Principles of fractures and dislocations

Samantha Fredman
Mind Map by Samantha Fredman, updated more than 1 year ago
Samantha Fredman
Created by Samantha Fredman over 4 years ago
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Week 1 lecture Principles of fractures and dislocations Mechanism of Injury Examples
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Principles of fractures and dislocations
1 Stress fracture
1.1 normal bone
1.2
1.3 repetitive stress
2 Pathological fracture
2.1 abnormal bone
2.1.1 metastatic disease
2.1.2 benign lesion
2.2 vs
2.3 physiological stress
3 Force
3.1 Direct
3.1.1 break at point of impact (POI)
3.1.1.1 + soft tissue damage
3.2 Indirect
3.2.1 break away from POI
3.2.1.1 +/- soft tissue damage
4 Mechanism of Injury
4.1 Spiral
4.1.1 TORSION
4.1.1.1 rotational force applied to a lever
4.1.1.1.1 humerus
4.1.1.1.2 femur
4.2 Short Oblique
4.2.1 COMPRESSION
4.2.1.1 greenstick
4.2.1.1.1 children due to thickenss of periosteum
4.3 Butterfly
4.3.1 BENDING
4.3.1.1 Car accident
4.3.1.2 Comminution
4.3.1.2.1 e.g. vertebral comminution common when subject to
4.4 Transverse
4.4.1 TENSION
5 How to describe a fracture
5.1 open or closed?
5.1.1 open- antibiotics + cleaning of bone ends
5.2 bone(s)?
5.2.1 location?
5.3 simple or comminuted?
5.4 complete or incomplete?
5.5 involvement of joint?
5.6 displaced or non displaced?
5.6.1 displacement
5.6.1.1 translation
5.6.1.1.1 describe with reference to distal fragment (50%, 100%, or complete (off ended
5.6.1.2 alignment
5.6.1.2.1 angulation
5.6.1.3 rotation
5.6.1.3.1 twist
5.6.1.4 length
5.6.1.4.1 distraction
5.6.1.4.2 separation
5.6.1.4.3 overlap
5.7 traumatic, stress or pathological?
6 HEALING
6.1 INDIRECT
6.1.1 In tubular bone in the absence of rigid fixaiton
6.1.1.1 1. Haemotoma formation
6.1.1.2 2. Inflammation and Cellular proliferation
6.1.1.3 3.Callus
6.1.1.3.1 response to movement at the fracture site
6.1.1.3.2 stabilise
6.1.1.4 4. Consolidation
6.1.1.5 5. Remodelling
6.2 DIRECT
6.2.1 fracture immobilised
6.2.1.1 example
6.2.1.1.1 Fixed with metal plate
6.2.1.1.2 impacted cancellous bone fracture
6.2.1.2 fracture healing occurs directly between fragments WITHOUT CALLUS
6.3 HOW LONG?
6.3.1 dependant on age, nutrition, general health, blood supply, type of fracture, fracture stability
6.4 promoted by physiological loading of bone (DONT IMMOBILISE)
7 CLINICAL FEATURES
7.1 LOOK
7.1.1 swelling
7.1.2 bruising
7.1.3 deformity
7.1.4 skin intact?
7.2 FEEL
7.2.1 bony tenderness
7.2.2 crepitus
7.2.2.1 grating bone against bone
7.2.3 pulses
7.2.4 associated injuries
7.2.4.1 tense compartment= compartment syndrome
7.3 MOVE
7.3.1 maybe not if patient awake and conscious
7.3.1.1 x-ray might be more appropriate
7.4 NEUROVASCULAR EXAM
7.4.1 all nerves and vessels traversing the compartment
7.4.1.1 at presentaiton AND after any intervention
8 IMAGING
8.1 X-RAY
8.1.1 rule of 2's
8.1.1.1 views, joints, limbs, injuries, occassions
8.2 ADVANCED IMAGING
8.2.1 Technitium Bone Scan
8.2.1.1 may be "cold" if performed within 48-72 hours of injury
8.2.2 CT
8.2.2.1 complex or interarticular fractures
8.2.2.2 used to define bony anatomy
8.2.3 MRI
8.2.3.1 assessment of associate structures
8.2.3.1.1 spinal cord, nerve root, ligament injuries
8.2.3.2 soft tissue anatomy definition
9 TREATMENT
9.1 REDUCTION
9.1.1 aim for adequate apposition and normal alignment
9.1.2 closed
9.1.2.1 + anasthesia
9.1.2.2 distal limb pulled in line with bone
9.1.2.3 fragments disengage and are repositioned
9.1.2.4 alignment adjusted in each plane
9.1.2.5 use
9.1.2.5.1 most fractures in children
9.1.2.5.2 for fractures that are stable after reduction
9.1.2.5.2.1 can be fixated
9.1.2.5.3 Unstable fractures can be reduced prior to internal fixation
9.1.3 open
9.1.3.1 operative reduction under direct vision
9.2 FRACTURE IMMOBILISATION
9.2.1 casting/ FIXATION
9.2.2 continuous traction
9.2.2.1 typically children
9.2.3 cast splintage
9.2.4 funcitonal bracing
9.2.5 internal fixation
9.2.5.1 wires
9.2.5.2 plates and screws
9.2.5.3 intermedullary nails
9.2.6 external fixation
9.2.7 internal vs External
9.3 REHAB
10 COMPLICATIONS
10.1 EARLY
10.1.1 vascular injury
10.1.2 nerve injury
10.1.2.1 shoulder- axillary
10.1.2.2 humerus- radial
10.1.2.3 humerus supracondylar- radial or median
10.1.2.4 hip- sciatic
10.1.2.5 knee- fibular
10.1.3 compartment syndrome
10.1.3.1 5 P's
10.1.3.1.1 pain out of proportion to injury and pain on passive stretch most important
10.1.4 fracture blisters
10.1.5 infection
10.2 LATE
10.2.1 delayed union/ nonunion
10.2.1.1 Injury factors
10.2.1.2 treatment factors
10.2.1.3 Pt factors e.g. smoking, NSAIDs, drinking
10.2.1.4 Hypertrophic non-union: florid periosteal new bone formation, wants to heal- biology of healing okay just needs stability
10.2.1.5 Atrophic non-union- no signs of healing, needs improved biology
10.2.2 malunion
10.2.3 avascular necrosis
10.2.3.1 Femoral head, scaphoid, talus
10.2.4 growth disturbance
10.2.5 joint impairment
10.2.6 pain syndromes
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