Assessment of Fractures

Question 1

What are some types of fractures?

Answer 1

Complete, transverse, oblique, spiral, comminuted, incomplete, bowing, buckle, green stick, growth plate injuries, intra/extra-articular

Question 2

Where may fractures occur in the bone and what are some ways displacement can occur?

Answer 2

Location = diaphysis, metaphysis, epiphysis
Displacement = angulation, translation, rotation, distracted, impacted

Question 3

Where is it common for there to be other fractures above or below the main fracture?

Answer 3

Forearm and ankle at the joint

Question 4

What are some features of fracture documentation?

Answer 4

Legible and avoid acronyms, accurate description from patient, was it witnessed?, perceived external threats?

Question 5

What are you looking for on examination?

Answer 5

Likely pattern of injury based on age and mechanism, look for distracting injuries, zone of injury, open or closed, skin integrity

Question 6

What patient functions should be assessed?

Answer 6

General limb function, neural and vascular status

Question 7

How can fractures be imaged?

Answer 7

Plain x-ray, CT, MRI

Question 8

What does oNVD mean?

Answer 8

Patient has no neural deficit

Question 9

What should be involved in a neurovascular assessment?

Answer 9

Understand peripheral innervation of upper and lower limbs, and examine sensation and motor for each main peripheral nerve

Question 10

Why do you need to perform an examination?

Answer 10

Establish baseline function, identity potential for infection, assess for compartment syndrome and permanent loss of function

Question 11

What causes acute compartment syndrome?

Answer 11

Interstitial pressure increasing in closed osseofascial compartments = causes micro vascular compromise

Question 12

What are some common sites of acute compartment syndrome?

Answer 12

Anterior and deep posterior compartment of leg, volar compartment of forearm

Question 13

At what pressure does significant muscle damage occur?

Answer 13

Compartment pressures > 30-40 mmHg or within 10-30 mmHg of diastolic

Question 14

What are some causes of compartment syndrome?

Answer 14

Tibial fractures (especially in men aged 10-35), forearm fracture, IVDA, comatose prolonged lie, anticoagulation with trivial trauma, burns

Question 15

What are some symptoms of compartment syndrome?

Answer 15

Disproportionate pain, pain on passive stretch of muscles in involved compartment, paraesthesia

Question 16

How is compartment syndrome treated?

Answer 16

Immediate release of all dressings/cast to skin, don’t elevate, phone senior for help, theatre for emergency fasciotomy

Question 17

How should open injuries be managed initially?

Answer 17

Stop haemorrhage and then splint extremities

Question 18

What should be documented with an open injury?

Answer 18

Location and size of wound, nature incised wound or laceration, possible degloving, capillary refill, posterior tibial and dorsalis pedis pulses, tendon action

Question 19

What are some examples of neck pain where the patient should be referred for cervical spine imagine?

Answer 19

Fall from > 1m or 5 stairs, axial load to head, high speed RTA (combined speed >60mph), roll-over vehicle RTA, age >65, injured >48hrs earlier, known vertebral disease

Question 20

Patients with what score on the GCS should get cervical spine imaging?

Answer 20

Score <15 on assessment on ED or paralysis, focal neurological deficit or paraesthesia in extremities

Question 21

What blood pressure and respiratory rate qualify a patient for cervical spine imaging?

Answer 21

Systolic BP <90 mmHg

Respiratory rate outside of range of 10-24 breaths/minute

Question 22

What are flexion distraction injuries?

Answer 22

Uncommon injury caused by spine failing in tension = fall from height, RTA, 2 point seatbelt restraint

Question 23

What are some features of flexion distraction injuries?

Answer 23

Disruption of PCL, horizontally orientated fracture pattern, grossly unstable, bony or ligamentous, high rate of GI injuries

Question 24

What occurs in flexion distraction injuries?

Answer 24

Middle and posterior columns fail under tension = anterior column under compression

Question 25

How are flexion distraction injuries treated?

Answer 25

Operative stabilisation = posterior short segment stabilisation, pedicular screws in compression/fusion

Question 26

What are the aims of surgery for flexion distraction dislocations?

Answer 26

Restore stability, correct deformity and optimise neurological recovery