Fractures

Question 1

What neuromuscular structures in the elbow can be injured in supracondylar fracture?

Answer 1

Brachial artery entrapment:
Leads to white/pale hand with no pulse

Ulnar nerve damage

Question 2

How is a supracondylar fracture treated?

Answer 2

Reduce fracture
Hold in place using K-wires and a plaster cast. They should both be removed after 4 weeks and mobilisation should be encouraged

Question 3

How are open fractures classified?

Answer 3

Gustilo and Anderson classification system:
Grade 1 = clean wound <1cm length

Grade 2 = wound 1-10cm length but not extensive soft tissue damage, flaps or avulsions

Grade 3 = extensive soft tissue laceration (>10cm) or tissue damage or an open segmental fracture. This also includes fractures caused by farm injuries, injuries requiring vascular intervention, and fractures that have been open for 8hrs prior to treatment

Grade 3a = adequate periosteal covering of fracture bone despite soft tissue laceration or damage

Grade 3b = periosteal stripping, bone damage and extensive soft tissue laceration, massive contamination

Grade 3c = associated with arterial injury requiring repair

Question 4

What are the classic signs of a fractured NOF?

Answer 4

Pain

External rotation and shortening of leg

Question 5

What locations can hip fractures occur?

Answer 5

Intracapsular = from edge of femoral head to insertion of capsule of the hip joint. Blood supply to femoral head is damaged.

Extracapsular = either trochanteric or subtrochanteric.

Question 6

What is the Garden system classification for hip fractures?

Answer 6

Type I = stable fracture with impaction on valgus
Type II = Complete fracture but undisplaced
Type III = Displaced fracture, usually displaced and angulated, but still has bony contact
Type IV = Complete bony disruption

Blood supply usually disrupted in type III and IV

Question 7

How is an extracapsular hip fracture fixed?

Answer 7

Dynamic hip screw (DHS)

If reverse oblique, transverse or subtrochanteric: Intramedullary nail

Question 8

How is an intracapsular hip fracture fixed?

Answer 8

If undisplaced:
Internal fixation or hemiarthroplasty if unfit

If displaced:
In young and fit (i.e. <70yrs old) = Reduction and internal fixation
In older and reduced mobility = hemiarthroplasty or total hip replacement

Question 9

What is the initial management for open fracture?

Answer 9

IV Abx whilst waiting for debridement
Debridement with 6L of saline
Fracture stabilised and external fixator is often used in first instance

Question 10

What are the types of paediatric fractures?

Answer 10

Complete fracture - both sides of cortex are breached

Toddler’s fracture - oblique tibial fracture in infants

Plastic deformity - stress on bone resulting in deformity without cortical disruption

Greenstick fracture - unilateral cortical breach only

Buckle fracture - Incomplete cortical disruption resulting in periosteal haematoma only

Question 11

What can cause pathological fractures?

Answer 11

Metastatic tumours:
Breast
Lung
Thyroid
Renal
Prostate

Bone disease:
Osteogenesis imperfecta (brittle bone disease)
Osteoporosis
Metabolic bone disease
Paget's disease

Local benign condition:
Chronic osteomyelitis
Solitary bone cyst

Primary malignant tumour:
Chondrosarcoma
Osteosarcoma
Ewing’s tumour