Basics of fracture management

Question 1

What is external fixation

Answer 1

External fixation – putting pins into the bones with a frame on the outside

Question 2

What is an external monolateral frame

Answer 2

frame on one side

Question 3

What is an external circular frame

Answer 3

rings around the bone

Question 4

What is internal fixation

Answer 4

opening up the fracture and putting a metal device in to hold the fracture in the right position

Question 5

What is a IM nail and what is it used for

Answer 5

IM nail – intramedullary nail – bone placed in centre of femur – fracture heals and the rod keeps it in the right position as it heals – used in long bone treatments

Question 6

What is plate fixation

Answer 6

Plate fixation – plates hold the bones in place as they heal

Question 7

What is the management of a suspected fracture

Answer 7

immobilisation and then pain relief

Then assess the fracture and see if there is actually a fracture, if the circulation is fine, any nerve damage and if the skin is open or closed

Radiology is then done

Question 8

What is an open fracture

Answer 8

A fracture where there is direct communication between the external envionment and the fracture

Question 9

What is the prophylaxis in open fractures and what is the main thing it is trying to prevent

Answer 9

broad spectrum antibiotics - trying to prevent tetanus - tetanus boosters or tetanus toxoid can also be given

Question 10

What is the management of open fractures

Answer 10

Clean the open fracture - high pressure water can be used

Do not close the wound if the would is not clean

Fasciotomies if patient is at risk of compartment syndrome

Question 11

What is a stable fracture

Answer 11

A fracture that will not move under physiological loading conditions

Question 12

What are examples of unstable fractures which are succeptible to shortening

Answer 12

oblique - potential to be stable if less than 45 degrees
spiral
comminuted

Question 13

What is an example of a stable fracture

Answer 13

transverse fracture

Question 14

When does a fracture have to be reduced

Answer 14

reduce a fracture If it is out of place and if it heals in that position, it will cause problems

Question 15

What are examples of conservative fracture treatment which allow for mobilisation

Answer 15

strapping
brace

Question 16

What are the conservative fracture treatments which allow for immobilisation

Answer 16

cast
functional bracing
traction

Question 17

What is 3 point loading

Answer 17

Curved cast with 3 points of fixation of pressure which hold the bone in position to heal

Question 18

What is hydraulics

Answer 18

A brace is put around the fracture site which constrains the muscles around it - as force is put through the muscle and bone environment, the pressure is pushed against the outside environment which stops sliding of the fracture

Question 19

What does it mean for a bone to be sticky

Answer 19

When a bone heals , it produces callous which stops the bone sliding - can push around the fracture and it would not be painful but still at risk of sliding when pressure is applied through it

Question 20

What are the complications of traction

Answer 20

Blistering skin and compartment syndrome

Question 21

What are the indications for external fixaton

Answer 21

Fractures with poor soft tissue conditions - open fractures

Question 22

What are the complications of external fixation

Answer 22

Neurovascular injury

Pin tract infection

Loss of fracture alignment

The frames are heavy and can cause stiffening of the joints

The frame can stop union of the two parts of the fracture

Question 23

When is intramedullary nailing indicated

Answer 23

Long bone fracture - it has to be nailed above and below the fracture

Question 24

When are plates good for healing fractures

Answer 24

Healing fractures that affect the joints

Question 25

What is a compression plate

Answer 25

squeezes the bone together

Question 26

What is a neutralisation plate

Answer 26

resists rotating factors (spiral fractures)

Question 27

What is a butress plate

Answer 27

A fracture which goes into a joint - plate pushes the bone back