Dr Beaver's tute - fracture healing

Question 1

callus formation

Answer 1

mineralisation seen around a healing bone on x-ray: the first stage of bone that you can see on an x-ray

woven bone which will later be converted into lamellar bone (mature bone)

Question 2

how to describe a fracture

Answer 2

• which bone is involved
• how old is the patient
• which part of the bone is involved: epiphysis, metaphysis, diaphysis, physic
• closed or open: is the skin in tact
• is it comminuted: is it broken into more than 2 pieces
• what shape is the fracture: transverse, spiral, oblique
• displaced or undisplaced
• is it complicated: damage to nerves, vessels, joint surface, overlying skin
• segmental: two fractures in the same bone
• greenstick fracture?
• avulsion: ligaments or strong piece of muscle has pulled off a fragment of the bone

Question 3

what is an avulsion fracture

Answer 3

ligaments or strong piece of muscle has pulled off a fragment of the bone

Question 4

what does the periosteum do

Answer 4

a fibrous layer full of osteogenic cells that forms bone
a fracture may tear the periosteum or peel it off

Question 5

how do you describe displacement

Answer 5

always describe the position of the distal fragment
(this rule is often broken in the hip and the spine)

Question 6

words to use to describe position of bony fragments

Answer 6

displacement (translation)
angulation
shortening (includes impaction)
lengthening (distraction)
rotation

Question 7

what are the directions of the forearm called

Answer 7

the forearm is complicated by pronation so posterior/anterior can’t be used to describe directions
dorsal (hairy side of arm)
volar (underside of forearm)
palmer (underside of hand)
radial (thumb side )
ulnar (pinky side)

Question 8

what does a dinner fork deformity look like

Answer 8

Question 9

what is a colles fracture

Answer 9

fall onto dorsiflexed wrist
extension fracture
colles fracture

Question 10

features of a colles fracture

Answer 10

distal fragment is radially angulated and dorsally displaced
intraarticular extension is possible
? fracture ulnar styloid

Question 11

what is a smith’s fracture

Answer 11

fall onto palmar flexed wrist
flexion fracture

Question 12

smith’s fracture is often

Answer 12

often intra articular

Question 13

smith fracture clinical features

Answer 13

distal fragment is volarly angulated and volarly displaced
intraarticular extension, neurovascular compromise, an/or instability are more likely than in colles fracture

Question 14

what type of people get colles fracture

Answer 14

insufficiency fracture of the distal radius in osteopaenic bone
happens in elderly people

Question 15

who gets smith’s fracture

Answer 15

young persons

Question 16

smiths fracture occurs when

Answer 16

hand is landed on while pronated

Question 17

clinical evaluation of distal radius fracture

Answer 17

neurovascular exam
- assess radial and ulnar artery pulses and capillary refill time
- median nerve injury, radial nerve injury, ulnar nerve injury

Question 18

signs of nerve injury on clinical examintion

Answer 18

radial: wrist drop
ulnar: claw hand, froment sign

Question 19

what is a greenstick fracture

Answer 19

infants or very young people
named after a ‘stick’ of a plant that is still alive and thus bends instead of snaps
the bone breaks only on one side because children’s bones have a lot more collagen
however, when an adult’s bone is subject to force it breaks because it is brittle

Question 20

what happens to a child’s bone when put under pressure

Answer 20

it will bend and the convex side of the bend may break first
if enough force Is applied the other side may break as well
even if the bone fragments are lined up, the plastic deformation will persist

Question 21

Monteggia fracture/dislocation

Answer 21

the ulnar shaft is fractured and it has pushed the radial head out of the joint in the elbow
radial head dislocation in elbow
proximal or middle ulnar fracture with concommittant dislocation of the radial head

Question 22

clinical features of monteggiea

Answer 22

pain, crepitus, limited ROM at the elbow
radial head palpable in the ACF
shortened forearm

Question 23

galeazzi

Answer 23

radial head is broken
subluxation of the distal radioulnar joint

Question 24

night stick fracture

Answer 24

isolated ulnar fracture
defence injury - red flag
may be a sign of abuse/especially domestic violence
ask monica about the cow vs. man case

Question 25

supra condylar fracture is a red flag for

Answer 25

median nerve damage and brachial artery
neurovascular damage
can cause compartment syndrome

Question 26

what should you do with someone which the cupracondylar fracture

Answer 26

admit and watch (‘like a hawk’) for compartment syndrome

Question 27

condylar fracture

Answer 27

through the condyle of the distal humorous

Question 28

who gets a pulled elbow

Answer 28

toddlers being yanked by adults

Question 29

what is a pulled adult

Answer 29

subluxation of radius
head of radius that gets pulled out of ligament that holds the radial head in place

Question 30

how do you fix a pulled elbow

Answer 30

all the child to have a look at their arm and then pronate and supinate the arm very quickly which should click it back into place
don’t bother x-raying it just fix it