Common Fractures

Question 1

What are the 7 signs of fracture?

Answer 1

pain
deformity 
loss of function 
crepitus 
discolouration/bruising  
tenderness
swelling

Question 2

How are fractures investigated?

Answer 2

examination 
Xray 
CT 
Ultrasound 
Radioisotope Scanning

Question 3

How does radioisotope scanning work in fracture investigation?

Answer 3

radio labelled phosphate is taken up by injured bone faster than others so can be seen brighter on X-ray

Question 4

How is a fracture described?

Answer 4

which bone one which side?
where is it broken?
open/closed?
What shape? spiral, oblique, transverse etc
How many fragments?
Position of the distal fragment? (displacement, rotation and angulation)

Question 5

What is a pathological fracture?

Answer 5

A fracture which has occured due to underlying pathology of the bone itself e.g. brittle bones, tumour, osteoporosis

Question 6

How much blood can be lost from:

a) an unstable pelvic fracture?
b) femoral fracture

Answer 6

a) 6 units

B) 3 units

Question 7

How can pain be relived following a fracture?

Answer 7

Pain relief drugs - morphine

splint age/traction

Question 8

Why is special care required in open fractures?

Answer 8

Wounds are contaminated and so the risk of infection is high. Debridement must take place

Question 9

What kind of conditions may influence bone quality?

Answer 9

osteoporosis

brittle bones

Question 10

What is fracture reduction?

Answer 10

restoration of normal position - fractures must be reduced and then held there until it heals naturally

Question 11

How is closed reduction performed?

Answer 11

traction of the distal fragment and then relocation into the proximal fragment by manipulation

Question 12

When is open reduction performed?

Answer 12

When closed reduction is unsuccessful

Question 13

Name 4 methods of holding bone together:

Answer 13

casting
external fixation
internal fixation
traction

Question 14

How does cast work?

Answer 14

a cast acts as a splint to control joint movement and posture. it is moulded so it exerts 3 point pressure.

Question 15

What is a functional brace?

Answer 15

a plaster cast with hinges between segments so the joint is free but control is maintained

Question 16

What is external fixation?

Answer 16

fixation of a fracture via an external scaffold in a situation where there is extensive soft tissue damage

Question 17

When is internal fixation used?

Answer 17

where a high degree of accuracy is required

Question 18

What is used in internal fixation?

Answer 18

plates, nails, screws, wires

Question 19

What are the 4 ways internal fixation is done?

Answer 19

apposition
interfragmentary compression
interfragmentary compression and onlay device
inlay device

Question 20

What helps achieve interfragmentary compression?

Answer 20

screws

Question 21

What is an onlay device?

Answer 21

plate

Question 22

what are the downsides of plates?

Answer 22

they inhibit natural bone healing and delay full healing and full load bearing by eliminating micro-movement at the fracture site

Question 23

What is an inlay device?

Answer 23

IM nails

Question 24

What kind of bones do IM nails work well in?

Answer 24

long bones

Question 25

Why are implants removed?

Answer 25

Bone adapts to the loads placed on it and the support given by implants results in bone remodelling and weakening as there is a boundary between loaded and unloaded bone

Question 26

What are the three types of traction?

Answer 26

static balanced dynamic

Question 27

Why is balanced traction used over static traction?

Answer 27

Where static traction is going to cause damage to the body through pressure - balanced traction is balanced by a weight attached to the whole splint which takes the pressure off the skin

Question 28

What is dynamic traction?

Answer 28

where joints are still permitted to move but by means of pulleys, the pull is still maintained along the line of the broken bone

Question 29

How does bone heal?

Answer 29

``` swelling callus formation bone formation bone bone remodelling and bone returns to normal ```

Question 30

How is micro-movement useful in bone healing?

Answer 30

micro-movement along the axis of the long bone at right angles to the break stimulates external callus formation

Question 31

will fractures heal if no micro-movement is present?

Answer 31

Yes- but slowly and no callus formation takes place

Question 32

In a long bone fracture of low energy, what method of fixation is useful?

Answer 32

manipulation and casting

Question 33

What method is used to fix intra-articular fractures?

Answer 33

screws and wires

Question 34

In high velocity injuries, which type of fixation is useful

Answer 34

external fixation

Question 35

What is a pathological fracture?

Answer 35

When bone, subject to normal loading, abnormally fractures

Question 36

Why are fractures in the elderly commonly held using IF techniques?

Answer 36

early fixation leads to earlier mobility and functional ability allowing for reduced consequences like bedsores, muscle wasting etc.

Question 37

Name 6 early complications of fracture

Answer 37

``` blood loss infection fat embolism renal failure soft tissue injury compartment syndrome ```

Question 38

Name 5 late fracture complications

Answer 38

``` non-union delayed union mal-union growth arrest arthritis ```

Question 39

Name 5 secondary fracture complications (as a consequence of treatment)

Answer 39

``` plaster disease renal stones immobility infection compartment syndrome mal-union infection ```

Question 40

What are some signs of fat embolism?

Answer 40

tachypnoea confusion rash on chest and neck

Question 41

Which protein is found in the kidneys of people after trapped limbs or ischaemic limbs?

Answer 41

myoglobin

Question 42

How does compartment syndrome occur?

Answer 42

after fracture, bleeding and inflammation inside the fascial sheath causes increased pressure, which blocks of circulation and causes ischaemia and extreme pain out of proportion to the injury

Question 43

How is compartment syndrome treated?

Answer 43

remove plaster/dressings/bandages URGENT FASCIOTOMY

Question 44

What problems can be caused by immobility

Answer 44

``` hyper coagulability - DVT/PE osteoporosis renal stones stiffness muscle wasting bedsores ```

Question 45

Name some reasons for non-union

Answer 45

``` excess movement too little movement soft tissue interposition poor blood supply infection excessive traction ```

Question 46

What is mal-union?

Answer 46

where a fracture has been allowed to heal in a position that precludes normal function

Question 47

How can growth arrest occur after a fracture?

Answer 47

if the fracture breaches the germinal layer of the epiphyseal growth plate, bone growth may be arrested at the point of breach = deformity

Question 48

How can arthritis be caused after a fracture?

Answer 48

if a joint i excessively stressed if the joint is no longer congruent a very angulated fracture will put uneven forces on the joint