Fractures

Question 1

Define open fracture

Answer 1

There’s direct communication between external environment and fracture, usually through break in skin but not always (e.g. fragments of bone from a fractured pelvis penetrating the rectum)

Question 2

Describe a Type I open fracture (Gastillo classification)

Answer 2

Low energy, wound <1cm, Clean, often bone piercing skin from inside

Question 3

Describe a Type II Open fracture (Gastillo classification)

Answer 3

Moderate soft tissue damage, Wound <10cm, No soft tissue flap or avulsion

Question 4

Describe a Type III Open fracture (Gastillo classification) and the kind of injury it results from

Answer 4

High energy, wound > 10cm, extensive soft tissue damage, severe fracture
Results from any gunshot, farm accident, severe crush etc.

Question 5

What is the difference between Type III A, III B + III C (Gastillo classification)?

Answer 5

Type III A – +++ soft tissue damage but not grossly contaminated
Type III B – periosteal stripping, extensive muscle damage, heavy contamination
Type III C – associated neurovascular complication.

Question 6

Define dislocation and subluxation

Answer 6

Dislocation – complete disruption of a joint

Subluxation – partial dislocation (not fully out of joint)

Question 7

What are common sites of dislocation?

Answer 7

Shoulder
Elbow 
Hip 
Knee
Ankle
Subtalar joint

Question 8

What are complications of an open fracture?

Answer 8

Wound or tetanus infection 
Non-union 
Compartment syndrome 
Osteomyelitis 
Neurovascular injury

Question 9

What are complications of dislocations?

Answer 9

• Tearing of the muscles, tendons and ligaments that reinforce injured joint
• Nerve or blood vessel damage in and around the joint
• Susceptibility to re-injury if you have a severe dislocation or repeated dislocations
• Development of arthritis in the affected joint as you age

Question 10

Describe management of dislocations

Answer 10

• Reduction (moving bone back into joint)
• Immobilisation (stabilise joint once bone back in place)
• Surgery may be required if unable to put bone back into joint or if any damage to any blood vessels or nerves around joint
• Rehabilitation to restore function of affected joint

Question 11

Describe the management of open fractures

Answer 11

• Tetanus and Abx prophylaxis
• Photograph, cover and stabilise limb
• Surgical emergency – some within 6h, all within 24hrs

Question 12

What is involved in initial treatment and assessment of a fracture?

Answer 12

Immobilisation. Pain relief.

Assessment: clinical – fracture, circulation, neurological, open vs closed; radiological

Question 13

What are conservative treatment options for fractures?

Answer 13

No immobilisation – strapping, brace

Immobilisation – cast, functional bracing, traction

Question 14

What are operative Rx for Fractures?

Answer 14

External fixators – fixation from outside, pins or wires passed through skin and bone, fixed to an external frame

Internal fixation: Intramedullary rods/nailing, Screws and plates

Question 15

What are the complications in external fixation?

Answer 15

Neurovascular injury
Pin tract infection
Loss of fracture alignment

Question 16

What are the complications in internal fixation (screws and plates)?

Answer 16

Devascularisation
Wound problem
Infection

Question 17

What is involved in ATLS management?

Answer 17

ABC approach
Airway with C-spine control
Breathing with O2
Circulation with haemorrhage control (+volume replacement (e.g. IV) and monitoring volume replacement)
Disability w/ neurological examination (AVPU, GCS)
Expose and environment