Fracture Assessment

Question 1

Signs you would look for

Examination findings

Answer 1

Obvious deformity
-unusual angle, twisting, limb shortening
Breaks in skin
Bruises
Bony pieces pushing on skin

Compartment syndrome - tightness of skin, muscles
Peripheral pulses
Sensation, movement changes

Question 2

Initial management

Answer 2

Analgesia

Traction splint for long bones

• tension on displaced bone/joints
• immobilises joint in correct position
• stretches muscles to reduce spasms

Question 3

Complications from surgery

Answer 3

Infection
Nerve, vascular injury
Thrombosis
Fat embolism

Malalignment - bone does not heal in the correct position
Delayed/non union

Question 4

Complications of fractures

Answer 4

Compartment syndrome
Vascular, nerve damage
Open fractures => easy infection, difficult to manage

Question 5

Types of fracture in long bones

-characteristics

Answer 5

Open - bone pierces skin
Closed - no skin breajs
Partial - incomplete break
Complete - 2 pieces
Stable - broken ends have not moved out of place
Displaced - gap between broken ends

Question 6

Types of fracture

-by shape

Answer 6

Transverse - straight break across bone
Spiral - twisting mv
Greenstick - in children, bones bend and break but do not separate into 2 pieces
Stress - hairline fractures from repetitive mv
Compression - crushed bones
Oblique - sharp blow from an angle
Impacted - broken ends jammed together by force
Segmental - 2 breaks
Comminuted - 3+ pieces
Avulsion - fragment pulled off bone by tendon/ligament

Question 7

General criteria for fracture management

Answer 7

Non operative

• undisplaced/minimally displaced or stable
• not fit for surgery
• greenstick

Operative

• intraarticular fracture
• displaced/unstable/open fracture

Question 8

Non operative and operative management possible for fractures

Answer 8

Manipulation under anaesthesia
Immobilisation - POP, splints, synthetic casts

Operative - reduction with MUA + fixation

• close reduction, fixation => k wires, ext fixators
• open reduction internal fixation => lag screw, plates, k wires