What is a pathologic fracture?
- fractures that result from mild physical exertion or minor trauma (e.g. coughing/sneezing, lifting)
- occur due to abnormal / weakened bone structure due to underlying pathology e.g. osteoporosis
*these fractures would not normally occur - in a healthy bone
What are the complications of open fractures?
- infection
- poor wound healing
Two types of basic management of bone #
A. Conservative (splint, cast)
B. Surgery (anatomic reduction -> fixation -> immobilisation)
Complications of surgery for the #
- acute nerve
- vascular injury
- compartment syndrome
- avascular necrosis
- nonunion
The common type of long bone #
Complete vs incomplete fracture
What do they mean?
Complete: # that extends through the entire length of bone
What does comminuted fracture mean?
More than two fracture lines - results in multiple bone fragments
Types of fracture displacement
What’s segmental #?
Two fracture lines with a fragment of a bone between a distal and proximal portion of the bone
What’s a Salter-Harris fracture?
A paediatric fracture with a growth plate involvement
What’s a stress fracture?
A # caused by repetitive stress to the bone without an underlying bone pathology/ disease affecting it
What happens to the radius and ulna in Colle’s fracture?
distal radius +/- ulna
*due to fall on ‘outstretched’ hands
What’s Smith’s #?
Fracture of distal radius (anterior displacement)
Possible clinical presentation of the fractures
- Pain, redness, and swelling at the site of injury
- Deformity and axis deviation
- Bone fragments penetrating the skin
- Palpable step-off or gap
- Bone crepitus
- Concomitant soft tissue injuries
- Neurovascular compromise below site of injury
Features of:
Montaeggia vs Galeazzi fractures
What bone is typically located in ‘boxer #’? (punching a hard surface)
5th metacarpal neck
Scaphoid fracture
- what bone is involved
- typical Hx
- examination features
- the most common # of a carpal bone
- typical Hx: fall on outstretched hands
- examination features: pain when a pressure applied to anatomical ‘snuffbox’
What to assess for in a presentation of fracture?
Clinical assessment
- Assess for signs of a fracture and concomitant injuries
- Assess for neurovascular compromise and compartment syndrome with the 6 P’s: pain, pallor, pulselessness, paresthesia, paralysis and poikilothermia
What are 6 P’s in the assessment of a neurovascular compromise/compartment syndrome in a fracture?
6 P’s:
- pain
- pallor
- pulselessness
- paresthesia
- paralysis
- poikilothermia
(poikilothermia - impaired ability to regulate body temperature - cool limb)
General management of the #
General approach
- Wound care
- Pain management (e.g., non-opioid analgesics, opioids)
- Fracture care (conservative or surgical)
- Anatomic reduction
- Fixation
- Immobilization
Indications for a surgical management of the fracture
- open fracture
- inadequate manual reduction or fixation
- unstable fracture
- severe displacements and fragments
Outline the surgical procedure for the fractures (steps)
Procedure:
- anatomic reduction of the fracture
- fixation
- immobilization using external or internal fixation devices (e.g., plates, screws, wires
What’s Garden’s classification used for?
Categorisation of intracapsular neck of femur fractures
Types of hip fractures
A. Intracapsular
B. Extracapsular
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Random facts 124
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Fractures27
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Random facts 232
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Local anaesthetics28
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Jaundice33
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Vascular_142
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Vascular_229
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Pre-op45
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Fluids48
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Post-Op _134
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Random facts 35
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Wound30
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Compartment and Cauda Equina syndromes22
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Post_op 211
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IV and inhalational anaesthetics31
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Airway management and ventilation25
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Trauma management29
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Nutrition61
