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48 Cards in this Set
- Front
- Back
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What is a fracture?
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What is the rule for ordering radiographs of a suspected fracture?
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Rule of 2s
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What is the “Rule of 2s”?
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2 sides: get bilateral images
2 views: AP and lateral 2 joints: above and below suspected fracture 2 times: before and after the reduction |
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What is an open fracture?
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Fracture in which there is air or gas in soft tissues seen on X-ray
OR ANY fracture associated with a deep skin laceration/abrasion/puncture. |
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Name 8 parameters across which a fracture may be described.
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1) Open or closed?
2) Location: which bone, and where in the bone? 3) Morphology of fracture line: transverse, oblique, or spiral 4) Displaced? 5) Segmental? 6) Comminuted? 7) Shortening? 8) Bone quality? (osteopenic?) |
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How do you describe displacement of a fracture?
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Position of distal fragment relative to proximal fragment
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What are the phases of bone healing?
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...
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How long does it take a metaphyseal fracture to heal?
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6 weeks
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How long does it take a cortical fracture to heal?
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12 weeks
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How long does it take a cortical fracture to heal?
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12 weeks
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How do you determine clinically whether a fracture has healed?
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Non-tender to palpation, no instability
No pain on weight bearing |
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How do you determine radiographically whether or not a fracture has healed?
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Presence of bridging or callus across the fracture line
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How would you categorize the complications of fractures?
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Local (early and late)
Systemic |
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Name 5 early local complications of a fracture.
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Compartment syndrome
Nervous injury Vascular injury Infection Fracture blisters |
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Name 5 late local complications of a fracture.
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Mal-union/non-union
Avascular necrosis (AVN, or osteonecrosis) Osteomyelitis Heterotopic ossification Post-traumatic arthritis |
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What is the definition of nonunion?
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Failure of fracture to heal by 6 months
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Name 2 bones prone to nonunion
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Tibia, scaphoid
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Name 3 factors that impair bone healing.
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Smoking, NSAIDs, bisphosphanates
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Name 5 systemic complications of a fracture.
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Sepsis
Hemorrhagic shock DVT/PE Fat embolus ARDS |
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• Describe the pathophysiology of compartment syndrome.
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o Swelling in fascial compartments raises local pressure high enough to occlude local arterial inflow resulting in muscle and nerve ischemia and, potentially, death
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• Fractures of which bone are classically associated with compartment syndrome?
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o Tibia
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• Name an iatrogenic cause of compartment syndrome.
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o Cast that’s too tight!
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• What are the signs and symptoms of compartment syndrome?
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Remember the “5 P’s”
Pain (out of proportion), pallor, paraesthesia, puleslessness, paralysis |
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• How can the diagnosis of compartment syndrome be confirmed?
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o Determine compartment pressure (>30 mmHg) using arterial pressure line
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• What is the treatment for compartment syndrome?
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o Emergency fasciotomy
o Leave skin open o Usually needs skin grafting for closure |
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• What is heterotopic ossification?
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o Ossification of soft tissues (conversion of soft tissues to bone)
o Occurs after severe traumatic damage to soft tissue o Common in burn patients |
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• Name 4 indications for operative treatment of a fracture.
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Open fracture
More than 2 mm of intra-articular displacement Multisite trauma patient Inability to achieve or maintain an acceptable reduction |
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• IM nails are load...
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bearing!
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• Plates are load...
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sharing!
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When taking a history for joint complaints, what associated symptoms should you ask about?
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Remember CLIPS
Clicking Locking Instability ("giving way") Pain Swelling Also about functionality using the mnemonic DEATH Dressing Eating Ambulation Transfers (from bed to standing, standing to chair) Hygiene (bathing) |
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Radiologicall, how do you determine whether or not a closed tibial fracture is sufficiently reduced?
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1) Less than ten degrees of angulation in any direction (varus, valgus, anterior, posterior)
2) Minimum of 1 cm of shortening 3) Minimum of 50% apposition |
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What are the goals in reducing a fracture of the distal radius?
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Restoration of
1) Radial height 2) Radial inclination 3) Radial tilt |
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What is a normal amount of radial height?
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Normal radial height: 11mm
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What is a normal amount of radial inclination?
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Normal radial inclination --> 22 degrees
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What is volar tilt?
What is a normal amount of radial volar tilt? |
Normal volar tilt --> 11 degrees
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What type of immobilization device is used to treat a non-displaced humeral shaft fracture?
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Sugar-tong splint
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What is the treatment for a non-displaced proximal humeral fracture?
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Collar and cuff
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How are fractures of the clavicle broadly classified?
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Based on location (medial, middle, and distal 1/3)
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What is the treatment for a medial clavicular fracture?
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Sling for comfort only
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What is the treatment for a non-displaced middle or lateral clavicular fracture?
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Sling for comfort
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How much must the middle or distal clavicle be displaced before required ORIF?
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>2cm
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What type of immobilization device is used to treat a non-displaced humeral shaft fracture?
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Sugar-tong splint
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What is the treatment for a non-displaced proximal humeral fracture?
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Collar and cuff
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How are fractures of the clavicle broadly classified?
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Based on location (medial, middle, and distal 1/3)
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What is the treatment for a medial clavicular fracture?
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Sling for comfort only
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What is the treatment for a non-displaced middle or lateral clavicular fracture?
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Sling for comfort
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How much must the middle or distal clavicle be displaced before required ORIF?
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>2cm
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How do you treat an open fracture?
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Primary survey/resuscitation
Secondary survey Patient history Remove debris from wound and cover with dressing IV antibiotics and tetanus prophylaxis Splinting of injured area Reduction only if there's neurovascular compromise |
