Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

MSK T eaching series: Session 1, Fractures Delivered by: Hossein Abolmohammadpour Bonab Delivered by: Dr Sari Al HajajDisclaimer BIDA SW teaching is led by students with supervision of junior doctors and consultants across the UK. These teachings are created to support students’ learning but should not replace your local Medical School teaching material. Objectives • Review some common/high yield fractures including: how to assess, investigate and manage them. • Review the basic principles of interpreting a plain film radiograph of the MSK system • Describe fractures and be able to recognise the key features of a plain film radiograph of the MSK system. • Recognise some of the common pathologies on a plain radiograph of MSK system Fracture assessment • A-E • History => who?/what?/when?/where?/why? • Examine => do not forget to check for other injuries • Investigations Fracture assessment (1) Details • Patient • Date of Radiograph • Previous Radiograph • 2 different views Normal femur, X ray interpretation (2,3) Adequacy • Area (joint above & below) • Rotation • Exposure Normal femur X ray (2, 3) ABCS approach • Alignment • Bones • Cartilage • Soft tissues Normal femur X ray (2, 3)How to report a fracture • Location => metaphysis?/epiphysis?/articular surface? • What is the type of fracture? (Transverse?/Oblique?) • Is this Open vs Closed • Any pathological changes present? How to report a fracture (2)Management 4R’s • Resuscitate • Reduce • Retain • Rehabilitate Fracture management (1) Fracture types Fracture types (4) Angulations: Dorsal vs Volar Radius fractures (5) Angulation vs Displacement Radius fractures (6)Case 1 A 42-year-old male involved in a high-speed motor vehicle accident presented to the emergency department with severe pain, swelling, and deformity of his left thigh.Case 1 “displaced oblique femoral mid shaft fracture” (7)Case 2 A 30-year-old female, was walking down the stairs at her home when she missed a step and fell, twisting her right ankle. She experienced immediate pain and swelling in her ankle and was unable to bear weight on the affected foot.Case 2 “a horizontal fracture through the lateral malleolus, below the level of the ankle joint, consistent with Weber A” (8) Weber classifications Weber classification (8) Weber classifications Vs Weber classification (8)Case 3 a 25-year-old male, fell off his skateboard and landed on his outstretched hand, resulting in immediate pain and swelling in his wrist.Case 3 “transverse fracture through the waist of the scaphoid” (9) Carpal bones Carpal bones (1)Case 4 a 55-year-old female, tripped over a rug in her home and fell onto her outstretched hand, resulting in immediate pain and swelling in her wrist.Case 4 “Extra-articular fracture of distal radius with dorsal angulation and impaction.” (10)Case 5 a 45-year-old male, fell off a ladder at work and landed on his hand bent forward, resulting in immediate pain and swelling in his wrist.Case 5 “A fracture of the distal radius with volar angulation of the fractured distal fragment, representing a Smith fracture. Widening of the scapholunate interval is also noted.” (11)Colles vs Smith (12)Case 6 a 12-year-old female, fell from a bicycle and landed on her outstretched arm, resulting in immediate pain and swelling in her elbow.Case 6 “A displaced and overlapped fracture of the ulnar shaft is present. Additionally the radial head is dislocated anteriorly.” (13)Case 7 a 40-year-old male, was involved in a motorcycle accident and fell onto his outstretched arm, resulting in immediate pain and swelling in his wrist.Case 7 “Open transverse fracture at the junction of the distal and middle third of the radial diaphysis with volar dislocation of the distal radio-ulnar joint.” (14)Monteggia vs Galeazzi (15)Case 8 a 25-year-old male, was playing football when he was tackled and fell onto his shoulder, resulting in immediate pain and tenderness in his collarbone.Case 8 “comminuted fracture of mid and distal third significant displacement and overlap of the fracture ends” (16) Classification Normal clavicle (17)Image source: https://pub.mdpi-res.com/children/children-09-00049/article_deploy/html/images/children-09-00049-g001.png?1641189313Useful resources • Geeky medics • OSCEstop • Radiology master class • Radiopaedia (for all the cases) References 1. Samuel. Fracture Management (2023): OSCEstop: OSCE Learning [Internet]. OSCEstop. 2022 [cited 2023Mar7]. Available from: https://oscestop.education/acutely-unwell-patients/fracture-management/ 2. Samuel. Musculoskeletal radiograph interpretation - generic approach (2023): OSCEstop: OSCE Learning [Internet]. OSCEstop. 2022 [cited 2023Mar7]. Available from: https://oscestop.education/interpretation/musculoskeletal-radiograph-interpretation/ 3. Gołofit P. Normal femur radiographs. Radiopaediaorg. 2017; 4. Interpretation· DRDR. Musculoskeletal (MSK) X-ray interpretation – OSCE guide [Internet]. Geeky Medics. 2021 [cited 2023Mar7]. Available from: https://geekymedics.com/musculoskeletal-msk-x-ray-interpretation-osce-guide/ 5. Deng F, Jones J. Distal radial fracture. Radiopaediaorg. 2015; 6. Figure: Spatial relationship between Fracture Fragments [Internet]. MSD Manual Professional Edition. [cited 2023Mar8]. Available from: https://www.msdmanuals.com/professional/multimedia/figure/spatial-relationship-between-fracture-fragments 7. Morgan M, Benoudina S. Femoral shaft fracture. Radiopaediaorg. 2013; 8. Al Kabbani A, Gaillard F. Weber classification of ankle fractures. Radiopaediaorg. 2008; 9. Murphy A, Datir A. Scaphoid fracture. Radiopaediaorg. 2008; 10. Niknejad M, Desai P. Colles fracture. Radiopaediaorg. 2008; 11. Foster T, Qureshi PA. Smith fracture. Radiopaediaorg. 2016; 12. Table: Wrist fractures: Colles and smith [Internet]. MSD Manual Consumer Version. [cited 2023Mar8]. Available from: https://www.msdmanuals.com/en-kr/home/multimedia/table/wrist-fractures-colles-and-smith 13. Er A, Gaillard F. Monteggia fracture-dislocation. Radiopaediaorg. 2008; 14. Kusel K, Gaillard F. Galeazzi fracture-dislocation. Radiopaediaorg. 2008; 15. Er A, Stanislavsky A. Galeazzi and monteggia fracture-dislocations (mnemonic). Radiopaediaorg. 2010; 16. Hacking C, Datir A. Clavicular fracture. Radiopaediaorg. 2008; 17. Hacking C. Normal clavicle radiographs. Radiopaediaorg. 2015;FOR FEEDBACK AND QUERIES: Email @ info@bidasw.com