Fractures

Question 1

How should fractures be treated generally?

Answer 1

return to anatomic position and immobilize

Question 2

What are the types of fracture?

Answer 2

• closed (simple)
• open (compound)
• displaced (pulled out of normal alignment)
• pathologic
• spiral

Question 3

What is a closed (simple) fracture?

Answer 3

fracture in which the bone does not pierce the overlying skin

Question 4

What is a open (compound) fracture?

Answer 4

the bone is exposed to the environment through the wound (infection risk).

Procedural washout and antibiotics should be used in treatment of these fractures

Question 5

Compression fractures?

Answer 5

common in the vertebrae due to collapse of the anterior portion of a process (commonly due to osteoporosis)

Question 6

What is a comminuted fracture?

Answer 6

fracture has broken the bone into a number of pieces (high impact, gunshot wounds)

Question 7

What is an impacted fracture?

Answer 7

when bone fragments are driven into each other

Question 8

What is a spiral fracture?

Answer 8

fracture from torque

Question 9

Something to always consider with a spiral fracture?

Answer 9

child abuse because they may indicate child abuse (twisting arm or leg)

Question 10

What type of spiral fracture in children suggests a LOW suspicion of child abuse?

Answer 10

spiral fracture of the distal tibia (toddler’s fracture)- can occur normally

Question 11

Complete vs. incomplete fracture

Answer 11

complete- bone fragments completely separated

Question 12

What is a stress (hairline) fracture?

Answer 12

caused by stress or repeated stress (commonly in weight bearing bones) that may require CT span to ID (x-ray may not pick up).

Question 13

What is a scaphoid fracture?

Answer 13

often secondary to a fall on an outstretched hand

Question 14

How does a scaphoid fracture present typically?

Answer 14

patients will have snuffbox pain but usually an x-ray is unremarkable. Patients still should be splinted or the proximal scaphoid may undergo avascular necrosis

Question 15

What is a Baslar skull fracture?

Answer 15

usually secondary to trauma and may present as:

• periorbital ecchymoses (raccoon eyes)
• mastoid ecchymoses (Battle sign)
• CSF leakage through the ear (otorrhea) or nose (rhinorrhea with salt, metallic taste)

Question 16

Notes on femoral head fractures?

Answer 16

common in elderly and have a high mortality (10-15% die in a year)

Question 17

Types of femoral head fractures?

Answer 17

• intracapsular (prone to avascular necrosis)
• extracapsular

treatment is variable to patient, usually arthroplasty

Question 18

Series of events following fracture

Answer 18

1) hematoma fills fracture gap and surrounding area of injury allowing platelets and inflammatory cells to enter
2) end of week 1- tissue is primed for new matrix synthesis
3) Weeks 2-3- early callus formation (cannot support weight)
4) Around 6 weeks- bony callus mineralized to the point to where controlled weight bearing can be tolerated

Question 19

What is compartment syndrome?

Answer 19

occurs when fracture disrupts vascular supply to the extremity. The legs and forearm are the areas most often affected

Question 20

How does compartment syndrome present?

Answer 20

patients will experience severe pain and exam will reveal a tense, wedlock compartment

Question 21

Diagnosis of compartment syndrome?

Answer 21

measuring the intra-compartmental pressure

Question 22

How is compartment syndrome treated?

Answer 22

fasciotomy (release tension via fascia incision)

Question 23

HandP five P’s of compartment syndrome

Answer 23

Pain
Pallor
Pulselessness
Paralysis
Parastesias