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Flashcards in Week 118 - Fractured Hip Deck (69):
1

Week 118 - Fractured Hip: Give a definition of fracture.

The loss of continuity of a bone due to physical stress.

2

Week 118 - Fractured Hip: Give a definition of dislocation.

The complete loss of contact between articulating surfaces of a joint.

3

Week 118 - Fractured Hip: What are the five types of fractures of long bones? Give a brief description of each.

• Transverse - Across the bone.
• Spiral - As it says on the tin.
• Oblique - diagonally down the bone.
• Comminuted - The bone breaks into several pieces. (close together).
• Segmental - The bone breaks into more than 2 pieces but the breaks are quite far apart.

4

Week 118 - Fractured Hip: What are the two types of fractures for cancellous bones. Give a brief description of each.

• Impacted - A fracture when bone fragments are driven into each other.
• Crush / Compression - Mostly associated with spinal.

5

Week 118 - Fractured Hip: What is an avulsion fracture?

• This is when a bit of bone is pulled off the rest of a bone by a tendon/ligament.

6

Week 118 - Fractured Hip: What are the four types of deformity that can occur?

• Displacement (shift)
• Angling (Tilt)
• Rotation
• Shortening

7

Week 118 - Fractured Hip: What are the four stages of fracture healing?

• Inflammation
• Soft callus
• Hard callus
• Remodelling

8

Week 118 - Fractured Hip: What is present in a fracture haematoma?

• Fibrin clot
• Platelets
• Monocytes
• Polymorphs

9

Week 118 - Fractured Hip: What marks the start and end of the soft callus stage of fracture healing?

• Begins when pain and swelling subsides.
• Ends with bony fragments being united by fibrous or cartilaginous tissue.

• Bone ends are no longer freely moveable but angulation is still possible.

10

Week 118 - Fractured Hip: What occurs during the hard callus stage of fracture healing?

• Mineralisation of cartilage.
• Osteoblasts convert cartilaginous tissue into woven bone.
• Increasing fracture stiffness.
• External callus.

11

Week 118 - Fractured Hip: What occurs during the remodelling stage of fracture healing?

• Woven bone is converted into lamellar bone.
• Excessive callus removed.
• Medullary canal reconstructed.
• May not be completed for years.

12

Week 118 - Fractured Hip: Which type of fixing methods give relative stability?

• Plaster cast
• IM nails
• External fixation
• Traction
• Circular frames
• Internal fixation with relative stability.

13

Week 118 - Fractured Hip: Which fixing method gives absolute stability?

• Internal fixation with absolute stability.

14

Week 118 - Fractured Hip: What are the rules of two for radiographs?

• Two views (90º)
• Two joints
• Two limbs
• Two occasions

15

Week 118 - Fractured Hip: What are the non-operative options for retention of a fracture?

• Strapping
• Plaster slab/cast
• Traction

16

Week 118 - Fractured Hip: What are the operative options for retention of a fracture?

• Plates and screws
• IM nails
• External fixator
• Percutaneous screws.

17

Week 118 - Fractured Hip: What are the indications for internal fixation?

• Displaced intra-articular fractures.
• Fractures with tenuous blood supply.
• Multiple injuries.
• More than one fracture in a single limb.
• Pathology of long bones.

18

Week 118 - Fractured Hip: What would you expect to see in arterial vascular trauma from a fracture?

• Painful
• Pale or plum coloured
• Paraesthetic
• Pulseless
• Perishing cold

19

Week 118 - Fractured Hip: What is fat embolism? What is the classic triad of symptoms?

• Fat globule in lung parenchyma and peripheral circulation post long bone fracture or major trauma.
• Respiratory, Neurological, Petechial Rash.

20

Week 118 - Fractured Hip: What is compartment syndrome and what are the complications?

• Muscle swelling within a closed osseo-fascial compartment leading to increased pressure.
• Capillary ischaemia and death > neurovascular damage.

21

Week 118 - Fractured Hip: What are the three symptoms of compartment syndrome?

PAIN
PAIN out of proportion of injury.
PAIN on passive stretch of muscles.

22

Week 118 - Fractured Hip: What are two signs of compartment syndrome that come on late and show that you are too late.

• Pins and Needles
• Pulselessness

23

Week 118 - Fractured Hip: What is non union?

• Fracture has failed to unite and healing process is no longer active.
• Fracture will never unite unless treatment is altered.

24

Week 118 - Fractured Hip: What are the two main types of non-union?

• Hypertrophic non-union.
• Atrophic non-union.

25

Week 118 - Fractured Hip: What is hypertrophic non-union?

• Inadequate stability but bone ends are viable.
• Sclerotic and flared bone ends make excessive callus - 'Elephants foot'.
• Visible fracture line filled with fibrous tissue / cartilage.
• Good blood supply.
• Stabilise and union will occur.

26

Week 118 - Fractured Hip: What is Atrophic non-union?

• No evidence of cellular activity.
• Bone ends are rounded and sclerotic.
• Treatment is less reliable and more complex than for hypertrophic non-union.
• Bone ends are removed and rigid stabilisation.

27

Week 118 - Fractured Hip: Where are the most common places that avascular necrosis of bone occurs?

• Femoral head, scaphoid, talus, lunate.

28

Week 118 - Fractured Hip: What is myositis ossificans? What are the most common locations?

• Calcified soft tissue near joints.
• Restricts movement.

• Elbow fracture / dislocation.
• Acetabular fracture.

29

Week 118 - Fractured Hip: What are the local signs of osteitis?

• Tenderness
• Swelling
• Smell
• Discharge

30

Week 118 - Fractured Hip: What is the treatment for osteitis?

• Sample of exudate.
• High doses of appropriate antibiotics.
• Drainage
• Removal of implants?

31

Week 118 - Fractured Hip: What is the definition of a pathological fracture?

Fracture occurring following minimal stress through abnormal bone.

32

Week 118 - Fractured Hip: What are the five types of cancer that most commonly produces bone mets?

• Breast
• Thyroid
• Bronchus
• Prostate
• Kidney

33

Week 118 - Fractured Hip: What are stress fractures?

These are fractures that occur in healthy people, with healthy bones, from repeated forces.

34

Week 118 - Fractured Hip: What are the three types of fracture that are specific to children?

• Greenstick fracture
• Buckle fracture
• Plastic deformity

35

Week 118 - Fractured Hip: What is the difference between child and adult bone?

• Childs periosteum is thicker and more metabolically active.
• There is increased collagen, more porous and elasticity in childrens bones.

36

Week 118 - Fractured Hip: What are the key stages of treatment for open fractures?

• Thorough debridement.
• Skeletal stabilisation.
• Early skin cover.
• Rehabilitation.

37

Week 118 - Fractured Hip: What are the two types of bone?

• Trabecular - Scaffolding
• Cortical - Shell

38

Week 118 - Fractured Hip: What is a Colles fracture?

Fracture of the distal radius with dorsal and radial displacement of the wrist and hand.

39

Week 118 - Fractured Hip: What are the risk factors for developing osteoporosis?

• Age
• Female
• Genetics
• Oestrogen deficiency (Early menopause / late menarche)

40

Week 118 - Fractured Hip: What is a DEXA scan used for and how are the results presented?

• Measures peak bone density and compares it to mean peak bone density.
• Results are presented as standard deviations above or below mean peak bone mass. (T-score)

41

Week 118 - Fractured Hip: How does the z-score differ form the t-score?

• z-score compares for age also whilst t-score compares against young adult.
• T-score is best for assessing fracture risk.

42

Week 118 - Fractured Hip: How does the T-score classification system work?

• 0 > -1 - Normal.
• -1 > -2.5 - Osteopenia.
• -2.5 or below - Osteoporosis.
• -2.5 or below with fracture is severe osteoporosis.

43

Week 118 - Fractured Hip: Which DEXA scoring system is used for young adults and children?

• Z-score

44

Week 118 - Fractured Hip: What is the lifestyle treatment for osteoporosis?

• Adequate calcium and vitamin D intake.
• Exercise
• Modify risk factors
• Falls prevention/intervention
• Raise awareness.

45

Week 118 - Fractured Hip: What is the medical treatment for osteoporosis?

• Decrease bone resorption - Bisphosphonates, RANK ligand inhibitors.

• Increase bone formation - Teriparatide, Strontium Ranelate.

46

Week 118 - Fractured Hip: What is the mechanism of action of bisphosphonates? Give examples and give the side effects.

• Inhibit osteoclasts.
• Alendronic acid, Risedronate, Zolendronic acid, ibandronate.
• GI disturbances
• Rare - osteonecrosis of the jaw, atypical femoral fracture.

47

Week 118 - Fractured Hip: What is Denosumab?

• RANK ligand inhibitor.
• Prevents osteoclast differentiation, activation and survival.
• SC injection every 6 months,
• Side-effects - Rare- osteonecrosis of the jaw and atypical fractures.

48

Week 118 - Fractured Hip: What is teriparatide?

• Recombinant human parathyroid hormone.
• Normally PTH causes bone loss, but this is given in pulses which increases bone production and increases BMD.
• Side effects - Bone/muscle pain

49

Week 118 - Fractured Hip: What are the actions of vitamin D? (5)

• Maintain calcium homeostasis
• Maintain bone health
• Increase Ca2+ from the gut
• Increase phosphate absorption from the gut
• Osteoclast function/maturation

50

Week 118 - Fractured Hip: How does vitamin D deficiency lead to reduced bone mineral density?

• Low VitD > Reduced Ca2+ from gut > Reduced serum Ca2+ > Increased PTH > Ca2+ absorbed from bone > reduced BMD.

51

Week 118 - Fractured Hip: What are some of the causes of Vitamin D deficiency?

• Inadequate sunlight.
• Inadequate diet.
• Malabsorption
• Medication (Rifampicin, Phenytoin)
• Abnormal Vit. B metabolism.
• Hypophosphataemia

52

Week 118 - Fractured Hip: What is osteomalacia / rickets?

Vitamin D deficiency in adults / children.

53

Week 118 - Fractured Hip: What are the symptoms of osteomalacia?

• Bone pain/tenderness
• Proximal muscle weakness
• Back pain
• Stress fractures

54

Week 118 - Fractured Hip: What blood results give you a diagnosis of vitamin D deficiency?

• Serum 25(OH) Vit D - low
• Serum PTH - increased
• Serum calcium - low/normal
• Serum phosphate - low
• Alkaline phosphatase - Increased

55

Week 118 - Fractured Hip: What is Paget's disease?

Disordered bone metabolism
- Osteoclast overactivity
- Followed by compensatory osteoblast activity
- Leads to disordered woven bone
- Weaker than normal bone

56

Week 118 - Fractured Hip: What are the bones that are commonly affected by Paget's disease?

• Spine
• Pelvis
• Skull
• Femur

57

Week 118 - Fractured Hip: What are the symptoms of Paget's disease?

• Direct - Bone pain (deep, constant, worse on weight bearing, pathological fracture)
• Indirect - High cardiac output, compression effects depending on site.

58

Week 118 - Fractured Hip: What are some of the compression symptoms of Paget's disease?

• Skull - Cranial nerve palsies, Basilar invagination.
• Spine - Sciatica/nerve root entrapment, Cauda equina syndrome.

59

Week 118 - Fractured Hip: What is the treatment of Paget's? Who Should be treated?

• Symptomatic, in danger of nerve compression, around a weight bearing joint.
• Bisphosphonates - Risedronate, Zolendronate.

60

Week 118 - Fractured Hip: In terms of levels of Ca, P, Alk. P what would you expect to find in osteoporosis?

• All normal

61

Week 118 - Fractured Hip: In terms of levels of Ca, P, Alk. P what would you expect to find in osteomalacia?

• Ca - Normal or Low
• P - Low
• Alk. P - High

62

Week 118 - Fractured Hip: In terms of levels of Ca, P, Alk. P what would you expect to find in Paget's disease?

• Ca - Normal
• P - Normal
• Alk. P - High

63

Week 118 - Fractured Hip: What is Gardens classification of hip fractures?

1) Incomplete fracture, undisplaced.
2) Complete fracture, undisplaced.
3) Complete fracture, incompletely displaced.
4) Complete fracture, complete displacement.

64

Week 118 - Fractured Hip: What are the four surgical options for the treatment of intracapsular hip fracture?

• Dynamic hip screw.
• Cannulated screw.
• Hemiarthroplasty.
• Total hip replacement.

65

Week 118 - Fractured Hip: What are the surgical options for the treatment of an extracapsular hip fracture?

• Dynamic hip screw.
• Intermedullary femoral nail.

66

Week 118 - Fractured Hip: A dynamic hip screw is the preferred method of surgery for hip fractures in which situations?

• Provides optimal stability.
• Preferred in extra-capsular hip fractures, since the risk of AVN is lower.
• Used in younger patients with intracapsular hip fractures wherever possible.

67

Week 118 - Fractured Hip: What is a cannulated screw?

• A surgical option where additional rotary stability is required, a further screw is added to a dynamic hip screw.
• Preferred in extracapsular fractures due to lower risk of avascular necrosis, but is also used for intracapsular fractures in younger patients.

68

Week 118 - Fractured Hip: Hemiarthroplasty.

• Most common surgical treatment for fractured hips.
• Used for intracapsular fractures or when the risk of AVN is high.
• The femoral head is replaced by a prosthesis.

69

Week 118 - Fractured Hip: What is the FRAX tool used for?

• This assesses 10 year hip, spine, shoulder and forearm fracture risk.