Trauma and fractures Flashcards
1
Q
polytrauma definition
A
trauma with more than on of; major long bone pelvis chest abdo region
…fractures
2
Q
treatment of open fractures (5)
A
broad spectrum antibiotics (flucloxacillin, gentamicin, metronidazole) sterile dressing tetanus injection debridement surgery surgery to fix fracture
3
Q
when describing a fractures displacement and angulation, which fragment are you referring to (distal or proximal)
A
distal
4
Q
splintage examples
A
temporary plaster
sling
5
Q
what is ORIF and when is it used
A
open reduction and internal fixation
surgery with intramedullary nails, pins, plates, screws etc
used for displaced intra articular fractures
6
Q
when would you do joint replacement for a fracture
A
periarticular fracture with risk of AVN
7
Q
what is external fixation and when would you do it
A
external brace with nails into bone
if there is swelling or unstable fracture, need swelling to be down to do surgery
8
Q
is the bone remodeling rate the same in all bones
A
no changes depending on site
9
Q
is bone remodeling quicker or slower in kids
A
quicker
10
Q
when does primary bone healing take place (size of fracture + 2 examples)
A
fracture <1mm
hairline fractures
fractures fixed with screws
11
Q
what cell is involved in primary bone healing
A
osteoblasts
12
Q
what do osteoblasts do in primary bone healing
A
form a bridge over the fracture
13
Q
when does secondary bone healing take place (instead of primary bone healing)
size of fracture
A
fracture >1mm
14
Q
requirements for secondary bone healing (4)
A
oxygen
nutrients
stem cells
little movement (stabilisation with cast)
15
Q
what are the 4 stages of secondary bone healing
A
- inflammation
- soft callus/bridging callus
- hard callus
- remodelling
16
Q
in secondary bone healing, what cell is involved in stage 2. soft callus/bridging callus
what do they form
A
chondroblasts
cartilage
17
Q
in secondary bone healing, what cell is involved in stage 3. hard callus
A
osteoblasts
18
Q
in secondary bone healing, what happens in stage 4. remodelling
A
smoothing of bone
19
Q
what is the most serious complication of fractures in limbs
A
compartment syndrome
20
Q
what is compartment syndrome
A
broken bone = swelling of tissue = increased pressure in a limb compartment
21
Q
what is the consequence of increased pressure in a compartment in compartment syndrome
A
occludes venous drainage = muscle ischaemia
22
Q
how does compartment syndrome present (5)
A
severe pain, worse on stretching of muscle swollen limb tender limb loss of peripheral pulse cold
23
Q
treatment of compartment syndrome
A
MEDICAL EMERGENCY
fasciotomy - open fascia to release pressure, leave open for a few days then fix problem
24
Q
early local complications of fractures (5)
A
vascular injury nerve injury compartment syndrome necrosis blistering
25
early systemic complications of fractures (5)
```
hypovolaemia
shock
ARDS
SIRS
multi organ dysfunction syndrome
```
26
late local complications of fractures (3)
non union
volkmanns ischaemic contracture
complex regional pain syndrome
27
late systemic complications of fractures (1)
pulmonary embolism
28
what is volkmanns ischaemic contracture
aetiology
fibrotic contracture of muscle after fracture
aetiology - missed compartment syndrome
29
what is complex regional pain syndrome
swelling
stiffness
exaggerated pain response
in a sight of previous fracture
30
aetiology of atrophic non union after fracture
not enough blood supply
too big gap
drugs
infection
NOT MOVEMENT
31
aetiology of hypertrophic non union after fracture
movement or infection
think HYPER kids move a lot
32
are kids bones better or worse at remodeling than adults
better
33
what is a broken posterior rib in a kid a sign of
non accidental injury
34
'bucket handle fracture'
| 'corner joint fracture' in kids
non accidental injury
35
long bone injury in kids
non accidental injury
36
if you ?non accidental injury in a kid <2, what investigation do you do
full skeletal survey
37
what is the classification of fractures in kids
salter harris classification
38
type I salter harris fracture
in kids
S traight along growth plate
(remember I = S in SALTEr)
39
type II salter harris fracture
in kids
A bove the growth plate (along the top then into metaphysis)
(remember II = A in SALTEr)
40
type III salter harris fracture
in kids
L ower than growth plate (goes along growth plate then down into epiphysis)
(remember III = L in SALTEr)
41
type IV salter harris fracture
in kids
T hrough growth plate (doesnt travel along is, cuts through it)
(remember IV = T in SALTEr)
42
type V salter harris fracture
```
in kids
E rosion (compression on growth plate)
```
(remember V = E in SALTEr)
43
greenstick fracture in kids (xray appearance)
where
when one side of the bone breaks but the otherside is intact
in ulna
44
tores fracture/buckle fracture in kids (xray appearance)
where
looks like a little nob on radius
45
where is a monteggia fracture
midshaft of ulna
46
where is a galeazzi fracture
midshaft of radius
| gAleazzi = rAdius
47
which 2 fractures of the forearm are closely associated (if you get one youll probs get the other)
monteggia and galeazzi fracture
48
what joint is commonly affected in both galeazzia and monteggia fractures
distal radio-ulnar joint (DRUJ)
49
aetiology of supracondylar fracture
fall onto outstretched hand (FOOSH)
50
what nerve is commonly affected in a supracondylar fracture
how can its function be tested
median nerve
make 'ok' sign
51
aetiology femoral shaft fracture in kid <2
non accidental injury
52
treatment of femoral shaft fracture in <6
stabilise
53
treatment of femoral shaft fracture in >6
intramedullary nail (flexible 6-16, non flexible for >16)
54
are dislocations more common in males or females
why
females
more lax ligaments
55
treatment of hip fractures
pelvic hip binder/external fixator
56
complications of hip fractures (5)
```
internal iliac injury (blood loss = hypovolaemia)
bladder injury
nerve injury
urethral injury
pre-sacral venous plexus injury
```
57
is it common to get 1 hip fracture
why
example
no
pelvis is a ring = will break in more than one place
eg open book pelvis
58
investigations of pelvic fracture
PR exam - sacral nerve function
xray
CT
59
who does pubic rami fractures occur in (2)
elderly
| osteoporosis
60
who does acetabular fractures occur in
RTA
| elderly
61
which group of people mainly get proximal femur fractures
elderly
62
what is an intracapsular proximal femur fracture (location)
on or above the intertrochanteric line
63
what is an extracapsular proximal femur fracture (location)
below the intertrochanteric line
64
which type of proximal femur fracture (intracapsular or extracapsular) interfere with the blood supply to the femoral head
intracapsular
65
how do proximal femur fractures present (apart from the obvious lol)
shortened and externally rotated
think about it - if it was dislocated (it presents the opposite) it would be internally rotated bc the femur will pop out of the socket
66
what is the gardens fracture classification for
intracapsular proximal femur fractures
67
xray appearance of intracapsular proximal femur fracture
not smooth shentons line (follow the inside of the femur into the inferior aspect of the superior pubic rami)
compare to the other side if unsure
68
immediate treatment for proximal femur fracture
analgesia - WHO pain ladder
| vit D
69
surgery for intracapsular proximal femur fracture
surgery to sort out the joint (depends on age etc...)
70
treatment of displaced intracpasular proximal femur fracture in active 60 year old
total hip replacement
71
treatment of intracapsular proximal femur fracture in 90 year old in care home
hemiarthroplasty
72
treatment of undisplaced intracapsular proximal femur fracture in active 60 year old
fixation with screws - get to keep their femoral head!
73
treatment of extracapsular proximal femur fracture
internal fixation - dynamic hip screw or intramedullary nail
74
complications of intracapsular proximal femur fracture (3)
non union
AVN
dislocation
75
complications of extracapsular proximal femur fracture (1)
non union
NO RISK OF AVN BC NOT AT THE HEAD!
76
prognosis of someone in a care home that falls and has proximal femur fracture
poor - will drop one level in mobility (stick to zimmer frame to wheelchair etc)
77
aetiology of femoral shaft fractures
high energy - RTA
78
treatment of femoral shaft fractures
Thomas splint
| intramedullary nail - if unstable
79
complications of femoral shaft fractures
BLOOD LOSS = hypovolaemia
80
treatment of proximal tibial fracture
anatomic reduction and internal fixation (eg nails)
81
treatment of proximal tibial fracture if there is swelling
external fixator until swelling goes down then internal fixation
82
complications of proximal tibial fracture (3)
post trauma osteoarthritis
compartment syndrome
common peroneal nerve injury (= foot drop)
83
what is a general complication of fractures around joints
post trauma osteoarthritis
84
aetiology of a impacted tibial plateau fracture (on lateral condyle)
valgus force on a planted foot
eg car knocking over pedestrian
85
what is also likely to break in a tibial shaft fracture
fibula shaft
86
common complication of tibial shaft fracture
how do you prevent it
compartment syndrome
keep them in over night
87
treatment of tibial shaft fracture
cast
| intramedullary nail
88
complication of proximal fibial fracture
common peroneal nerve injury (= foot drop)
89
aetiology of ankle fractures
twisting forces
90
what is the weber classification for
ankle fractures
91
definition of stable ankle fracture
low in fibula BUT no medial malleolus fracture OR rupture of deltoid ligament
92
definition of unstable ankle fracture
low in fibula AND medial malleolus fracture OR rupture of deltoid ligament (bruising)
CAUSES TALAR SHIFT
93
what type of fracture cause talar shift
unstable ankle fracture
94
treatment of stable ankle fracture
cast
95
treatment of unstable ankle fracture
open reduction internal fixation (ORIF) surgery
96
which metatarsal is most commonly fractured
5th
97
where are stress fracture most common in the foot
metatarsal 2 and 3
98
can you see all foot fractures on xray
no - may be too small!
99
toe fracture treatment
boot/strap up
| analgesia
100
foot fracture treatment
moonboots
| cast
101
treatment of proximal humerus fracture (3)
SLING AND PHYSIO
joint replacement - if shattered bone
internal fixation - if young patient (causes stiffness in older people so avoided)
102
humeral shaft fracture treatment (2)
```
BRACE
internal fixation (intramedullary nail, screw etc) - if brace not tolerated
```
103
complication of humeral shaft fracture
radial nerve injury = wrist drop and loss of sensation in first dorsal web space
104
treatment of supracondylar fracture (2)
ORIF
| joint replacement
105
olecranon fracture aetiology
fall onto point of elbow
106
complication of olecranon fracture
avulsion fractures - fragment tears away from rest of bone
107
why are you likely to break your ulna (monteggia fracture) if you break your radius (galeazzi fracture)
they are in a ring
108
treatment of one or both monteggia/galeazzi fractures
ORIF
109
what is a dinner fork/swans neck deformity in the wrists name
colles fracture
110
aetiology of colles fracture
fall onto outstretched hand (FOOSH)
111
complications of colles fracture (3)
carpal tunnel syndrome from blood in compartment
extensor pollicis longus rupture
loss of grip
112
what happens in a colles fracture
ulna??? displaced dorsally
113
reverse colles fracture
smiths fracture
114
fall onto back of hand/flexed wrist
smiths fracture
115
fall onto outstretched hand (FOOSH) = wrist fracture
colles fracture
116
treatment of smiths fracture
plates and screws (ORIF)
117
intraarticular wrist fracture
bartons fracture
118
bartons fracture treatment
plates and screws (ORIF)
119
colles fracture treatment
splint - if stable
| plates and screws - if unstable
120
fracture dislocation at base of thumb
bennetts fracture
121
complication of untreated bennetts fracture (thumb base)
arthritis at joint
122
treatment of bennetts fracture (thumb base)
surgical stabilisation
123
fall onto outstretched hand (FOOSH) hand fracture
scaphoid fracture
124
presentation of scaphoid fracture
pain in anatomical snuffbox
125
treatment of scaphoid fracture
cast
126
which metacarpals do fractures typically occur in
3, 4 and 5
127
what is a 5th metacarpal fracture characteristic of
boxers fracture
128
treatment of boxers fracture (5th metacarpal)
make sure no misalignment
| strap to finger next door
129
complication of boxers fracture (if actually punched someone face and laceration)
septic arthritis
130
phalangeal fracture treatment
strap to neighbouring finger
131
cell proliferation in which bone layer causes increased girth
periosteum
132
cell proliferation in which bone layer causes increased bone length
growth plates
133
what does a sclerotic bone look like on xray
medullary density
| featureless white bone
134
which antibiotics are given prophylaxis in total hip replacement
what is the significance of this
coamoxiclav and amoxicillin
coamoxiclav = 4c antibiotic = c diff risk!
135
treatment of ANY fracture with an open wound
debridement
| then fix problem
136
low impact undisplaced wrist fracture treatment
cast for 5 weeks (just needs stabilisation)
137
most common salter harris fracture
type II - Above the growth plate (epiphysis)
