Fractures

Question 1

What is a compound fracture

Answer 1

the skin is broken and the broken bone is exposed to the air. The broken bone can puncture through the skin.

Question 2

What is a stable fracture

Answer 2

refers to when the sections of bone remain in alignment at the fracture

Question 3

What does a comminuted fracture refer to

Answer 3

Breaking into multiple fragments

Question 4

What is a colle’s fracture

Answer 4

transverse fracture of the distal radius near the wrist, causing the distal portion to displace posteriorly (upwards), causing a “dinner fork deformity”. This is usually the result of a fall onto an outstretched hand (FOOSH)

Question 5

What type of fracture can a FOOSH result in

Answer 5

Scaphoid fracture

Question 6

Key signs of scaphoid fracture

Answer 6

tenderness in the anatomical snuffbox (the groove between the tendons when extending the thumb).

Question 7

Complications of scaphoid fracture

Answer 7

scaphoid has a retrograde blood supply, with blood vessels supplying the bone from only one direction.

This means a fracture can cut off the blood supply, resulting in avascular necrosis and non-union.

Question 8

What do ankle fractures tend to involve

Answer 8

lateral malleolus (distal fibula) or the medial malleolus (distal tibia)

Question 9

Classification used for ankle fractures

Answer 9

Weber classification

Question 10

What is important for stability and function of ankle joint

Answer 10

tibiofibular syndesmosis

Question 11

Main cancers that metastasise to the bones

Answer 11

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

Question 12

Guidelines used to guide medical treatments for fragility fractures

Answer 12

NOGG guidelines

Question 13

How can fractures be mechanically re-aligned

Answer 13

Closed reduction via manipulation of the limb

Open reduction via surgery

Question 14

What is a fat embolism

Answer 14

Fat embolism can occur following the fracture of long bones (e.g., femur). Fat globules are released into the circulation following a fracture (possibly from the bone marrow).

These globules may become lodged in blood vessels (e.g., pulmonary arteries) and cause blood flow obstruction.

Question 15

Presentation of a fat embolism

Answer 15

Gurd’s major criteria:

Respiratory distress
Petechial rash
Cerebral involvement

Question 16

Risk factors for hip fractures

Answer 16

Age

Osteoporosis

Question 17

Classification system used for intra-capsular NOF

Answer 17

Garden classification is used for intra-capsular neck of femur fractures:

Grade I – incomplete fracture and non-displaced
Grade II – complete fracture and non-displaced
Grade III – partial displacement (trabeculae are at an angle)
Grade IV – full displacement (trabeculae are parallel)

Question 18

Features of non-displaced intra-capsular fractures

Answer 18

have an intact blood supply to the femoral head, meaning it may be possible to preserve the femoral health without avascular necrosis occurring.

Question 19

Mx of non-displaced intra-capsular hip fractures

Answer 19

internal fixation (e.g., with screws) to hold the femoral head in place while the fracture heals.

Question 20

Mx of displaced intra-capsular fractures

Answer 20

Displaced intra-capsular fractures (grade III and IV) disrupt the blood supply to the head of the femur. Therefore, the head of the femur needs to be removed and replaced.

Question 21

What does hemiarthroplasty involve

Answer 21

Hemiarthroplasty involves replacing the head of the femur but leaving the acetabulum (socket) in place. Cement is used to hold the stem of the prosthesis in the shaft of the femur. This is generally offered to patients who have limited mobility or significant co-morbidities.

Question 22

What does total hip replacement involve

Answer 22

Total hip replacement involves replacing both the head of the femur and the socket. This is generally offered to patients who can walk independently and are fit for surgery.

Question 23

Types of extra-capsular hip fractures

Answer 23

Intertrochanteric fractures

Subtrochanteric fractures

Question 24

Mx of intertrochanteric fractures

Answer 24

Dynamic hip screw(sliding hip screw)

Question 25

Mx of subtrochanteric fractures

Answer 25

The fracture occurs to the proximal shaft of the femur. These may be treated with an intramedullary nail (a metal pole inserted through the greater trochanter into the central cavity of the shaft of the femur).

Question 26

Hip fracture presentation

Answer 26

Pain in the groin or hip, which may radiate to the knee
Not able to weight bear
Shortened, abducted and externally rotated leg

Question 27

IX for hip fractures

Answer 27

Two views are essential, as a single view can miss the fracture. Anterior-to-posterior (AP) and lateral views are standard.

Question 28

What is a Shenton’s line

Answer 28

Shenton’s line can be seen on an AP x-ray of the hip. It is one continuous curving line formed by the medial border of the femoral neck and continues to the inferior border of the superior pubic ramus. Disruption of Shenton’s line is a key sign of a fractured neck of femur (NOF).

Question 29

IX in hip fracture if x-ray is negative

Answer 29

MRI/CT

Question 30

Mx of hip fractures on admission

Answer 30

Appropriate analgesia
Investigations to establish the diagnosis (e.g., x-rays)
Venous thromboembolism risk assessment and prophylaxis (e.g., low molecular weight heparin)
Pre-operative assessment (including bloods and an ECG) to ensure they are fit and optimised for surgery
Orthogeriatrics input

Question 31

When would an x-ray be required for a suspected ankle fracture

Answer 31

Ottawa rules

if there is any pain in the malleolar zone and any one of the following findings:

bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)

bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)

inability to walk four weight bearing steps immediately after the injury and in the emergency department

Question 32

Features of colles’ fracture

Answer 32

Transverse fracture of the radius
1 inch proximal to the radio-carpal joint
Dorsal displacement and angulation

Colles’ - Dorsally Displaced Distal radius → Dinner fork Deformity

Question 33

Initial mx of open fractures

Answer 33

Open fractures constitute an emergency and should be debrided and lavaged within 6 hours of injury