationship of the longitudinal axis of one fragment to another

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11
Q

what is angulation

A

deviation from normal alignment

The direction of angulation is
determined by the direction of the
apex of an angle formed by the two
fracture fragments

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12
Q

what is a complete fracture

A

if it interrupts both cortices of the bone and incomplete if it only involves one

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13
Q

what is avulsion

A

bone fragment is pulled away from normal position either by

  • forceful contraction of a muscle
    or
  • resistance of a ligament to a force in the opposite direction
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14
Q

what is impaction

A

forceful collapse of one fragment of bone into or onto another

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15
Q

examples of diseases that cause structural weakness thus predisposing to injury are…

A

primary or metastatic malignancies
cysts
cysts
osteomalacia
ostogenesis imperfecta
scurvy
rickets
pagets disease

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16
Q

repeated low intensity forces may lead to…

A

resorption of normal bone resulting in a stress fracture

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16
Q

what occurs in the inflammaoty phase of healing

A

granulation tissue forms on the fracture surfaces. Resorption of the hematoma provides the first continuity between the fragments; however, this procallus provides no structural rigidity.

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16
Q

what occurs in the haematoma phase of healing

A

haematoma is caused by the rupture of vessels crossing the fracture line. the haematoma bridges the fragments

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17
Q

what occurs in the remodelling phase of healing

A

callus is formed on the periosteal and endosteal surfaces of the bone acting as a biologic splint

area becomes mineralised by deposition of calcium phosphate and then undergoes osseous metaplasia?

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17
Q

malunion meaning

A

occurs when a
residual deformity exists.

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18
Q

what occurs in the final stage of healing

A

callus is resorbed, development of firm bony union

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19
Q

rate of fracture healing is affected by which factors

A

type of bone
degree of fracture
opposition and systemic states such as hyperthyroidism or
excess corticosteroidism.
exercise = speeds healing
chronic hypoxia = slows repair

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20
Q

nonunion meaning

A

is a failure of a
fracture to unite.

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21
Q

pseudoarthrosis

A

when nonunion results in a false joint

22
Q
A
23
Q

What happens radiographically to a fracture site in the first 3 weeks of fracture healing

A

In the first 10 days the bone surrounding the fracture becomes less dense due to resorption and bone remodelling. Fascia becomes easier to detect on X ray

After 2-3 weeks the swelling of soft tissue will regress and callus becomes visible - will be mottled and starts to become dense

24
Q

What are green stick fractures

A

Mostly occur in children

Are incomplete angulated fractures of long bone

Bowing of the bone present

25
Q

What is a torus fracture

A

In children

Incomplete fracture characterised by a wrinkling or buckling of cortex due to impact ion

26
Q

What can mimic fractures of x rays

A

Epiphysis and epiphyseal growth plates

27
Q

What does a type I fracture in children indicate

A

Injuries involve only a slip of the zone of provisional classification

28
Q

What do type II fractures in children indicate

A

Fracture extends into the metaphysis

= most common fracture in children

29
Q

What does a type III fracture in children indicate

A

Injuries are composed of a slip of the growth plate plus a fracture through the epiphysis involving the articular surface

30
Q

What does a type IV fracture in children indicate

A

Like type III but extends into the metaphyssis

31
Q

What does a type V fracture in children indicate

A

Crushing injuries of the epiphyseal plate usually due to compressive forces

32
Q

What diagnostic modalities are used for fractures

A

Plain X rays (at least two views which are perpendicular to each other required. Oblique view also used)

Radionucleotide bone scanning = helpful in detecting stress fractures + occult fractures. Inject small amount of radioactive material

Computed tomography = CT used to confirm or define better displacements, alignment, fragmentation or fracture

MRI = expensive and time consuming. Should only be used when there is doubt in diagnosis

33
Q

What is the primary complication of fractures especially open fractures

A

Infections such as osteomyelitis or septic arthritis

Treated with vigorous irrigation and debridgement of wound. Use of antibiotics if needed

34
Q

What is another complication of a fracture

A

Haemorrhage - large amounts of blood loss, shock and death can occur ( exsanguination)

35
Q

Apart from bone which other structure can be damaged during a fracture

A

Vascular injuries such as to the popliteal artery in knee injuries

36
Q

What are the 5 Ps

A

Pulseless
Paralysis
Paraesthesia
Pain
Pallor/pale

37
Q

What is neuropraxia (complication)

A

Contusion of a nerve which disrupts ability of nerve to transmit impulses but function regains after a few weeks to months

38
Q

What is axonotmesis (complication)

A

Severe crush injury to nerve.

Spontaneous healing possible but very slow

39
Q

What is neurotmesis (complication)

A

Severing of a nerve usually requiring surgical repair.

All functions are absent if severed ( touch, pain and temperature etc)

40
Q

What is compartment syndrome (complication)

A

Raised blood pressure within a muscle that leads to reduced blood flow and pain.
serious acute emergency complication that should be considered whenever pain and paraesthesia occur in an extremity after a fracture within an enclosed space.

41
Q

What is the treatment for compartment syndrome

A

Complete fasciotomy

42
Q

What is fat embolism syndrome ( complication)

A

Fat globules in the lung parenchyma and peripheral circulation after a long bone fracture or major trauma

Occurring most commonly after long bone fractures in young adults and after hip fractures in elderly patients. ARDS ( acute respiratory distress syndrome) and hypoxaemia are the earliest manifestations.

43
Q

What are fracture blisters ( complication)

A

Tense blisters that accompany high energy injuries in areas of little skin coverage such as ankle, elbow, foot and knee

44
Q

What is subluxation

A

Partial loss of continuity between two articulating surfaces

45
Q

What is dislocation

A

Complete loss of continuity between two articulating surfaces

Presents as sev pain especially on movement of joint

46
Q

Before attempting reduction the patient should be given..

A

Analgesia
Sedation
Nerve block

47
Q

What are sprains

A

Classified as a soft tissue injury in which ligaments are damaged resulting from an abnormal motion of a joint

Injury to the fibres of a supporting ligament of a joint

48
Q

How should sprains be treated and managed

A

Apply ice

Elevation

Analgesia

NSAIDS

Physical therapy and rehabilitative exercises

Immobilisation techniques such as splints, braces, air casts, elastic bandages

49
Q

What is tendinitis

A

Inflammatory condition = pain at tendinous insertions into bone occuring in the setting of overuse

Presents as pain with motion and limited function, may be tender

50
Q

Common sites for tendinitis

A

Rotator cuff of shoulder

Achilles tendon

Radial aspect of the wrist and elbow joint

51
Q

What is bursitis

A

Painful inflammation of a bursa

52
Q

Causes of bursitis

A

Trauma

Infection

Systemic illness

53
Q

Where does bursitis usually occur

A

Olecranon

Subacromial

Greater trochanter of femur

Prepatellar bursa

54
Q

How to treat tendinitis

A

Use of rest

ICE

NSAIDS

Rehabilitation and training

55
Q

Orthopaedic injuries are part of the secondary survey unless…

A

There is profuse bleeding or ischaemia of limb

Block 12 (11 decks)

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