fractures: general management

Question 1

how long does it take for soft callus to form after a break

Answer 1

2-3 weeks

Question 2

how long does it take for hard callus to form after a break

Answer 2

6-12

Question 3

how do transverse fractures usually occur + what are they

Answer 3

bending force (can angulate) // perpendicular - 1 break

Question 4

how do oblique fractures usually occur + what are they

Answer 4

shearing force with fall or deceleration // diagonal along long axis of bone

Question 5

how are oblique fractures usually managed

Answer 5

screw

Question 6

how to spiral fractures usually occur + what are they

Answer 6

rotational force // severe form of oblique fracture

Question 7

how are spiral fractures managed

Answer 7

screws

Question 8

how are segmental fractures managed + what are they

Answer 8

long rods and plates // more than 1 fracture in a bone

Question 9

what classification is used for open fractures

Answer 9

Gustila and anderson: 1 = <1cm wound // 2 = >1cm wound + some soft tissue damage // 3 = >1cm wound + significant soft damage // a = enough coverage // b = not enough coverage // c = vascular injury

Question 10

mx open fractures

Answer 10

immobilise, IV abx, debride, external fixation

Question 11

how are undisplaced fractures usually managed

Answer 11

splint, immobilise, rehab

Question 12

how are angulated/ displaced fractures usually managed

Answer 12

reduction under anaesthesia + cast // X ray for progress

Question 13

how are unstable extra-articular fractures usually managed

Answer 13

ORIF (plates and screws)

Question 14

how are displaced intra-articular fractures usually managed

Answer 14

ORIF (wires, screws, plates) - poor outcomes

Question 15

what early local complications of fractures can occur

Answer 15

compartment, neurovascular injury, ischaemia

Question 16

what systemic complications of fractures can occur

Answer 16

hypovolaemia, ARDS, renal failure, SIRS, PE, fat embolism

Question 17

which fractures usually cause compartment syndrome

Answer 17

supracondylar (humerus at elbow) or tibial shaft

Question 18

symtpoms compartment syndrome

Answer 18

pain+++, loss of function, swollen, pallor, extensive analgesia (pulse may still be present)

Question 19

invx compartment syndrome

Answer 19

pressure >40 mmHg // Xrays will not show anything

Question 20

mx compartment syndrome

Answer 20

remove tight clothing // fasciotomy // IV fluids

Question 21

SE fasciotomy

Answer 21

myoglobulinuria

Question 22

what neurovascular component is commonly damaged in knee dislocation

Answer 22

popliteal artery

Question 23

what neurovascular component is commonly damaged in paediatric supracondylar fracture at elbow

Answer 23

brachial artery

Question 24

what neurovascular component is commonly damaged in shoudler dislocation

Answer 24

axillary

Question 25

RF fat embolism

Answer 25

long bone fracture

Question 26

symptoms fat embolism

Answer 26

tachypnoea, dyspnoea within 72 hours injury, hypoxia, brown peticheal rash, oral or eye haemorrhage, confusion + agitation

Question 27

invx fat embolism

Answer 27

CTPA - ground glass appearance

Question 28

mx fat embolism

Answer 28

DVT prophylaxis and supportive care

Question 29

symptoms of a non-union fracture

Answer 29

pain, oedema, movement, xray: bridging callus

Question 30

which fractures have poor blood supply

Answer 30

scaphoid, distal clavicle, femur

Question 31

what fractures may cause DVT

Answer 31

pelvic or lower limb

Question 32

which fractures may cause AVN

Answer 32

femoral neck, scaphoid, tallus

Question 33

which fractures may cause OA

Answer 33

intra-articular