Basic Orthopaedics

Question 1

What are the 4 R’s of Fracture Treatment?

Answer 1

1) Resuscitate
2) Reduce
3) Retain
4) Rehab

Question 2

What is the ABC’s of an orthopaedic xray?

Answer 2

A: Alignment (Dislocation)
B: Bone (Fractures)
C: Cartilage (Widened joint)
S: Soft Tissues (Swelling and Effusion)

Question 3

What is the physis?

Answer 3

Growth plate in paediatric bone

Question 4

How are paediatric bones able to rapidly reheal?

Answer 4

Thick periosteum

Question 5

What are the 3 initial steps in management of fractures?

Answer 5

1) Reduce fracture (Restore length, alignment and rotation)
2) Immobilise
3) Rehabilitate

Question 6

What is usually the 1st line management option for paediatric fractures?

Answer 6

Non-Operative management e.g. splint/cast as paediatric bone heals quickly

Question 7

What happens if the physis in bone is damaged?

Answer 7

Growth arrest –> Deformity

Question 8

What classification system is used for physis fractures?

Answer 8

Salter-Harris fracture classification

Question 9

What are the types of S-H fractures?

Answer 9

T1: Transverse through growth plate
T2: Fracture through growth plate and metaphysis
T3: Fracture through growth plate and epiphysis
T4: Fracture through metaphysis, physis and epiphysis (Needs fixation usually)
T5: Crush injury of growth plate (Growth arrest likely!)

Question 10

What are the main signs of non-accidental injury in children?

Answer 10

1) Multiple bruises and fractures

2) Long bone fracture in child unable to walk

Question 11

What is the usual management for non-accidental child injury?

Answer 11

1) Admit child
2) Skeletal survey
3) Refer to paediatric team and safeguarding specialists

Question 12

What can cause a supracondylar fracture in children and what nerve may be affected?

Answer 12

Falling on an outstretched hand –> Median nerve

Treated by K wires

Question 13

What are the main complications of fractures?

Answer 13

1) Open fractures
2) Neurovascular compromise
3) Mal union (Heals with deformity)
3) Non union (Fails to heal)
4) Compartment syndrome
5) Cast problems e.g. tightness, compartment syndrome, plaster burns/blister

Question 14

What are the 3 main patterns of bone fracture?

Answer 14

1) Comminuted
2) Segmental
3) Impacted

Question 15

What ways can displacement of a bone occur?

Answer 15

1) Length - Shortened
2) Alignment: Translated/Angulated
3) Rotated

Question 16

What are the 4 stages of the bone remodelling cycle?

Answer 16

1) Resting
2) Resorption
3) Formation
4) Mineralisation

Question 17

What are the 4 stages of callus formation?

Answer 17

1) Bleeding
2) Soft callus
3) Bony callus
4) Remodelling

Question 18

What are the 2 different methods of bone healing?

Answer 18

1) Direct: Gap <1mm, absolute stability, compression, gap healing and no callus
2) Indirect: Relative stability with callus formation