Fractures

Question 1

what is a compound fracture

Answer 1

skin is broken with bone exposed to air

Question 3

What is a stable fracture

Answer 3

sections of bone remain in alignment

Question 4

what fractures typically occur in children

Answer 4

Greenstick and buckle fractures
Salter-Harris - as involves growth plates

Question 5

what is a Colles fracture?

Answer 5

Transverse fracture of distal radius

Question 6

What fractures are normally caused by FOOSH

Answer 6

Colles
Scaphoid fracture

Question 7

what is a sign of a scaphoid fracture?

Answer 7

Tenderness in the anatomical snuff box

Question 8

what is the risk of a scaphoid fracture and why

Answer 8

Avascular necrosis as it as a retrograde blood supply, only one direction so fracture can cut off supply

Question 9

Which bones are at a risk of avascular necrosis with fractures>?

Answer 9

scaphoid
femoral head
humeral head
Talus
Navicular
fifth metatarsal of foot

Question 10

what is the Weber classification system?

Answer 10

Defines fractures of the lateral malleolus in relation to syndesmosis which is important for stability of the ankle joint
Type A - below ankle joint , syndesmosis intact
Type B - at Level of ankle joint - syndesmosis will be intact or partially torn
Type C - above ankle joint, syndesmosis will be disrupted

Question 11

What are risks of pelvic ring fractures?

Answer 11

Can lead to significant intra-abdominal bleeding either due to:
vascular injury
from cancellous bone of pelvis

Question 12

What are the main cancers that metastasise to the bone

Answer 12

PORTABLE
P - prostate
R - renal
T - thyroid
B - breast
Le - lung

Question 13

What is FRAX

Answer 13

A tool to predict risk of a fragility fracture over the next 10 years

Question 14

What does a DEXA scan measure

Answer 14

Bone mineral density

Question 15

What T score indicates osteoporosis

Answer 15

Less than -2.5

Question 16

What T score indicates osteopenia

Answer 16

-1 to -2.5

Question 17

What is a normal T score

Answer 17

More than -1

Question 18

What are first line treatments to reduce risk of fragility fractures

Answer 18

Calcium and vitamin D
Bisphosphonates

Question 19

What are side effects of bisphosphonates? How do they work

Answer 19

Interfere with osteoclasts to reduce their activity and prevent reabsorption of bone
SE:
Reflux and oesophageal erosions
Atypical fractures e.g. femoral
Osteonecrosis of the jaw
Osteonecrosis of the external auditory canal

Question 20

What is an alternative to bisphosphonates

Answer 20

Denosumab

Question 21

What are initial complications of fractures?

Answer 21

Damage to local structures
Haemorrhage
Compartment syndrome
Fat embolism
VTE

Question 22

What are long term complications of fractures

Answer 22

Delayed union
Malunion
Non-union - failure to heal
Avascular necrosis
Infection
Joint instability and stiffness
Contractures
Arthritis
Chronic pain
Complex regional pain syndrome

Question 23

How soon can a fat embolism occur after fracture

Answer 23

24-72 hours

Question 24

What criteria are used for diagnosis of a fat embolism?

Answer 24

Gurd’s major criteria:
1. Resp distress
2. Petechial rash
3. Cerebral involvement

Minor criteria:
Jaundice
Thrombocytopenia
Feveer
Tachycardia

Question 25

What is management of fat embolism

Answer 25

Supportive while condition improves