Fracture Managment

Question 1

Major functions of bone

Answer 1

Mechanical support and stability

Helps with locomotion

Primarily source of calcium bank

Question 2

PE findings to look out for with fractures

Answer 2

Swelling and ecchymoses

Tenderness/ crepitation

Marked pain with PROM

Motor/ sensory/pulses/cap refill will be lower

Check for compartment syndrome

Question 3

Rule of 2s with xrays

Answer 3

At least 2 views ( AP and lateral)

2 limbs (always check for comparison and rule out benign issues)
- kids always get contralateral limb 

2 joints (always image above and below fracture joints

2 injuries (check for other injuries on nearby areas)

2 occasions ( get follow up xrays to see latent injuries)

Question 4

Incomplete fractures

Answer 4

Not completely divided and the periosteum remians intact
- very common in kids

Examples
- compression and green stick

Question 5

Comminuted fracture

Answer 5

More than two fragments of a complete fracture

Question 6

Goals of fracture management

Answer 6

Protect soft tissues

Realign fracture for proper sealing

Provide a protective environment for healing

Question 7

Inital management for bone fractures

Answer 7

Crutches for lower leg injuries
- if possible then dont because Wolffs law implies more stress on the bone accelerates bone growth

Sling for upper injuries if not weight baring
- should be well padded on skin side to avoid burns to the skin

RICE

NO SURGERY UNLESS NEEDED

Question 8

Jones for pseudo jones fracture

Answer 8

Jones fracture = diaphysis of 5th metatarsal
-Has poor blood circulation so often requires fixation through surgery

Pseudo jones fracture = metaphysis of 5th metatarsal
- good blood supply so usually only needs a walking boot and no surgery

Question 9

Lisfranc fracture dislocation

Answer 9

Second metatarsal is avulsed/dislocated usually anteriorly

Seen in hyper plantarflexion and appears as increased widening of the distance between 1st and 2nd metatarsals

-requires surgical fixation

Question 10

Ankle fractures

Answer 10

Usually through rotation injuries with or without trauma/ force

Fibula fractures are classified via Webber classification
A = below mortise (stable)
B= at mortise (stable if no ligamentous damage)
C = Above mortise (not stable)

Unstable usually shows widening of the syndesmoses of the tibia and fibula

More stable = more likely to use conservative treatment

More unstable = surgery/ fixation or walking boots

Question 11

Maisonneuve fracture

Answer 11

Twisting during evertion and pornation of the foot

Seen in AP and mortise xray views

• cracked proximal tibia
• ripped deltoid and fibular ligaments
• interosseous membrane is ripped

Shows very swollen ankle and cant weight bare

• requires surgery

Question 12

Tibia fractures

Answer 12

Simple or comminuted usually
- simple usually conservative treatment, especially in kids

• comminuted usually surgery especially in adults

Surgery is usually through rods

Question 13

Tibial plateau fractures

Answer 13

High energy fractures that usually require fixation to heal if displaced

If not displaced may be able to use conservative treatment

Question 14

Patella fractures

Answer 14

If displaced requires surgery and brace

If not displaced, just brace is fine

Question 15

Hip fractures

Answer 15

Two types mainly

Femoral neck: near the femoral surgical neck

• often produces blood supply issues and can lead to avascular necrosis
• requires surgery all the time and sometimes replacement, especially in elderly
• hemiarthroplasty or THA replacement

intertrochanteric: near the metaphysis
- no blood supply loss
- requires surgery but only for fixation, never replacement
- plates or nails

Question 16

distal Wrist fractures

Answer 16

Most common is collies fractures showing anterior displacement of the wrist
- treatment is to reduction and splinting or casting heals, avoid surgery unless needed

• splint needs to have padding on right side or else will burn patient

Scaphoid fractures are the next common and can show avascular necrosis (especially if proximal)
- treatment is thumb casts if caught early, surgery for reduction if not caught early or very displaced

Question 17

Elbow fractures

Answer 17

Really need to get two views for these on both arms

• supracondylar fractures are most common
  Usually require surgery since almost always displaced and often slips with casts
• olecronon fractures require surgery every time
• radial head fractures usually dont require surgery unless very displaced. Use sling to treat

Question 18

Humerus fracture

Answer 18

Comminuted humerus fractures always require surgery
- usually use ORIF for fixation

Simple fractures usually dont unless very displaced.
- Sarmiento brace is used for non displaced simple fractures

Question 19

Shoulder fractures

Answer 19

Simple and/or non displaced = sling and conservative

Comminuted and/or displaced = fixation with surgery
- reverse arthroplasty or ORIF

Question 20

Clavicle fractures

Answer 20

Simple and/or nondisplaced = sling and conservative treatment

Communicated and/or displaced = surgery
- usually ORIF

Question 21

Testing off the skin in clavicle fractures

Answer 21

Sign of not treated displaced fractured.

Often a potential sign for avascular necrosis so need to surgically intervene quickly

Question 22

Juvenile tillaux fracture

Answer 22

SAltar Harris 3 fracture in the distal tibia of children