1: Principles Of Fracture Management

Question 1

What is a fracture

Answer 1

partial or complete disruption in continuity of the bone

Question 2

What are 3 classes of fracture

Answer 2

• Stress
• Traumatic
• Pathological

Question 3

What are stress fractures

Answer 3

Multiple low velocity injuries results in several hairline fractures to the bone

Question 4

What is a pathological fracture

Answer 4

Abnormal bone (eg. malignancy or osteoporosis) that fractures on minimal trauma

Question 5

What are 6 risk factors for poor healing

Answer 5

• Old age
• Diabetes
• Smoker
• NSAIDs
• Corticosteroids
• Osteoporosis

Question 6

What is an oblique fracture

Answer 6

Fracture lies obliquely to the long bone

Question 7

What is a comminuted fracture

Answer 7

When there are more than two fragments

Question 8

What is a segmental fracture

Answer 8

When there are more than two fractures in a long bone

Question 9

What is a transverse fracture

Answer 9

Fracture lies horizontal to long bone

Question 10

What is a spiral fracture

Answer 10

Severe oblique fracture. With rotation along the long axis

Question 11

What is an open fracture

Answer 11

Fracture where a fragment of bone breaks through skin

Question 12

What is a Colle’s fracture

Answer 12

Fracture of the wrist that has 3 features (can be remembered by ‘TOD’)
Transverse fracture of the radius
One initial proximal to the carbo-metacarpal joint
Dorsal displacement and angulation of the distal radius fragment

Question 13

What is a Smith’s fracture

Answer 13

Transverse fracture of the radius with volar angulation and displacement

Question 14

What is a Monteggia’s fracture

Answer 14

Dislocation of the PROXIMAL radio-ulna joint and associated fracture of the ulna

Question 15

What is a Galeazzi’s fracture

Answer 15

Dislocation of the DISTAL radio ulna joint with associated radial shaft fracture

Question 16

What is a Bennet’s fracture

Answer 16

Fracture of the first carpo-metacarpal joint

Question 17

What is a Boxer’s fracture

Answer 17

Fracture of the 5th MCP joint

Question 18

What is a Pott’s fracture

Answer 18

Bi-malleolar fracture

Question 19

What is Barton’s fracture

Answer 19

Fracture of the distal radius wit radio-carpal dislocation

Question 20

What is an open fracture

Answer 20

Disruption in cortex of the bone associated with an overlying laceration

Question 21

What system is used to classify open fractures

Answer 21

Gustillo-Anderson

Question 22

In the Gustillo-Anderson classification, what is Grade I

Answer 22

• Low energy trauma

- Less than 1cm laceration

Question 23

In the Gustillo-Anderson classification, what is Grade 2

Answer 23

• Low energy trauma

- More than 1cm laceration

Question 24

In the Gustilo-Anderson Classification what is Grade 3A

Answer 24

• Adequate soft tissue coverage

Question 25

In the Gustilo-Anderson Classification what is Grade 3B

Answer 25

- Inadequate soft tissue coverage

Question 26

In the Gustilo-Anderson Classification what is Grade 3C

Answer 26

- Associated arterial injury

Question 27

What Gustily-Anderson classification will an open fracture caused by high energy trauma be

Answer 27

Grade 3 (automatically)

Question 28

How should a fracture be managed (General principles)

Answer 28

1. Antibiotics for all open injuries 2. Reduce 3. Hold 4. Rehabilitate

Question 29

If a high-energy traumatic fracture how should it be managed (General principles)

Answer 29

1. Resuscitate (ATLS) 2. Reduce 3. Hold 4. Rehabilitate

Question 30

What is reduction of a fracture

Answer 30

restoring the anatomical alignment of a fracture or dislocation

Question 31

What is the aim of reducing a fracture

Answer 31

- Reduce pressure on soft-tissues (reducing swelling) - Reduce pressure on nerves that could lead to neuropraxia - Reduce pressure on blood vessels that may cause ischaemia - Reduce tamponade of bleeding at fracture site - Promote healing

Question 32

How is reduction achieved (General principle)

Answer 32

Apply force equal and opposite to the force which caused the fracture

Question 33

What are the two types of reduction

Answer 33

Open reduction | Closed reduction

Question 34

In an emergency what type of reduction is often used

Answer 34

Closed reduction

Question 35

What is open reduction

Answer 35

Taken to operating theatre. Fracture is visualised and internally reduced with instruments

Question 36

What should be given prior to reduction

Answer 36

Analgesia

Question 37

What is the preferred method of analgesia for reduction of fractures

Answer 37

Local nerve block

Question 38

What does 'hold' refer to in general principles of fracture management

Answer 38

Immobilisation of the fracture to enable healing

Question 39

What are the most common methods to immobilise a fracture

Answer 39

- Plaster cast | - Splint

Question 40

What is a rare (old-fashioned) method to immobilise a fracture

Answer 40

Traction

Question 41

When may traction be required in 'holding phase' of management

Answer 41

If an unstable fracture (eg. muscles pull on fracture sites causing it to be unstable) - subtrochanteric fracture, pelvic fracture

Question 42

What type of cast should be applied in the first 2W of a fracture and why

Answer 42

Back-slab. (NEVER apply a circumferential cast in the first two weeks)

Question 43

What will happen if a circumferential cast is applied within the first 2W following fracture

Answer 43

oedema and expansion of the tissues will be compressed in the cast and may lead to compartment syndrome

Question 44

How is the 'length' of a cast decided

Answer 44

- If risk of axial instability (fracture can rotate along long-axis) then joint above AND below - If no risk, just the joint distal to the injury

Question 45

What has replaced traction

Answer 45

Internal and external fixation

Question 46

In which population may traction be used

Answer 46

cHILDREN

Question 47

What fractures are repaired by open reduction and internal fixation (ORIF)

Answer 47

fractures involving joint articulations

Question 48

What are 6 indications for ORIF

Answer 48

1. Articular fractures 2. Unstable fractures 3. Open fractures 4. More than two fractures in one limb (segmental fracture) 5. Identical bilateral fractures 6. Failed medical management

Question 49

What are 4 methods of internal fixation

Answer 49

- Intra-medullary nails - Kirschner wires - Plates - Screws

Question 50

What is the benefit of plates

Answer 50

Provide strength and stabilise fractures involving articular fractures

Question 51

What are intra-medullary nails

Answer 51

screw into the medulla of bones

Question 52

What are Kirschner wires

Answer 52

flexible stabilisation wire used as a temporary measure in internal fixation before definitive fixation

Question 53

When are external fixation used

Answer 53

when there is soft-tissue damage to the trauma site (burns, loss of skin, loss of bone) as they are less disruptive

Question 54

How is external fixation achieved

Answer 54

Pins/Wires/Rods are placed away from the zone of injury in various configurations to provide stabilise. Pins/Wires are placed through bone and connected using rods and clamps

Question 55

What does rehabilitation involve

Answer 55

Need for patients to undergo PT and progressive loading following a fracture

Question 56

What are 5 immediate complications of a fracture

Answer 56

- Organ injury - Internal bleeding - External bleeding - Nerve or skin injury - Vessel injury causing secondary ischaemia

Question 57

What are 4 local late complications of a fracture

Answer 57

- Skin necrosis - Pressure sores - Infection - Delayed union

Question 58

What are 4 general late complications of a fracture

Answer 58

- Fat embolism - PE - Pneumonia - Arthritis

Question 59

Where to fat emboli occur from

Answer 59

Bone marrow

Question 60

What day do symptoms from fat emboli often present

Answer 60

2-3d

Question 61

What type of injury is neuromuscular disruption common

Answer 61

Knee dislocation

Question 62

What is the most common complication of fractures

Answer 62

Infection

Question 63

What is delayed union

Answer 63

When a fracture has not healed within the expected time frame

Question 64

What is non-union

Answer 64

No evidence of fracture healing

Question 65

What is mal-union

Answer 65

When a fracture has not haled in expected anatomical alignment increasing the risk of contractures, loss of function and increased risk of secondary OA

Question 66

What are 3 common fractures in the elderly

Answer 66

- NOF - Colle's - Vertebrae (wedge)