Fractures and Sprains

Question 1

Classifications of bones?

Answer 1

Compact (cortical), spongy bone (trabecular)

Question 2

Why do we use casts? Should you be immobilized?

Answer 2

Casts are for maintaining position, you should bear weight/ move as soon as possible to allow for bone rebuilding

Question 3

Regulation of bone remodelling and resorption - factors

Answer 3

RANK, RANK L (binds to RANK triggers the clasts, OPG (blocks RNAK L protects bone) PTH - triggers clasts if calcium is low

Estrogen (stimulates apoptosis of clasts), Vit D (activates blasts), Ca++, corticosteroids (increase clast lifespan), bisphosphonates (block clasts)

Question 4

Stages of secondary bone healing?

Answer 4

1. Inflammatory (1-5) - hematoma forms and release of cytokines, can put local into the hematoma
2. Fibrocartilage callus formation (5-11), angiogenesis, rejoins fracture
3. Bony callus formation (11-28) - RANK L stimulated bone formation
4. Bone remodelling (18 onwards) - woven bone replaced by laminar bone

Question 5

NSAIDs good vs bad in the bone healing process

Answer 5

Not great, decrease cytokines the inflammatory phase. But still used all the time.

Question 6

What is primary bone healing?

Answer 6

Only happens if fixed - less than 1mm apart only with surgical plating. Reestablishes cortex without a callus.

Question 7

Adverse factors effecting healing?

Answer 7

Infection, poor blood supply, malnutrition, obesity, Immuno suppression, age, smoking, drugs, diabetes

Question 8

Types of fracture

Answer 8

Traumatic , pathologic, stress, Salter-Harris

Question 9

Stable vs Unstable spinal #

Answer 9

Stable - anterior column, no NVS symptoms, not moving around
Unstable - mid/posterior columns, NVS, moving around on palpation

Question 10

Triad of fat emboli sx?

Answer 10

Petechial rash, decreased LOC and SOB, more common in femoral fracture, not to do with BMI, supportive management

Question 11

Guidelines for BMD?

Answer 11

<50 - medications put at risk
50-64 - pre-existing conditions
All adults over 65 - 5-10 years if low risk

Question 12

Cancer Mets to bone? Locations?

Answer 12

Breast, kidney, lung, prostate , most common to spine and pelvis

Question 13

Ankle fracture vs sprain?

Answer 13

Is the pain right on the tip of the malleolus or is it more posterior, not on the bone

If sprain not on bone, give crutch and wrap
Waking boot for #

Question 14

Describing a fracture?

Answer 14

Say the anatomic location, whether closed or open fracture, simple or compound, complete or incomplete, direction and degree of angulation, stable or unstable,

vascular and neurological impairment of an injury for documentation or referral purposes

Question 14

Comminuted fractures vs segmental

Answer 14

Comminuted - multiple fragments per fractured part

Segmental - one fragment per complete fractured part

Question 15

Risk factors for osteoporosis?

Answer 15

Smoking, poor diet, low body weight, Fhx

Female, post-menopausal, inactivity, drug use (steroids)

Question 16

Osteoporosis BMD criteria?

Answer 16

> 2.5 SD from mean, usually female and over 50

Question 17

How do you measure BMD?

Answer 17

Dexascan

Can use screening tools FRAX and CAROC for fracture risk

Question 18

Tx of low risk (of #) osteoporosis?

Answer 18

Calcium (1000-1200) and vitamin D - 5-10 years BMD

Question 19

Tx of high risk osteoporosis?

Answer 19

( or already had a fracture)
Initiate on bisphosphonates or prolia, BMD ever 1-3 years

Bisphosphonates (alendronate) - 1st line in males
Denosumab - 1st line in females (if poor renal function can use zoledronic acid)
Raloxifene - for post-menopausal (estrogen agonist)

Question 20

Canadian C-spine rule?

Answer 20

If greater than 65, dangerous mechanism (fall from heights, axial load, MVC (high speed)) or parasthesias need CT

Question 21

Possible scaphoid fracture?

Answer 21

Tenderness over the anatomical snuffbox, FOOSH, may not see initially on X-ray

Put in a thumb spica, for 4 weeks check on every weeks operate if displaced.

Question 22

Ottawa ankle rules

Answer 22

Bone tenderness at the post tip of the lateral or medial malleolus inability to bear weight

Question 23

Indications for ORIF

Answer 23

Non-union 
Open fracture 
Neurovascular compromise 
Displaced Inara articular 
Salter Harris (3-5) 
Poly trauma

Question 24

Pulled elbow or nursemaids elbow?

Answer 24

Seen in children - yanked up by elbow

Question 25

Salter-Harris Fracture?

Answer 25

Paediatric fracture of the growth plate

Stage 1 - just a plate separation 
Stage 2 - + transverse fracture
Stage 3  - through the epiphysis and growth plate separation 
Stage 4  - + transverse fracture 
Stage 5 - crush injury

Question 26

Colles fracture?

Answer 26

Fracture of the ulna with radial displacement - FOOSH

Question 27

Most commonly sprained ankle ligament?

Answer 27

ATF

Question 28

Boxer’s fracture?

Answer 28

From punching something, 5th metacarpal

Question 29

What is a greenstick fracture?

Answer 29

Disruption of the cortex and the periosteum on the side of tension but it is intact on the other side - involves angulation

In kids because their bones are still flexible

Question 30

Maisonneuve fracture

Answer 30

Separation of the ankle mortise, fracture of the fibular and ligamenous injury