ANKLE FRACTURES
- what classification?
- Type A?
- Type B?
- Type C?
- also have Maisonneuvre fracture - leads to widening of ankle joint?
- Weber’s classification
- Type A - below level of ankle joint - stable - give PoP or ORIF
- Type B - at the level of the ankle joint - unstable - require ORIF
- Type C - above the level of ankle joint - unstable - require ORIF
- spiral fibular fracture - needs surgery
CHARCOT’S JOINT
- seen in whom?
- joints are typically?
- bony growths?
- Neuropathic arthropathy seen in diabetics with peripheral neuropathy
- red, hot and swollen
- Bony growths/spurs due to plantar pressure.
WEDGE FRACTURES
- where is it?
- seen in whom?
- how does it occur?
- Wedge shaped vertebrae – with increased joint space on one side.
- osteoporosis patients.
- Compression fracture resulting from flexion.
OPEN FRACTURES
- all patients with open fractures should receive?
- complication of open fracture?
- All patients with open fractures should receive cefalozin or equivalent gram +ve coverage
- Also tetanus Ig administration.
- compartment syndrome.
COMPARTMENT SYNDROME
- most commonly found where? associated with which fractures?
- what is it?
- clinical features? - 6P’s
- . If interstitial pressure exceeds capillary perfusion pressure for several hours (4-6) then you get ?
- Tx?
- Most commonly found in lower leg (commonly associated with tibial fractures)
- increased interstitial pressure in an anatomical compartment.
- muscle necrosis and eventually nerve necrosis may result
- surgery.
ANKLE FRACTURES
- what part of ankle has to be affected for it to go from a stable to an unstable fracture?
- medial malleolus,
- syndesmosis
- medial deltoid ligament
HUMERAL FRACTURES
- which nerve is at risk of injury?
- nerve injury at this level results in?
- radial nerve
- wrist drop and reduced sensation in first web space
SUPRACONDYLAR FRACTURES
- most frequently occur in?
- caused by FOOSH?
- on XRay see what sign?
- anterior or posterior fat pad normal?
- injury to which nerve?
- Tx?
- Most frequently in children
- Caused by FOOSH.
- Presentation: see ‘Sail’ sign on lateral X-ray of elbow and represents anterior fat pad being lifted.
- Anterior fat pad is normal but posterior fat pad is never normal
- medial nerve
- internal fixation with K wires
SUPRACONDYLAR FRACTURES
- what classification?
- along with medial nerve injury - what branch of the medial nerve can be affected and how do you test it?
- along with medial nerve - what artery can be compromised?
Gartlands Classification
- Type I – undisplaced
- Type II – displaced but still intact.
- Type III – completely displaced.
- anterior interosseous nerve
- assessed by flexion of the thumb and index finger to make an OK sign - if not then they have AIN palsy
- brachial artery
HUMERAL MIDSHAFT FRACTURES
- What type of fracture?
- Tx? (if displaced or not)
- what nerve can be affected?
- Usually spiral fractures.
- If displaced – ORIF, if not then plaster.
- Complications include radial nerve injury or malunion.
CLAVICLE FRACTURE
- typically presents where on clavicle?
- Tx?
- Typically presents in middle 1/3 of clavicle.
- Treatment – conservative management in a sling, malunion is common but accepted.
what is a pathological fracture?
- Sudden onset pain
- +/- loss of function
- Following normal stress
DISTAL RADIAL FRACTURES
- complications of radial head injuries?
- what ligament surrounds the radial head?
- colles’ fracture?
- smiths fracture?
- barton’s fracture?
- which one of the three above is unstable?
- how do you treat colles/smiths?
- how do you treat Barton’s?
bennett’s fracture?
- boxer’s fracture?
- Tx for boxer’s/any pharyngeal fracture?
- OA
- annular ligament
- colles fracture = dorsal angulation of distal segment
- smiths = palmar angulation of distal segment
- fracture line runs into joint whereas colles/smiths don’t
- barton’s fracture
Colles/smiths - K wiring +/- ORIF
Barton’s - ORIF
- bennett’s = fracture at 1st MCP (base of thumb)
- fracture at distal end of 5th MCP - punching hard things
- buddy/neihgbour strapping to 4th pharyngeal (goes for any pharyngeal fracture
tenderness in anatomical snuffbox?
what mechanism of fall?
complication if untreated?
Tx?
scaphoid fracture
- FOOSH
- avascular necorsis - may develop OA
- undisplaced: PoP
- DISPLACED : ORIF
classification of fractrure Management:
- if closed + undisplaced?
- if closed + minimal displacment)
- if closed + grossly displaced?
- if open ?
- Closed fracture with no displacement – plaster.
- Closed fracture with minimal displacement – manipulation under anaesthesia + plaster.
- Closed with grossly displaced – ORIF or intramedullary nails.
- Open fracture – external fixation.
NOF FRACTURES
- Common in whom?
- presentation?
- When you look at neck of femur fractures – you follow what line to ensure that there is a smooth curvature and to help identify a fracture line?
- intra or extracapsular at risk of AVN?
- classification of intracapsular NOF fractures?
- what is the catchy phrase for trying to remember Tx criteria ?
Hip fractures are common in elderly women due to osteoporosis.
Clinical presentation is a shortened, externally rotated lower limb which is unable to weight bear.
When you look at neck of femur fractures – you follow shenton’s line to ensure that there is a smooth curvature and to help identify a fracture line.
Intracapsular – at risk of AVN.
Garden’s classification of intracapsular neck of femur fractures:
Grade I – partial subcapital fracture.
Grade II – undisplaced subcapital fracture.
Grade III – partially displaced subcapital fracture.
Grade IV – displaced subcapital fracture.
Grade I + II try and screw, Grade III + IV, get the head out the door!!
NOF FRACTURES
Fractures occurring between the lesser and the greater trochanters are called?
are they intra or extracapsular?
intertrochanteric
are extra-capsular as they occur out at the attachment of the hip joint capsule
NOF FRACTURES
An extra-capsular (outside joint capsule) fracture you have two types:
intertrochanteric - Tx?
subtrochanteric - Tx?
- Intertrochanteric – fix with a Dynamic Hip Screw (DHS).
- Subtrochanteric – fix with a intramedullary nail.
In displaced neck of femur fracture the blood supply to the head of the femur may be disrupted - what is the blood supply affected?
femoral circumflex vessels).
Hip Dislocation
- occurs anteriorly or posteriorly?
- presents as shortened limb that is internally or externally rotated?
- complications?
- Mx?
- Occurs posteriorly.
- Presents as a shortened limb that is internally rotated.
Complications include:
- sciatic nerve damage,
- AVN of femoral head and secondary OA.
- Management: analgesia, reduce under sedation.
Patellar Fracture
how do you get a patellar fracture ?
unable to do what leg movement?
if transverse fracture - Mx?
if longitudinal fracture - Mx?
- Usually occurs due to direct fall onto knee.
- Presentation: unable to straight leg raise.
- If transverse fracture: ORIF with banding (most common).
- If longitudinal fracture: non-operative, long leg cylinder caste.
Tib-Fib Fractures
most common open fracture!!
- require what Mx?
- usually get fracture as a result of ?
- Most common ‘open fractures’
- Usually require external fixation.
- As a result of a sporting injury
Salter-Harris Classification
for whom?
ACRONYM:
I S II A III L IV T V ER
What is the most common type?
Childhood fractures – growth plate injuries
I - S – Straight II – A- Above III – L -Lower IV – T - Through V – ER – Erasure of growth plate.
TYPE 2 - 95% are this one
PoP
- how long for upper limb?
- how long for lower limb?
- Principles of plaster technique?
Upper limb is 6 weeks in plaster, lower limb usually 12-16.
Principles of plaster: cover fracture, joint above and below needs to be covered.
