Fractures

Question 1

Galearazzi Fracture

Answer 1

Fracture of the distal 1/3rd of the radius with dislocation of the distal radioulnar joint

Question 2

Monteggia Fractire

Answer 2

Fracture of the proximal 1/3rd of the ulna with dislocation of the proximal head of the humerus

Question 3

Risks associated with supracondylar fracture of humerus

Answer 3

Poses risk to.

• Brachial artery
• Median nerve
• Radial nerve
• Ulnar nerve

Question 4

Fractures of proximal femur epidemiology

Answer 4

Commoner in females 
Young people (high energy accidents)

Question 5

Fractures of proximal femur risk factors

Answer 5

Age
Osteoporosis 
Smoking
Malnutrition 
Alcohol 
Neuroimpairment

Question 6

Vessels supplying femoral neck

Answer 6

Intramedullary artery

Medial and lateral circumflex branches

Vessel of ligament Teres

Question 7

Fractures of Proximal Femur Types

Answer 7

Intracapsular

Extracapsular

Question 8

Intracapsular fractures of proximal femur

Answer 8

Displaced
Undisplaced

Garden Classification:
Garden 1
- Incomplete, stable fracture with importation in valves

Garden 2
- Complete but not displaced fracture with no disturbance of the. medial trabecular lines

Garden 3
- Completely displaced fracture with virus and all 3 trabecular lines disturbed

Garden 4
- Completely displaced fracture that is completely displaced

Can lead to

• AVN
• Non-union

Question 9

Extracapsular fractures of proximal femur.

Answer 9

Basicervical
Intertrochanteric
Subtrochanteric

Can lead to

• Mal-union
• Non-union

Question 10

Fractures of proximal femur investigations

Answer 10

X-ray

• AP and lateral
• Shenton’s line is broken

MRI

Question 11

Intercapsular fractures of proximal femur treatment

Answer 11

Undisplaced

• FIx fracture and leave femoral head
• Nail
• Dynamic hip screw and plate

Displaced

• Old patients: hip replacement or semi-arthroplasty
• Young patients: fix fracture and leave femoral head or nail or dynamic hip screw and plate

Question 12

Extracapsular fracture of proximal femur treatment

Answer 12

Almost always heal

Dynamic hip screw can be used

Question 13

Pelvic fractures epidemiology 1

Answer 13

Young
- High energy accidents

Old

• Osteoporosis
• Pre-sacral venous plexus

Question 14

Pelvic Fractures: Vessels prone to injury

Answer 14

Internal iliac artery

pre-sacral venous plexus

Question 15

Patterns of pelvic injury

Answer 15

Lateral compression injury
Vertical sheer fracture
Anteroposterior compression injury

Question 16

Lateral Compression injury (pelvic fracture)

Answer 16

Half of pelvis is displaced medially

Typically caused by a side impact

Question 17

Vertical Sheer Fracture (pelvic fracture)

Answer 17

Axial force on one semi-pelvis causing superior displacement

Risk to

• sacral nerve roots nad lumbosacral plexus
• Major haemorrhage

Leg on affected side will be shorter

Question 18

Anteroposterior compression injury (pelvic fracture)

Answer 18

Open back pelvic fracture

Wide disruption of the pubic symphysis

Pelvic space increases greatly in size so no more blood can be held , encouraging bleeding

Bleeding can be reduced by

• tied sheet or pelvic border to reduce pelvic space
• external fixator

Ongoing harm-dynamic instability

• angiogram
• embolisation
• open packing of the pelvis

Question 19

Pelvic Fracture Important investigations

Answer 19

Plain X-rays 
CT scan 
PR exam
- Assess sacral nerve root function 
- Look for presence of blood