Fractures

Question 1

What classification system is used for ankle fractures? Describe it

Answer 1

Weber classification. Category A Fracture of the lateral malleolus distal to the syndesmosis (the connection between the distal ends of the tibia and fibula). Category B Fracture of the fibula at the level of the syndesmosis. ​Category C Fracture of the fibula proximal to the syndesmosis.

Question 2

Define non-union

Answer 2

Absence of fracture healing within the expected period of time

Question 3

What are the possible causes of non-union?

Answer 3

• Diabetes
• Smoking
• Poor nutrition
• NSAIDs (affecting intial inflammatory process)
• Pathological reason for fracture
• High energy fracture/open fracture (loss of local bood supply)

Question 4

What are the five stages of fracture healing (secondary bone healing)?

Answer 4

1. Bleeding/haematoma formation
2. Inflammation
3. Soft callus formation (cells prolioferate and early bone and cartilage is formed).
4. Hard callus formation (woven bone is transformed into stronger llamellar bone).
5. Remodelling (bone remodels according to the stresses placed on it; form follows function).

Question 5

When does primary bone healing occur?

Answer 5

To repair microfractures

Question 6

What is the average expected time for fracture healing of a heralthy adult (for the purpose of detrmining length of time a pt. should be in a cast) in:

1. The upper limb?
2. The lower limb?
3. Ankle fractures?
4. Hand fractures?

Answer 6

1. 6 weeks
2. 12 weeks (note tibia/femur fracture can take up to 6 months for full strength to be regained).
3. 6 weeks
4. 4 weeks

NB, the younger the patient the faster the healing time