Fractures

Question 1

What are the effects of bone fractures?

Answer 1

• immobilise
• possible vascular / neural injury
• infection (compound fractures = open wounds)
• significant injury / organ damage
• medical referral

Question 2

Define external trauma

Answer 2

Caused by high force/speed collisions, direct/forceful blows and impact against vulnerable / unprotected sites

Question 3

Define internal trauma

Answer 3

Caused by twisting (closed kinetic chain creates shear force from own muscles onto bone causing internal trauma)

Question 4

What is a closed fracture?

Answer 4

Bone is broken but enclosed by skin

Consider:
*angulation
*non-displaced vs displaced
*stable vs unstable

Question 5

What is an open (compound) fracture?

Answer 5

Bone pierced through skin, exposed to environment.

Consider:
*infection
* vascular/neural injuries
* definitive medical management (check pulse and sensation)

Question 6

How does a greenstick fracture occur?

Answer 6

• applied bending force breaks convex side although not complete fracture
• painful, swollen and occur typically in children <10y
• generally stable fractures - common in mid-diaphysis of bone

Question 7

What are the risk factors of bone fractures in young athletes?

Answer 7

Mild injuries may be mistaken for bruises or sprains

Question 8

What is the fracture peak incidence in adolescence?

Answer 8

Girls 11-12y
Boys 13-15y

Coincides with peak height velocity (PHV)

Question 9

What are the two type of radius/ulnar fractures?

Answer 9

1. Colles caused by FOOSH
2. Smith caused by falling on back of hand

Question 10

What does SALTER stand for in growth plate injuries?

Answer 10

T1: Straight across
T2: Above (most common)
T3: Lower or beLow
T4: Two or Through
T5: Erasure of growth plate or cRush (rare)

Question 11

What are the complications of slipped upper femoral epiphysis (SUFE)?

Answer 11

can occur without acute trauma, often during development (if detected early, can be corrected)

Question 12

What are avulsion fractures?

Answer 12

Bone fragment torn off at tendon (muscular) or ligament attachment site
- frequently associated with secondary apophysis
- 3-5x more likely in young males

Question 13

Define bone bruising and provide examples of bruising.

Answer 13

It is a microtrabecular fracture
- associated with oedaema / haemorrhage after traumatic insult
- bone bruises often coincide with acute ACL tear

Example 1: interosseous bruise = bleeding in bone marrow
Example 2: subchondral bruise = between cartilage and bone beneath causes cartilage to separate from bone

It is the beginning of OA sequence