Fractures

Question 1

7 parts to describing a fracture

Answer 1

which bone?
area of bone?
articular involvement?
# pattern?
displacement?
open/closed?
neurovasc status?

Question 2

when describing the displacement of a fracture, do you describe the proximal or the distal displacement

Answer 2

DISTAL compared to proximal

Question 3

4 types of displacement

Answer 3

angulation (anterior/posterior, varus/valgus)
rotation
shortening
translation

can’t describe them so you will have to look at pics!

Question 4

5 different types of fracture pattern

Answer 4

spiral
long/short oblique
transverse
wedge (butterfly fragment)
segmental

Question 5

how to describe location

Answer 5

bone (incl L or R!)

then segment: diaphyses (shaft), metaphysis (in between), epiphysis (end)

Question 6

what does fracture reduction mean

Answer 6

realignment (it hasn’t got anything to do with reducing)

Question 7

varus vs valgus

Answer 7

generally using this word it always describes distal in relation to proximal

valgus: distal part is outward (knocked knees)
varus: distal part inward (bow legs)

(rum keeps knees apart, gum sticks knees together)

Question 8

how to describe joint involvement

Answer 8

• extra articular
• partial articular (some part of joint remains in continuity with diaphysis
• complete: joint completely detached from metaphysis

Question 9

rx options #

Answer 9

• symptomatic rx
• non surgical external immobilisation
• surgical fixation (external rings and rods, or internal plates/rods)
• replacement

Question 10

why reduce a #?

Answer 10

• protect nerves, vessels, soft tissue
• minimise swelling
• prevent further fat emboli
• increase stability
• relieve pain
• allow restoration of function

Question 11

only specifically orthopaedic emergency

Answer 11

broken pelvis leading to haemorrhage

Question 12

open # guidelines

Answer 12

1 stop bleeding
2 NV exam
3 splint (recheck NV status - recheck after u do anything)
4 cover
5 abx
6 tetanus
7 image
8 surgical debridement and coverage

Question 13

what is compartment syndrome

Answer 13

raised pressure within closed osteofascial compartment -> ischaemia -> necrosis

Question 14

clinical features of acute compartment syndrome

Answer 14

increasing pain despite immobilisation
tenderness and swelling
pain with passive movement
5Ps LATE SIGN (pain, pallor, paresthesia pulselessness, paralysis)

Question 15

acute compartment syndrome most commonly due to?

Answer 15

trauma (crush, gunshot, burns)

also tight casts or dressings

Question 16

why may someone get renal failure in compartment syndrome

Answer 16

pressure -> muscle death -> myoglobinuria -> renal failure

Question 17

dx of compartment syndrome

Answer 17

clinical but there are ways to measure intracompartmental pressure

pressure in compartment >30mmHg diastolic is associated with compartmental syndrome

Question 18

where does compartment syndrome usually occur

Answer 18

limbs

Question 19

what is a pelvic binder

Answer 19

used to compress pelvis in those with pelvic # to stop bleeding

Question 20

rx compartment syndrome

Answer 20

urgent decompression to prevent ischaemia

Question 21

what is a lipohaemoarthrosis

Answer 21

layer of fat floating over blood in xray (google it) pathogonomic of #
important to know if the pt was lying/standing when xray was taken to know where to look for the level between the fat and the blood

Question 22

commonest cause of hip dislocation

Answer 22

high energy trauma e.g. RTC - knees impact dashboard

Question 23

what nerve injury occurs in 10% of hip dislocation

Answer 23

sciatic

Question 24

remember to check the NV status

Answer 24

pre and post reduction

NAME THE NERVES YOU HAVE TESTED, don’t just write NB (tick!)

Question 25

complications of a fracture

Answer 25

non union deformity -> can lead to premature OA

avascular necrosis