Term
| which fractures may disrupt blood supply to head of femur and cause avascular necrosis? |
|
Definition
|
|
Term
| how far below the lesser trochnacter can the fracture be to be named an extracapsular fracture? |
|
Definition
| needs to be less than 5cm below lesser tronchanter of femur. |
|
|
Term
|
Definition
age
osteoporosis
malignancy and mets
falls
gait disturbance
smoking |
|
|
Term
| typical presentation of NOF fracture? |
|
Definition
| shortened leg, adducted and externally rotated |
|
|
Term
| mortality after surgery for NOF? |
|
Definition
|
|
Term
Shentons line is not continuous in NOF fractrues.
what does this line represent? |
|
Definition
it represents the relationship between the HEAD OF FEMUR TO ACETABULUM
it is broken in NOF fractures. |
|
|
Term
| if you suspect a hip fracture but xrays do not show it what should you perfomr |
|
Definition
MRI
if this is CI due to pacemaker or not available in 24 hour then do CT |
|
|
Term
| how are intracapsular NOF fractures normally graded? |
|
Definition
using the Gardens classification.
grade I - cortex intact. no displacement
grade II - fracture in cortex but still no displacement
grade III - slight displacement/roattaion
grade IV - gross displacement of femoral head |
|
|
Term
| what would be included in your early assessment for someone presenting with fracture NOF? |
|
Definition
FBC- anemia
cross match - hypovolemia and later surgery
UE- rhabdomyolysis, electrolyte imbalance and AKI
glucose- uncontrolled diabetes
ECG - arrhythmias
CXR - uncontrolled HF, or chest infection |
|
|
Term
| surgical mx of intracapsular fractures? |
|
Definition
surgery within 1 day of admission
undisplaced fractures - internal fixation with screws
displaced intracapsular fracture?- THR or hemiarthroplasty |
|
|
Term
|
Definition
| internal fixation with screws |
|
|
Term
| displaced intracapsular fracture needs? |
|
Definition
| THR or hemiarthroplasty because there is a risk of lack of blood to femoral head causing avascular necrosis. |
|
|
Term
| factors that need to be considered when doing a THR for displaced intracapsular fractures for NOF? |
|
Definition
pt shold be able to walk independently with with only use of walking stick
they cannot be cognitively impaired
they need to be fit for anesthesia |
|
|
Term
| 3 factors that need to be present for a person to have a THR for a displaced intracapsular fracture NOF? |
|
Definition
walk independently with only use of walking stick
no cog impairement
safe for anesthesia and surgery |
|
|
Term
| mx of extra capsular fractures? |
|
Definition
DHS
this is also the mx for undisplaced intracapsular fractures. |
|
|
Term
| complications of surgery after NOF fracture |
|
Definition
infection
avascular necrosis
haemorrhage
delayed union, mal union
pneumonia
MI
stroke |
|
|
Term
| I am a fracture that lies obliquely to the long axis of the bone? |
|
Definition
|
|
Term
| if a fracture has >2 segments it is known as a? |
|
Definition
|
|
Term
| if there is > 1 fracture along the bone it is known as? |
|
Definition
|
|
Term
| classification of intracapsular fractures is by the Garden system. what classification is used for Open fractures? |
|
Definition
Gustillo and Anderson. there are 3 classifications
1- low energy fracture <1 cm
2- > 1cm. moderate soft tissue damage
3- this is further divided and is high energy wound more than 1 cm |
|
|
Term
| key points in mx of fractures? |
|
Definition
immobilise fracture incl proximal and distal joints
check neurovascular status especially after immobilisation and reduction
mx infection incl tetatnus
if open injury: IV broad spec Abx |
|
|
Term
common mx for open fractures?
how quickly should open fractures be managed? |
|
Definition
thorough debridement and washout
IV broad spec Abx
Avoid internal fixation or use with caution
open fractures constitute an emergency and should be debrided and lavaged within 6 hours. |
|
|
Term
| avascular necrosis of the femoral head is a risk in which type of fractures? |
|
Definition
| displaced fractures. this is because the blood supply to the femoral head runs up the neck of femur |
|
|
Term
| using Garden classification tell me which classes of fracture cause most blood supply disruption? |
|
Definition
| Class III and IV because these 2 are displaced. |
|
|
Term
| mx of undisplaced intracapsular fracture with no co morbidities? |
|
Definition
|
|
Term
| mx of undisplaced intracapsular fracture with major illness or advanced organ specific disease? |
|
Definition
|
|
Term
| displaced intracapsular fracture age < 70 what Is the mx? |
|
Definition
| internal fixation if possible if not then hip arthroplasty |
|
|
Term
| displaced intracapsular #NOF in a pt > 70. what is the mx? |
|
Definition
|
|
Term
| displaced intracapsular fracture but the pt is immobile what would you do? |
|
Definition
|
|
Term
|
Definition
|
|
Term
extracapsular# subtrochanteric. what is the management?
this is also the mx for reverse oblique and tranverse fractures. |
|
Definition
|
|
Term
| what is an intracpsular # AKA? |
|
Definition
subcapital #
this goes from the edge of the femoral head to the insertion of the capsule of the hip joint. |
|
|
Term
| what is the name of the # that typically results from punching a hard surface such as a wall. which metacarpal does this fracture typically affect? |
|
Definition
Boxer #
affects 5th metacarpal. results in minimal displacement. |
|
|
Term
features of a buckle fracture.
this # is characterised by bulging of the cortex |
|
Definition
occurs in 5-10 year olds
incomplete fractures of shaft of long bone.
self limiting and do not usually need operating
you can splint and immobilise rather than a cast. |
|
|
Term
Colles fracture is known as a dinner form deformity. what are the classic features of this?
this is due to falling on outstretched hand |
|
Definition
Tranverse # of radius
1 INCH PROXIMAL TO RADIO-CARPAL JOINT
there is dorsal displacement and angulation |
|
|
Term
| what is the # that is known as the reverse Colles fracture? what are the features? |
|
Definition
Smiths fracture (garden spade deformity)
occurs in distal radius
due to falling backwards on outstretched palm or falling with wrists flexed. |
|
|
Term
| which # can be due to fist fights and on XRAY you see a triangular fragment at the ulnar base of the metacarpal |
|
Definition
Bennet's #
this affects the 1st carpometacarpal joint |
|
|
Term
| what is the name of the # where there is dislocation of the proximal radioulnar joint in association with a ulnar fracture. |
|
Definition
Monteggias #
this is due to a fall on outstretched hands with forced pronation
this is needs urgent diagnosis to avoid disability |
|
|
Term
Pott's # occurs in the foot. It is characterised by a bimalleolar ankle #.
when can this occur? |
|
Definition
| when the foot has be forced into eversion |
|
|
Term
where does a Galeazzi # occur?
what is it caused by? |
|
Definition
in the radial shaft
caused by a direct blow
there is associated dislocation of the distal radioulnar joint. |
|
|
Term
| if a colles or a smith # is associated with radiocarpal dislocation what is the # called? |
|
Definition
Barton's #
the fall is onto an extended wrist with pronation |
|
|
Term
| which radial shaft # can occur after a fall on the hand with a rotational force superimposed onto it? |
|
Definition
Galleazzi #
RADIAL SHAFT# WITH DISLOCATED DISTAL RADIOULNAR JOINT.
there is bruising/swelling/tenderness over lower end of forearm
xrays: displaced radius# with prominent ulnar head due to dislocation of inferior radioulnar joint. |
|
|
Term
| which position must the hand be put in to visualise a scaphoid #? |
|
Definition
| Ulnar deviation and AP xray needed. |
|
|
Term
| which incomplete fracture common in children results in a periosteal haematoma. mx for this #? |
|
Definition
Buckle fracture
self limiting. doesn't need operation but can be put into a splint rather than a cast. |
|
|
Term
| which classes of Salter harris # will need surgery? |
|
Definition
|
|
Term
| which class of Salter Harris # is associated with disruption to growth? |
|
Definition
|
|
Term
| metastatic causes of bone # |
|
Definition
Breast
Bronchus -lung
Kidney
Thyroid
Prostate |
|
|
Term
| Strontium ranelate is a dual action bone agent. remember this because there are 2 words in its name. what are the actions? |
|
Definition
promotes bone formation by encouraging osteoblasts
reduces bone resorbtions by inhibiting clasts. |
|
|
Term
| Raloxifene... to remember the mode of action just think it rhymes with Tamoxifene. Now tell me what is the MOA? |
|
Definition
SERM. selective estrogen receptor modulator.
increased risk of VTE
reduces risk of breast cancer
can worsen menopausal symptoms |
|
|
Term
| which osteoporosis prevention meds are give once monthly and 6 monthly. what are their MOA? |
|
Definition
Ibandronate - once month. bisphosphonate that inhibits osteoclasts.
Denosumab - inhibits RANK that inhibits maturation of osteoclasts. given once 6 monthly |
|
|
Term
| at what age should men and women be assssed for osteoporosis according to NICE? |
|
Definition
|
|
Term
| features of ruptured ACL? |
|
Definition
due to a high twisting force applied to a bent knee
loud crack, pain and rapid swelling (haemarthroses)
poor healing
mx: surgery or rapid physio |
|
|
Term
|
Definition
injury with hyperextension of knee
the tibia lies back on the femur |
|
|
Term
| features that indicate a meniscal tear? |
|
Definition
delayed knee swelling
locking |
|
|
Term
which injury occurs in teenage girls and results in pain going up and down stairs or at rest?
there may also be tenderness and quadriceps wasting |
|
Definition
|
|
Term
| tibial plateau fractures occur when the knee is forced into varus or valgus. basically the ligament is stronger than the bone so the bone breaks before the ligament snaps. these fractures are common in elder but how are they classified? |
|
Definition
| using the Schatzker system |
|
|
Term
| mx of impacted # of the humer through the surgical neck |
|
Definition
collar and cuff for 3 weeks followed by physiotherapy
more significant displaced # may need open reduction and fixation with intramedullary device. |
|
|
Term
| Ottawa ankle rules are used to minimised the unnecessary used of ankle xrays what are the rules? |
|
Definition
if there is pain in the malleolar zone and :-
inability to weight bare for 4 steps
tenderness over distal tibia
bone tenderness over distal fibula |
|
|
Term
weber classification is used to describe ankle #'s
this is related to the level of the FIBULAR #
what are the features? |
|
Definition
Type A - below syndesmoses
Type B - level of syndesmosis
Type C - above syndesmosis |
|
|
Term
|
Definition
| a slightly movable fibrous joint e.g. distal tibia and fibula joint. |
|
|
Term
|
Definition
need to be promptly reduced to reduce pressure on overlying skin and subsequent necrosis.
young people can get surgery using compression plates
but in elderly conservative mx is better as their thin bones do not hold metal well. |
|
|
Term
| which two # carry the highest risk for compartment syndrome? |
|
Definition
tibial shaft injuries
supracondylar fractures. |
|
|
Term
in compartment syndrome what pressures would worry you.
what pressure is diagnostic of this syndrome.
mx? |
|
Definition
pressures >20mmHg are abnormal
pressures > 40mmHg are diagnostic
MX: fASCIESTOMY
complications: AKI from myoglobiuria. the pt wil need aggressive fluids. |
|
|
Term
| features of wound healing |
|
Definition
haemostasis : mins to hours
inflammation: 1-5 days
regeneration:7-56 days
remodelling: 6weeks to 1 year |
|
|
Term
| which stage of wound healing is characterised by vasospasm in nearby vessels, platelet plug formation and a fibrin rich clot? |
|
Definition
|
|
Term
| this stage of wound healing involves migration of neutrophils, realease of growth factors, replication of fibroblasts? |
|
Definition
inflammation stage
typically occurs on days 1-5
macrophages and fibroblasts couple matrix regeneration and clot substitution |
|
|
Term
| in this stage of wound healing angiogenesis occurs and the wound resembles granulation tissue. which stage? |
|
Definition
|
|
Term
| this is the longest phase of the healing process. what is it and what are the features? |
|
Definition
remodelling
fibroblasts deferentiate into myofibroblasts and help wound contraction
collagen fibres are remodelled and microfibers regress leaving a pale scar |
|
|
Term
| what factors can impair healing? |
|
Definition
vascular disease
sepsis
shock
jaundice: impairs fibroblast synthetic function and immunity.
nutrition |
|
|
Term
| difference in appareance between a hypertrophic and a keloid scar? |
|
Definition
hypertrophic scar: remains within the boundaries of the original wound. may contain nodules and can regress over time
keloid: passes beyond boundary of the original wound.does not contain nodules and does not regress over time. |
|
|
Term
| drugs that can impair wound healing? |
|
Definition
NSAIDS
steroids
immunosuppressive drugs
anti cancer drugs |
|
|
Term
| factors that predispose to development of pressure ulcers? |
|
Definition
malmourishment
incontinence
diabetes
lack of mobility and pain (leads to lack of mobility) |
|
|
Term
| the Waterlow pressure ulcer grading. what are the features? |
|
Definition
grade 1- non blanching erythema on intact skin
grade 2- partial thickness skin loos. may present as an abrasion or a blister
grade 3 -full thickness skin loss
grade 4- extensive destruction, damage to muscle, bone and tissue necrosis. |
|
|
Term
| if a person has a non blanching red patch in a area of skin overlying bone and they are immobile what grade of ulcer using Waterlow score is this? |
|
Definition
grade 1 - non blanching ulcer
grade 2 - may present as a blister or abrasion
grade 3 - full thickness ulcer
grade 4 -extensive destruction |
|
|
Term
| in care of pressure ulcers what kind of environment encourages wound healing? moist or dry? |
|
Definition
a moist environment. this is why the use of soaps are not advised.
hydrocolloid dressing and hydrogels may facilitate healing. |
|
|
Term
| measures that may increase risk of surgical site injury? |
|
Definition
shaving rather than using clippers
tissue hypoxia
using a non iodine impregnated incise drape if one is required
delayed admin of prophylactic Abx in tourniquet surgery |
|
|
Term
| which part of clostridium is implicated in tetatnus? |
|
Definition
the exotoxin.
spores are found in the soil.
the toxin prevents release of GABA |
|
|
Term
| Abx of choice in tetatnus? |
|
Definition
|
|
Term
| how many doses of tetanus is considered to provide adequate protection? |
|
Definition
|
|
Term
in what sort of injuries would you give tetatnus prophylaxis?
in which form would you give this in |
|
Definition
irrespective of whether the pt has had their 5 tetanus 5 boosts you would give in cases where:-
high risk wounds e.g compound #, delayed surgical intervention, or if there is a significant degree of devitalised tissue.
you give IM human tetanus immunoglobulin. |
|
|
Term
| a person has a high risk wound. their tetatnus vaccination hx is unknown how would you treat them? |
|
Definition
give them teatanus vaccine in combo with IM human tetanus immunoglobulin.
high risk wound = delayed surgical intervention, large areas of devitalised tissue, compound fracture. |
|
|
Term
| if someone has diabetes and they are on a surgical list when would you operate on them? |
|
Definition
|
|
Term
stages of bone healing are loosely classified into:-
inflammatory
repair
late remodelling
describe features |
|
Definition
haematoma. after a few days
fibrocartilagenous callous formation: soft callous formation from granulated tissue.
after a few weeks:-
bony callous formation stage: soft callous become bony callous
after several months
bony callous remodels to become fine bone |
|
|
Term
| in which stage can smoking slow down bone healing? |
|
Definition
| in the repair stage when fibroblasts are laying down stroma- soft callous stage |
|
|
Term
| 4 stages of bone remodelling? |
|
Definition
Haematoma
fibrocartillagenous soft callous stage
bony callous formation
remodelling into compact bone. |
|
|
