Fractures

Question 1

What is a fracture?

Answer 1

A fracture is a broken bone

– it can either be completely broken or cracked

Question 2

What causes fractures?

Answer 2

Direct:

– Break occurs at point of impact

Indirect:

– Force is transmitted along bone
– Injury occurs at some point distant to impact
– E.g. femur, hip, or pelvic fracture due to knees
hitting dash

Question 3

What are the mechanisms of injury (cause of fracture)?

Answer 3

• Twisting
• Avulsion
• Stress
• Pathological

Question 4

Twisting

Answer 4

Distal limb remains fixed but proximal part rotates
❑ E.g. football or skiing accidents

Question 5

Avulsion

Answer 5

❑ Muscle and tendon unit with attached fragment of bone ripped
off bone shaft
❑ E.g. commonly children (growth spurts), adult athletes or
dancers

Question 6

Stress

Answer 6

❑ Occur in legs/feet secondary to prolonged running or walking

Question 7

Pathological

Answer 7

❑ Result of fracture with minimal force
❑ E.g. in patients with cancer or osteoporosis

Question 8

What are the type of fractures?

Answer 8

• transverse
• spiral
• comminuted
• oblique
• impacted
• greenstick (in paediatric patients)

Question 9

Transverse?

Answer 9

Right angle to long axis (horizontal fracture line)
Often caused by direct injury

Question 10

Spiral?

Answer 10

Fracture site coils through bone (like a spring)
Occurs with torsion

Question 11

Comminuted?

Answer 11

Bone shatters into 3 or more pieces
Such as in high energy impact,
crush injury or osteoporosis

Question 12

Oblique?

Answer 12

Occurs at angle to long axis

Question 13

Impacted?

Answer 13

Compression (ends jammed together)
Frequently no loss of function

Question 14

Greenstick?

Answer 14

Pliable bone splinters on 1 side but
without complete break

Question 15

Closed fracture?

Answer 15

the fractured
bone does not break
or pierce the skin

Question 16

Open (compound) fracture?

Answer 16

the fractured
bone tears or pierces the skin
- check for wounds around injury site
- wounds increase the risk of infection,
as they expose the bone as well as
underlying tissues)

Question 17

What is a stable fracture?

Answer 17

the ends of the injury remain in place
(the bone itself may not be completely broken)

Question 18

What is an unstable fracture?

Answer 18

the ends of the fractured bones can easily
be displaced (this could damage
blood vessels, nerves or organs)

Question 19

fracture in the upper extremity

Answer 19

rarely life-threatening, but may result in long-term impairment

Question 20

Fracture in the lower extremity

Answer 20

associated with more severe injuries -
possibility of significant blood loss e.g.
femur fracture, pelvic injuries

Question 21

What are the specific fractures?

Answer 21

• pelvic
• patella
• calcaneal
• mid shaft of femur
• neck of femur

Question 22

Pelvic

Answer 22

– Direct or indirect force, likely to break in 2 places

• Fragments can damage blood vessels, urinary
  bladder, rectum and nerves
• Must use pelvic splint and treat as potentially critical

Question 23

Patella

Answer 23

Due to direct impact

Question 24

Calcaneal

Answer 24

Results from falls (foot landing), consider lumbar
sacral compression

Question 25

Mid shaft of femur

Answer 25

high speed deceleration with impact.

• can cause hypovolaemia so use traction splint!

Question 26

Neck of femur

Answer 26

r - Leg tends to shorten and rotate outward
(external rotation)

• Minimal blood loss due to joint capsule