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20 Cards in this Set
- Front
- Back
Define fracture
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A breach of the integrity of part or the whole of a bone.
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Define subluxation
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Partial separation of the articular surfaces of the joint.
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Define dislocation
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Complete separation of the articular surfaces of a joint.
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Define a fracture dislocation
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A dislocation where there is also a fracture involving one or more of the articular surfaces of a joint.
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Define sprain
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Stretching of the joint capsule and ligaments of a joint, insufficient to produce subluxation or dislocation.
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How does bone break?
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Depends of the force/energy of the blow
- A normal bone will break under excess energy - A weak bone will break under normal energy |
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Give 3 possible causes for weak bones
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1. Osteoporosis = decreased density of bone
2. Osteogenesis imperfecta = Type II collagen not present, or only present in small quantities → fractures and bends easily 3. Metastases = osteoblastic and osteolytic lesions both weaken the bone |
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What are the 5 major signs and symptoms of a fracture?
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1. Pain
2. Swelling 3. Tenderness 4. Bruising 5. Deformity Also crepitus and abnormal movement, although may be far harder to assess |
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What causes the pain of a fracture?
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- Nerves of the bone
- Nerves surrounding the fracture - Bleeding, causing inflammation |
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What are the 2 types of fracture?
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1. Simple (closed) fracture = bone does not pierce the skin
2. Compound (open) fracture = bone pierces the skin |
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What are complicated fractures?
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Fractures that cause subsequent damage to other systems e.g. blood vessels, brain / spinal cord / nerves, contents of the chest or abdomen (e.g. broken ribs can puncture lungs)
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How can a fracture be diagnosed?
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1. History and examination
2. X-ray = antero-posterior, lateral, oblique 3. CT 4. MRI 5. Ultrasound 6. Bone scan |
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Describe the pathologies that may occur at the clavicle
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- Clavicle usually have a lateral sided dislocation = break ligaments or breaks bones
- Sternoclavicular joint may be dislocated anteriorly or posteriorly. Posterior S-C dislocations very important to notice as can obstruct subclavian arteries and vein, causing oedema - More likely to fracture towards the acromio-clavicular joint → may lead to damage of brachial plexus or subclavian vein and subsequent paralysis - Treatment of fracture = arm in sling for comfort but little else. Usually results in malunion and a bump, which may be lost in a young child throguh remodelling |
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Describe dislocations and fractures at the scapula
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- Dislocations of the glenohumeral joint most common anteriorly = humerus drops down and looks like a lightbulb
- Posterior dislocations less common and usually caused e.g. by epileptic fit or electric shock. Head of the humerus looks like a lightbulb and seems to overlap the glenoid fossa - Kocher's method now the most advocated for putting the bone back = put the bone back the same way that it came out of the joint - Fracture dislocations not uncommon e.g. anterior dislocation may fracture greater tuberosity of humerus off - Fractures commonly on blade, spine and glenoid fossa - Trauma may cause damage to the axillary nerve and subsequent nerve loss on the regimental patch and limited deltoid function. Also may lead to axillary vein thrombosis |
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Describe the common places for humerus fractures
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- Proximal humerus:
• Greater tuberosity • Head • Anatomical neck • Surgical neck - Diaphysis fractures common and may result in radial nerve injury and wrist drop - Distal fractures = supracondylar fractures (Gartland fractures) → extension injury common in children. Three classes = third worse and has complete displacement and filling with blood. May cause damage to brachial artery, median nerve, or anterior interosseous nerve (leading to damage of extensor indicis) |
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What is compartment syndrome?
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- Increased pressure in a muscular compartment e.g. because it is full of bood or due to swelling → no more blood will enter → muscle death
- Characterised by the 5 P's: 1. Pain = which gets worse, even with analgesia 2. Paraesthesia of cutaneous nerves of compartment 3. Pallor with tense swollen shiney skin 4. Lack of peripheral pulse (less common) 5. Paralysis - eventually - If allowed to continue will result in Volkmann's ischaemic contracture resulting from acute ischaemia of the muscles of the forearm. Permanent flexion contracture of the hand at the wrist, resulting in a claw-like deformity of the hand and fingers. |
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Describe dislocations at the elbow
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- May cause damage or pulling on ulnar nerve running behind medial epicondyle → claw hand
- In children, common to get a pulled elbow due to being pulled or swung from the hands → dislocation of head of radius from the annular ligament as is smaller and less well-fitted than in adult. Easy to fit back in |
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Describe the 2 most common fractures of the forearm
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1. Monteggia fracture
- Fracture in the head of the radius - Since ulna and radius are associated, will get plastic deformation (bowing) of the ulna → shortening - If caught early can put back into place and add a plate to increase ulnar length 2. Colles' fracture - Presents as a dinner-folk deformity of the lower arm and wrist - Radius and ulna are associated so fracture of the distal radius may result in a fracture along the styloid process of the ulnar - May result in median nerve damage so must check for pins and needles and parasthesia etc. |
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What is a Bennett's fracture?
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- Wrist fracture at the base of the 1st metacarpal
- Fracture segment may necrose → degenerative arthritis - Very important as can lose opposition |
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Describe fractures of the scaphoid
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- Pain in the anatomical snuff box
- If suspect but can't see on radiograph treat as a fracture then radiograph again in 2 weeks to confirm - If not treated can lead to avascular necrosis and degenerative arthritis |