Fracture

Question 1

How to report on X-ray

Answer 1

1. Patient details, penetration, view
2. Site of fracture - what bone, what part of the bone
3. Type of fracture - transverse, oblique, spiral
4. Simple or comminuted
5. Displaced or not
6. Angulated or not
7. Bone of normal consistency or not

Question 2

What does ORIF mean?

Answer 2

Open reduction, internal fixation

plates and screws

Question 3

CRIF?

Answer 3

Closed reduction, internal fixation

less common
k-wires percutaneously and intermedullary fixation of long bones with wires or IM nails

Question 4

Simple fracture

Answer 4

= bone split into 2 pieces

Question 5

Comminuted fracture

Answer 5

= bone split into 3 or more pieces

Question 6

In simple fractures, what should be done to the fracture site?

Answer 6

Compression

Allows healing without callus formation

Question 7

Problem with intracapsular hip fractures rather than extracapsular?

Answer 7

Disruption to blood supply - medial circumflex femoral artery

Question 8

First thing to do with an open fracture

Answer 8

Assess - primary and secondary survey, assess neurovascular status of the limb

Question 9

Then what do you do before treating the open fracture

Answer 9

Remove gross contamination, photograph

Question 10

First thing to treat the open fracture

Answer 10

Dress with saline soaked gauze

Question 11

After gauze on open fracture

Answer 11

Splint limb, usually in backslab
IV Abx (asap and every 8 hours until wound debridement)

Question 12

Open fracture in theatre

Answer 12

Within 24 hours on day list
Wound washout and debridement
Stabilisation

Question 13

Principles of treating any fracture

Answer 13

Reduce
Stabilise (preserve blood flow)
Rehabilitate

Question 14

Causes of pathological fracture

Answer 14

Osteoporosis
Osteomalacia
Osteopenia
Tumours - primary or secondary
Infection
Metabolic bone disease
Medications

Question 15

Local factors for delayed union or non-union of bone

Answer 15

Location - eg scaphoid, distal tibia, base of 5th metacarpal at risk bc of blood supply
Stability
Infection
Pattern - segmental fractures higher risk

Question 16

Systemic factors for delayed union or non-union of bone

Answer 16

Diet
Smoking
Diabetes
HIV
Medications eg corticosteroids, NSAIDs

Question 17

Examples of intracapsular hip fractures

Answer 17

Subcapital

Transcervical

Question 18

Examples of extracapsular hip fractures

Answer 18

Base of cervical
Intertrochanteric
Subtrochanteric

Question 19

How to manage extracapsular hip fracture

Answer 19

Fix with DHS or IM nail

Question 20

Intracapsular garden classification

Answer 20

1 - undisplaced, incomplete. include valgus impacted fractures
2 - undisplaced, complete
3 - partially displaced, complete
4 - completely displaced, complete

Question 21

Rhyme for treating garden classification hip fractures

Answer 21

1,2 give it a screw, 3,4 austin moore

Intracapsular undisplaced = fix with eg DHS
Intracapsular displaced = hemiarthroplasty or total hip replacement

Question 22

Criteria for total hip replacement rather than partial

Answer 22

No cognitive impairment

Independently mobile

Question 23

Indication for IM nail for fixation

Answer 23

Fixation rather than replace, so either undisplaced intracapsular or extracapsular

Pathological fracture