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Phase II: Musculoskeletal > Complications of fractures > Flashcards

Flashcards in Complications of fractures Deck (36):
1

Name 5 urgent local complications of fractures

  • Vascular injury
  • Local visceral injury
  • Compartment syndrome
  • Haemarthrosis
  • Nerve injury
  • Infection
  • Gas gangrene

2

Name 5 less urgent local complications of fractures

  • Pressure sores and blisters
  • Nerve entrapment
  • Heterotopic ossification: bone formation in soft tissue
  • Ligament injury
  • Tendon lesions
  • Joint stiffness
  • Regional pain syndrome

3

Name 5 late local complications of fractures

  • Malunion
  • Non-union
  • Avascular necrosis
  • Muscle contracture
  • Joint instability
  • Regional pain syndrome
  • Osteoarthritis

4

Name 2 emergency viscercal injuries following fracture

  • Pneumothorax: rib fractures
  • Ruptured bladder or urethra: pelvic fractures

These require emergency treatment prior to fracture treatment

5

Name the 3 commonest vascular injuries seen with fractures?

  • Anterior tibial artery: high tibial fracture
  • Brachial artery: supracondylar fracture
  • Femoral artery: femoral shaft fracture

6

List the hard signs of arterial injury

  • External bleeding
  • Rapidly expansile haematoma
  • Audible bruit
  • Palpable thrill
  • Signs of acute limb ischaemia
    • not corrected upon reduction or relignment of fracture

7

Outline the clinical features of acute limb ischaemia

  • Pain
  • Pallor
  • Paraesthesia
  • Paralysis
  • Pulselessness
  • Perishingly cold

8

What is the warm ischaemia duration prior to irreversible ischaemic damage?

Up to 6 hours

9

Name the vessel injury associated with first rib fracture

Subclavian artery

10

Name the vessel injury associated with shoulder dislocation

Axilliary artery

11

Name the vessel injury associated with humeral supracondylar fracture

Brachial artery

12

Name the vessel injury associated with elbow dislocation

Brachial artery

13

Name the vessel injury associated with pelvic fracture

Presacral and internal iliac vessels

14

Name the vessel injury associated with femoral supracondylar fracture

Femoral artery

15

Name the vessel injury associated with knee dislocation

Popliteal artery

16

Name the vessel injury associated with proximal tibial fracture

Popliteal artery or anterior tibial artery

17

Name the nerve injury associated with shoulder dislocation

Axillary nerve

18

Name the nerve injury associated with humeral shaft fracture

Radial nerve

19

Name the nerve injury associated with humeral supracondylar fracture

Radial or median nerve

20

Name the nerve injury associated with elbow medial condyle fracture

Ulnar nerve

21

Name the nerve injury associated with elbow dislocation

Ulnar nerve

22

Name the nerve injury associated with Montegia fracture

Posterior interosseous nerve

23

Name the nerve injury associated with hip dislocation

Sciatic nerve

24

Name the nerve injury associated with knee dislocation

Peroneal nerve

25

What is the progonosis for nerve injuries in closed fractures?

  • Spontaneous recovery: 90% within 4 months
  • Nerve is rarely severed
  • If nerve has not recovered in the expected time, and conduction studies fail to show evidence of recovery -> exploration

26

What is the prognosis of nerve injuries in open fractures?

  • More likely to be complete lesion
  • Should be explored during wound debridement
  • Repaired at time of wound closure

27

Define gas gangrene

A life-threatening clostridial infection featuring:

  • Muscle necrosis
  • Sepsis
  • Gas production

28

Outline the pathophysiology of gas gangrene

Clostridium perfringens enters open fracturs usually after contact with soil. Since it is an anaerobic organism, it requires a sufficiently devitalised tissue environment to cause infection.

Toxins are released which lead to coagulation, thrombosis, and haemolysis of RBCs. They also cause cardiac depression and vasodilatation.

29

How does gas gangrene present?

Symptoms appearwithin 24 hours of injury

  • Intense pain
  • Swelling
  • Foul-smelling discharge
  • Mild fever, tachycardia
  • Vesicles and bullae develop
  • Rapidly develop sepsis

30

Name one important differential diagnosis for gas gangrene that must be ruled out, and why?

Anaerobic cellulitis: absence of myonecrosis

Failure to recognise the difference may lead to unecessary amputation for non-lethal cellulitis

31

How is gas gangrene prevented?

  • Explore all deep, penetrating wounds in muscular tissue
  • Completely excise all dead tissue
  • Leave wound open

32

How is gas gangrene treated?

  • Fluid replacement
  • IV antibiotics
  • Hyperbaric oxygen: limits spread of gangrene
  • Prompt decompression of wound and removal of all dead tissue
  • Amputation in advanced cases

33

Name 4 causes of delayed union of fractures

  • Severe soft-tissue damage
  • Poor blood supply
  • Periosteal stripping: avoid cause during internal fixation
  • Infection
  • Implant failure: loosen or break apart
  • Patient factors

34

What is complex regional pain syndrome?

Chronic debilitating continuous burning pain that affects the limbs.

Usually associated with sensory, motor, autonomic, skin, and bone abnormalities.

Type I: absence of identifiable nerve injury

Type II: presence of damage to a major nerve

35

List 3 symptoms of complex regional pain syndrome

  • Pain: typically burning and out of proportion
    • Not confined to a nerve or dermatome
  • Muscle weakness and disuse atrophy
  • Sensitivity to touch
  • Allodynia: pain from non-painful stimulus
  • Hyperalgesia: increased pain sensitisation
  • Swelling
  • Spontaneous temperature changes in limb
  • Spontaneous sweating
  • Pilomotor: goosebumps

36

What is the management of complex regional pain syndrome?

  • Analgesics or neuropathic medication
  • Education
  • Physical rehabilitation
  • Psychological needs