Fractures

Question 1

What is an open fracture?

Answer 1

There is a direct communication between the external environment and the fracture, usually through a break in the skin

Question 2

What are open fractures important?

Answer 2

High energy injury
Increased infection rate
Soft tissue complications
Long term morbidity

Question 3

How is a type 1 open fracture classified?

Answer 3

Low energy
<1cm
Clean
Often bone piercing skin from inside

Question 4

How is a type 2 open fracture classified?

Answer 4

Moderate soft tissue damage
Wound <10cm
No soft tissue flap or evulsion

Question 5

How is a type 3 open fracture classified?

Answer 5

High energy
Extensive soft tissue damage
Severe fracture (compound, displacement)
Wound >10cm
Any gunshot, farm accident, segmental fracture, bone loss, severe crush injury or marine

Question 6

What is a type 3A open fracture?

Answer 6

Soft tissue damage +++ but not grossly contaminated

Question 7

What is a type 3B open fracture?

Answer 7

Periosteal stripping
Extensive muscle damage
Heavy contamination

Question 8

What is a type 3C open fracture?

Answer 8

Associated neurovascular complication

Question 9

What is the management procedure of an open fracture?

Answer 9

Full ATLS assessment and treatment
Tetanus and antibiotic prophylaxis
Cefuroxime / Augmentin / Clindamycin- Gent at time of fixation
Repeated examination n/v status
Wounds only handled to remove gross contamination, photograph, cover (saline swabs) and stabilise limb
No provisional irrigation / exploration
Radiographs- orthogonal views including joint above and below

Question 10

What factors must be taken into account when deciding if amputation needs to occur?

Answer 10

Limb ischaemia
Age
Shock
Injury mechanism

Question 11

What is dislocation?

Answer 11

Complete joint disruption

Question 12

What is subluxation?

Answer 12

Partial dislocation, not fully out of joint

Question 13

What is a fracture?

Answer 13

Break in the continuity of the bone, may be a crack, split, break, crumpling, buckle

Question 14

Why do bones fail?

Answer 14

High energy transfer in normal bones
Repetitive stress in normal bones
Low energy transfer in abnormal bones

Question 15

What does ATLS stand for?

Answer 15

Advanced trauma life support

Question 16

What are the phases of bone healing?

Answer 16

Inflammatory
Reparative
Remodelling

Question 17

How can fracture healing be measured?

Answer 17

Clinical examination
Radiology
Biomechanically (stiffness)

Question 18

When is a fracture healed?

Answer 18

When patient can bear weight

X ray confirmation

Question 19

What are some systemic problems that can arise due to fractures?

Answer 19

Hypovalaemia
Crush syndrome
Fat embolism and ARDS
Psychological and social aspects

Question 20

What are some local problems that can arise due to fractures?

Answer 20

Neurovascualar damage 
Skin/wound problems 
Compartment syndrome 
Delayed union 
Nonunion 
Avascular necrosis

Question 21

What is malunion?

Answer 21

Fracture has healed, but not in an anatomically correct position

Question 22

What is delayed union?

Answer 22

Healing takes longer than average or that fracture in that individual

Question 23

What is nonunion?

Answer 23

No further progress towards union

Question 24

What are the problems associated with delayed or nonunion?

Answer 24

Inadequate immobilisation
Distraction of # by fixation device or traction
repeated manipulations
Periosteal stripping & soft tissue damage at operation
Anatomical vascular suspectibility, eg. femoral neck, scaphoid, talus, (distal tibia)

Question 25

What are the different types of nonunion?

Answer 25

Atrophic

Hypertrophic