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20 Cards in this Set

  • Front
  • Back
Define fracture
A breach of the integrity of part or the whole of a bone.
Define subluxation
Partial separation of the articular surfaces of the joint.
Define dislocation
Complete separation of the articular surfaces of a joint.
Define a fracture dislocation
A dislocation where there is also a fracture involving one or more of the articular surfaces of a joint.
Define sprain
Stretching of the joint capsule and ligaments of a joint, insufficient to produce subluxation or dislocation.
How does bone break?
Depends of the force/energy of the blow
- A normal bone will break under excess energy
- A weak bone will break under normal energy
Give 3 possible causes for weak bones
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
What are the 5 major signs and symptoms of a fracture?
1. Pain
2. Swelling
3. Tenderness
4. Bruising
5. Deformity
Also crepitus and abnormal movement, although may be far harder to assess
What causes the pain of a fracture?
- Nerves of the bone
- Nerves surrounding the fracture
- Bleeding, causing inflammation
What are the 2 types of fracture?
1. Simple (closed) fracture = bone does not pierce the skin
2. Compound (open) fracture = bone pierces the skin
What are complicated fractures?
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)
How can a fracture be diagnosed?
1. History and examination
2. X-ray = antero-posterior, lateral, oblique
3. CT
4. MRI
5. Ultrasound
6. Bone scan
Describe the pathologies that may occur at the clavicle
- 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
Describe dislocations and fractures at the scapula
- 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
Describe the common places for humerus fractures
- 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)
What is compartment syndrome?
- 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.
Describe dislocations at the elbow
- 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
Describe the 2 most common fractures of the forearm
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.
What is a Bennett's fracture?
- Wrist fracture at the base of the 1st metacarpal
- Fracture segment may necrose → degenerative arthritis
- Very important as can lose opposition
Describe fractures of the scaphoid
- 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