fractures

Question 1

what is the classification used for ankle fractures?

Answer 1

webers

Question 2

what is webers classification of fractures?

Answer 2

Type A – below the ankle joint – will leave the syndesmosis intact

Type B – at the level of the ankle joint – the syndesmosis will be intact or partially torn

Type C – above the ankle joint – the syndesmosis will be disrupted

Question 3

what is the syndesmosis and what is the clinical relevance ?

Answer 3

The tibiofibular syndesmosis is very important for the stability and function of the ankle joint.

If the fracture disrupts the syndesmosis, surgery is more likely to be required in order to regain good stability and function of the joint.

Question 4

what are the main cancers which metastasise to the bone and may lead to pathological fractures?

Answer 4

PORTABLE 
Po – Prostate
R – Renal 
Ta – Thyroid
B – Breast
Le – Lung

Question 5

what is a FRAX score?

Answer 5

Assesses patient’s risk of a fragility fracture over the next 10 years

Question 6

which guidelines are used alongside the fax score for management of fragility fractures?

Answer 6

NOGG guidelines

Question 7

what is the first line management for reducing the risk of fragility fractures?

Answer 7

Calcium and vitamin D

Bisphosphonates (e.g., alendronic acid)

Question 8

what are the risk factors for taking bisphosphonates?

Answer 8

Reflux and oesophageal erosions (oral bisphosphonates are taken on an empty stomach sitting upright for 30 minutes before moving or eating to prevent this)

Atypical fractures (e.g. atypical femoral fractures)

Osteonecrosis of the jaw

Osteonecrosis of the external auditory canal

Question 9

what is the mechanism of action of bisphosphonates?

Answer 9

Bisphosphonates work by interfering with osteoclasts and reducing their activity, preventing the reabsorption of bone.

Question 10

what are possible early complications of a fracture?

Answer 10

• damage to local structures
• haemorrhage leading to shock and death
• compartment syndrome
• fat embolism- causing fat embolism syndrome
• venous thromboembolism

Question 11

what is fat embolism syndrome and what is the diagnostic criteria?

Answer 11

Fat embolisation after a fracture can cause a systemic inflammatory response, resulting in fat embolism syndrome.
It typically presents around 24-72 hours after the fracture. Gurd’s criteria can be for the diagnosis.

Gurd’s major criteria:
Respiratory distress
Petechial rash
Cerebral involvement

There is a long list of Gurd’s minor criteria, including:
Jaundice
Thrombocytopenia
Fever
Tachycardia

Question 12

how can you reduce the risk of fat embolisation syndrome?

Answer 12

operate to fix the fracture early