Fractures

Question 1

List acute (5) + late (10) complications of fractures

Answer 1

ACUTE:
Nerve damage (e.g. elbow, knee, shoulder)
Vessel damage / bleeding
Mm damage (rhabdo)
Visceral damage (e.g. ribs, pelvic)
Compartment syndrome!!

LATE:
Delayed union
Mal-union
Non-union
Joint instability
OA
AVN
Complex regional pain syndrome

Infection
DVT/PE
Pressure sores

Question 2

What is the Management of Compartment syndrome (Really Excruciating Fascia Flattening)

Answer 2

Remove cast
Elevate limb
Fasciotomy ± debridement
Fluids (aggressive; myoglobin/AKI risk)

Question 3

List some RFs for poor healing in fractures (3+4)

Answer 3

Systemic:
Poor nutrition
Smoking
Steroids

Local:
Poor apposition 
Poor blood supply
Foreign bodies in the way
Infection

Question 4

How is non-union managed? (2+2)

Answer 4

Conservative:
Splinting
Functional bracing

Surgical:
Rigid fixation
± Bone graft

Question 5

How is mal-union managed? (4)

Answer 5

Re-manipulation
Osteotomy
Internal fixation
Limb lengthening

Question 6

How is a scaphoid fracture managed?

Answer 6

Conservative: immob in cast inc. thumb (thumb spica)
6–8wks
(warn pt risk of AVN/non-union req surg in 10%)

Question 7

What are the features of a Monteggia # VS Galeazzi #?

Answer 7

Monteggia:
Proximal ulnar #
Proximal radial dislocation

Galeazzi:
Distal radial #
Distal radio-ulnar dislocation

Question 8

What injuries can occur with a Galeazzi fracture? (3)

Answer 8

Anterior interosseous nn
(motor only; FPL+FDP; cannot make OK sign)

Radial nn injury – wrist drop
Extensor tendon injuries – wrist drop

Question 9

What is the conservative / surgical management of vertebral wedge fractures

Answer 9

RASS

Rest (1–2wks as wt bearing/moving worsens)
Analgesia
Strengthening/mobilising (physio)
Splint (only in severe >25% ht loss: thoraco brace)
Surgical: kyphoplastyn (for ongoing # pain)

Question 10

What are the diff types of cervical spine fractures (3)

Answer 10

Jefferson’s: C1 (axial compression from skull)
Hangman’s: C2 (neck hyperextension)
Odontoid

Question 11

What are the diff blood supplies to the NOF (3)

Answer 11

Intramedullary aa (within canal) (all # disrupt)
Medial**/Lateral circumflex anastomoses (displaceds)
Ligamentum teres aa (<10% supply)

Question 12

What would be seen O/E in a #NOF

Answer 12

Pain on passive movement

(if displaced:): leg shortened / ext rotated

Question 13

Describe the Garden classification of #NOF (4)

Answer 13

Garden 1: incomplete # / un-displaced
Garden 2: complete # / un-displaced
Garden 3: complete # / incompletely displaced
Garden 4: complete # / completely displaced

Question 14

How are intracapsular #NOFs managed according to their classification?

Answer 14

Garden 1/2 (stable); cannulated hip screws

Garden 3/4 (unstable); hemiarthroplasty/THR

For all young/fit/trauma pts: hip screws
For elderly but good mobility/ADLs: THR

Question 15

How are extracapsular #NOFs managed?

Answer 15

Intertrochanteric: Dynamic hip screw

Subtrochanteric: Intramedullar nail/hip screw

Question 16

What are the Ottawa rules in Ankle #?

Answer 16

XR ankle if:
• Unable to wt bear
• Pain AND bony tenderness at lat/med malleoli

XR foot if:
• Pt unable to wt bear
• Bony tenderness over navicular/5th metatarsal

Question 17

Describe the Weber Classification of Ankle # + management for each

Answer 17

Weber A: # below syndesmosis (tib-fib)
Stable / PoP 6wks

Weber B: # at syndesmosis level
?unstable / trial conservative
Repeat XRs wks 1/2/3 – talar shift

Weber C: # above syndesmosis
Unstable / ORIF (it pt fit)