A3- Common fractures, treatment and prevention

Question 1

What are the common fracutres?

Answer 1

Wrist>Hand>Ankle>Foot>Hip

Question 2

in the younger age group is more common for females or males to have fractures

Answer 2

males

Question 3

in the older age group is more common for females or males to have fractures

Answer 3

females

Question 4

What to look out for in a presenting complaint?

Answer 4

What - mechanism of injury & force involved

When - timing of injury

Where - situation of injury

Why - circumstances of injury (if due to fall, include before/during/after fall history)

Question 5

What do you include in an orthopaedic system review?

Answer 5

• Preinjury - any pain, stiffness, swelling, movement restriction/ ability to weight bear?
• any locking, giving way?
• any weakness, numbness, paresthesia?

Question 6

What to ask in PMHx

Answer 6

• any co-morbidities? (eg epilepsy, Parkinsonism, dementia, alcoholism, diabetes, thyroid disease)
• if indicated, tetanus vaccination history

Question 7

What are some conditions that predispose to fracture

Answer 7

• Rheumatoid disease
• Malabsorption syndromes
• Sex hormone deficiency
• Primary hyperparathyroidism
• Chronic liver disease
• Diabetes
• COPD
• Hyperthyroidism
• Neurological conditions

Question 8

What to look out for in drug history?

Answer 8

• In particular, any anticoagulants
• Bone loss medication –
• Steroids
• Breast and prostate cancer drugs
• Antiepileptic drugs
• Progesterone contraceptive
• Increase risk of fall

Question 9

What to cover in a social history?

Answer 9

• Occupation - will the injury likely impact employment? (eg builder)
• Any hobbies likely to be impacted by injury?
• Which hand is dominant?
• Assess need for cognitive testing later (AMTS score if elderly)
• smoking/ alcohol intake/ recreational use
• any social worker support? carers?
• How will independent living be impacted by injury and rehabilitation?

Question 10

What are some signs to look for in fractures

Answer 10

• Bruising • Swelling • Deformity • Previous scars

Question 11

How do you investigate a fracture

Answer 11

radiograph

Question 12

How do you go about looking at a radiograph?

Answer 12

• A – Adequacy, Anatomy, Alignment, Asymmetry
• B – Bone density
• C – Cartilage (joint, disk spaces, children)
• D – Deformity
• E – Erosions
• S – Soft tissues

Question 13

Emergency treatment for fractures?

Answer 13

• ATLS protocol
• Pain control
• Assess; NV status, ?wound, skin, state of soft tissues
• If open as per BOA /BAPRAS guidelines
• Photograph
• Remove any gross contaminants
• Sterile soaked gauze
• Relocate & splint
• Treat associated injuries
• Radiograph

Question 14

What is a force?

Answer 14

– an action that causes an object to accelerate “push or pull”

Question 15

What is a vector?

Answer 15

has direction and magnitude (eg. Velocity, acceleration, force, moment)

Question 16

What si newtons 1st law a

Answer 16

– the sum of all external forces applied to a body is zero

Question 17

What does a transverse fracture look like?

Answer 17

Question 18

What does a spiral fracture look like?

Answer 18

Twist injury

Question 19

What is an oblique fracture?

Answer 19

Question 20

what is the difference between relative stability and absolute stability

Answer 20

Absolute stability means whether system is stable or unstable. Relative Stability gives the degree of stability or how close it is to instability.

Question 21

WHat is the pereens strain theory?

Answer 21

• strain dictates the tissue at this stage
• in high strain environments granulation tissue perisists
• as chondroid tissue is layed down the fracure gets stiffer and can progress toward bony union

Question 22

What is absolute stability?

Answer 22

• Primary bone healing – does not produce callus
• Use it in fractures that the bone ends are in contact
• Around joints where callus would be unhelpful
• Good for single fracture lines
• Bad for comminution