Fractures & Dislocations

Question 1

Fracture of the distal third of ulna is AKA

Answer 1

Colles fracture

Question 2

What’s the X-ray abnormality associated with a Colles’ fracture?

Answer 2

Dinner-fork abnormality

Question 3

Describe a communited fracture

Answer 3

Break or splintering of bone into more than 2 segments

Question 4

Which fracture presents a particular risk of compartment syndrome?

Answer 4

Tibial fractures

Question 5

Non-angulated, oblique tibial fractures around the diaphysis are best treated with which method?

Answer 5

IM nailing

Question 6

What’s the emergency care for femur fractures?

Answer 6

Thomas splinting

Question 7

Humeral shaft fractures present particular risk to which nerve & how does this commonly present if damaged?

Answer 7

Radial nerve & wrist drop

Question 8

What’s more common - anterior or posterior shoulder dislocation?

Answer 8

Anterior

Question 9

Damage to the axillary nerve is a common sequelae of anterior shoulder dislocation. What is the indicative sign?

Answer 9

Numbness in the regimental badge area

Question 10

By definition, if the knee is dislocated, at least how many ligaments must be ruptured?

Answer 10

At least 3

Question 11

Damage to the popliteal artery in knee dislocation is a surgical emergency. True/false?

Answer 11

True

Question 12

Supracondylar fractures of the knee in children require what treatment?

Answer 12

Immediate reduction & pinning

Question 13

Anterior shoulder dislocations are commonly managed how?

Answer 13

Closed reduction & sling 3 weeks

Question 14

Which type of shoulder dislocation commonly presents from falling onto elbow?

Answer 14

Anterior dislocation

Question 15

Detachment of the anterior labrum of the glenohumeral joint is termed what?

Answer 15

Bankart lesion

Question 16

A shoulder injury where the glenoid labrum is detached AND the posterior humeral head is fractured is termed what?

Answer 16

Hill-Sachs lesion

Question 17

Rotator cuff tears are common sequelae in Hill-Sachs lesions, true or false?

Answer 17

True

Question 18

Re-dislocation of the shoulder is inversely proportional to age. True or false?

Answer 18

True - the younger you are the more likely to dislocate, the older the less likely to dislocate

Question 19

If you’re <20 and dislocate your shoulder, what’s the chance of a re-dislocation?

Answer 19

80%

Question 20

Is an X-ray required to confirm reduction in anterior shoulder dislocation?

Answer 20

Yes

Question 21

Describe a neuropraxia: severity, duration, pathophysiology (3)

Answer 21

1) Mildest form of nerve injury 2) Usually lasts <28 days (if more, consider a axontomesis) 3) Myelin sheath intact, caused by crushing damage leading to a block without degeneration

Question 22

Which manoeuvre is useful in closed reduction of shoulder dislocation?

Answer 22

Kocher

Question 23

Posterior shoulder dislocation commonly results from what injury?

Answer 23

A posterior force applied on an ADDUCTED and INTERNALLY ROTATED shoulder

Question 24

What’s the x-ray sign associated with posterior shoulder dislocation?

Answer 24

Light bulb sign

Question 25

Posterior shoulder dislocation is treated how?

Answer 25

Closed reduction & sling with physiotherapy

Question 26

Axillary nerve injury is commonly associated with loss of power in which muscle?

Answer 26

Deltoid

Question 27

Describe an axonotmesis

Answer 27

Loss of myelin and Wallerian degeneration of nerve. Recovery is possible without surgery (1mm per day).

Question 28

Describe a neurotmesis

Answer 28

Most severe form of nerve injury - when the nerve has been wholly transected

Question 29

A fall onto shoulder commonly results in which joint dislocating?

Answer 29

AC joint

Question 30

If the AC joint is only mildly displaced, how is it managed?

Answer 30

Conservatively

Question 31

Anterior or posterior SC joint dislocation is more serious?

Answer 31

Posterior - can compress trachea (worry about dyspnoea, dysphagia, venous congestion)

Question 32

A pure elbow dislocation (no fracture) requires what treatment?

Answer 32

Reduction and casting for 1 week, followed by physio

Question 33

Galeazzi fracture is of...

Answer 33

Radius fracture, ulnar dislocation (GRUsome)

Question 34

Monteggia fracture is of...

Answer 34

Ulnar fracture with radial head dislocation (MURder)

Question 35

Which dislocation is common in cricketers?

Answer 35

Dorsal PIPJ

Question 36

Dorsal PIPJ dislocation is best treated how?

Answer 36

Immediately with reduction on pitch (common in cricketers) under a LA

Question 37

Finger dislocation is long-term managed how?

Answer 37

Splintage for 3 weeks

Question 38

High energy hip dislocation is associated with posterior/anterior wall acetabulum fracture?

Answer 38

Posterior

Question 39

Femoral head avulsion fractures require emergency reduction, true or false

Answer 39

True

Question 40

What are the complications of hip fracture (2)

Answer 40

1) AVN of femoral head 2) Hetertropic ossification

Question 41

Hip dislocation presents a risk to which nerve?

Answer 41

Sciatic nerve

Question 42

Patellar dislocation commonly occurs toward which side?

Answer 42

Laterally from a sudden quadriceps contraction with or without direct blow to patella

Question 43

An osteochondral fracture of the patella gives a risk of what, visible on X-ray?

Answer 43

Lipohaemarthrosis within joint

Question 44

Predisposing factors to patellar dislocation include (6)

Answer 44

1) Female 2) \<20 yo 3) Ligamentous laxity 4) Genu valgum 5) Shallow trochela 6) Femoral neck anteversion

Question 45

Treatment for patellar dislocation (3)

Answer 45

1) Reduction 2) Splintage for 3 weeks 3) Physio

Question 46

Which nerve can be injured in knee injury?

Answer 46

Common fibular nerve

Question 47

Subtalar dislocations frequently occur toward which direction?

Answer 47

Median side

Question 48

Subtalar fractures are treated how?

Answer 48

Casting for 3 weeks

Question 49

What's serious complication of subtalar fractures?

Answer 49

Fracture of talar neck AKA "aviators astragalus" (high risk of AVN)

Question 50

A Lisfranc fracture dislocation is technically what dislocation

Answer 50

Tarso-metatarsal dislocation

Question 51

Lisfranc injuries commonly result while foot is what?

Answer 51

Rotated while hyperplantarflexed

Question 52

Lisfranc injuries are treated how?

Answer 52

Internal fixation

Question 53

Can neurotmesis recover without surgery?

Answer 53

No

Question 54

"Nerve axon dies distal to injury" describes what type of injury & degeneration?

Answer 54

Axonotmesis and "Wallerian degeneration"

Question 55

What % of function is expected to return from patients who suffered an axonotmesis injury?

Answer 55

70-80%

Question 56

Describe the EARLY and systemic complications of any fracture (4)

Answer 56

1) Hypovolaemia 2) Fat embolism 3) ARDS / SIRS 4) MODS

Question 57

Atrophic non-union of bone is commonly due to which factors (3)

Answer 57

1) Lack of nutrition (e.g. smoking) 2) Reduction in blood supply 3) Fracture gap too big to repair

Question 58

Which drugs can cause atropic non-union? (3)

Answer 58

1) NSAIDs 2) Steroids 3) Bisphosphonates

Question 59

Malunion is technically defined as....

Answer 59

When a fracture heals in a non-anatomic position sufficient to cause symptoms

Question 60

Primary bone healing occurs when bone is...

Answer 60

Able to fill gap (often minimal gap, \<1mm)

Question 61

Secondary bone healing fills the gap in bone initially with X then Y, then Z.

Answer 61

X = Granulation tissue Y = Cartilage Z = Bone

Question 62

Label the fracture types

Answer 62

A = Transverse B = Oblique C = Spiral D = Communited E = Segmental

Question 63

In fracture, angulation is reported according to the distal/proximal segment?

Answer 63

Distal

Question 64

Describe this fracture in terms of angulation & displacement?

Answer 64

Lateral displacement (around 50%) and lateral angulation (around 45 degrees)

Question 65

If a fracture is extra-articular, with minimal displacement, how is it best managed?

Answer 65

Conservatively (splintage)

Question 66

Which surgical fixation is contraindicated in significant soft-tissue swelling?

Answer 66

ORIF

Question 67

Do all intra-articular fractures require surgical stabilisation?

Answer 67

No. Undisplaced, intra-articular fractures may be stable and treated **non-operatively**

Question 68

How are displaced, intra-articular fractures managed?

Answer 68

Urgent reduction and internal fixation to prevent OA

Question 69

Which procedure is done to treat compartment syndrome?

Answer 69

Fascicotomy

Question 70

Unstable femoral shaft fractures are surgically stabilised using which method?

Answer 70

IM nail

Question 71

What are the risks associated with femoral shaft fracture? (2)

Answer 71

1) Blood loss (usually \>1L) 2) Fat embolism

Question 72

Proximal tibial fractures are surgically managed how

Answer 72

Anatomical reduction & internal fixation

Question 73

Tibial shaft fractures are associated with what seriosu complication?

Answer 73

Compartment Syndrome

Question 74

A pilon fracture occurs where?

Answer 74

Distal tibia

Question 75

Bimalleolar fractures are treated surgically using which method?

Answer 75

ORIF

Question 76

Most proximal humerus fractures are caused by what?

Answer 76

Osteoporosis

Question 77

Distal humerus fractures generally require which surgical method to correct?

Answer 77

ORIF

Question 78

The radial head of the elbow is responsible for which movements of the arm?

Answer 78

Supination/ pronation

Question 79

"FOOSH" is a buzzword for which fracture?

Answer 79

Colles

Question 80

Complications of Colles' fracture (4)

Answer 80

1) Median nerve injury 2) CRPS 3) Rupture of EPL 4) Loss of grip strength

Question 81

A minimally displaced Colles fracture is treated how?

Answer 81

Plastering

Question 82

A communited Colles' fracture requires which surgical method to treat?

Answer 82

ORIF

Question 83

Smith's fracture commonly results from falling onto what?

Answer 83

Back of hand

Question 84

Smith's fracture is surgically treated how?

Answer 84

ORIF

Question 85

A Barton fracture is intra or extra-articular?

Answer 85

Intra-articular