Fractures (injury basics)

Question 1

What is a fracture?

Answer 1

Loss of continuity of bone, usually due to trauma

Question 2

How long do different fractures take to heal?

Answer 2

• Upper limb = 1 unit of time (6 weeks)
• Lower limb = 2 units of time
• Kids = 0.5 unit of time

Question 3

How might fractures be classified?

Answer 3

• Open or closed?
• Deformity?
• Simple or comminuted?
• By aetiology

Question 4

At what ages do fractures occur?

Answer 4

• 3 peaks
• Very young, young adult, and elderly

Question 5

What grading system is used for open fractures?

Answer 5

Gustillo-Anderson Classification

Question 6

What are the 3 levels of the Gustily-Anderson Classification?

Answer 6

1) Low energy wound <1cm
2) >1cm with moderate soft tissue damage
3) high energy wound >1cm with extensive soft tissue damage (a, b, c)

Question 7

What are the 3 levels of Gustily-Anderson classification level 3?

Answer 7

a) Adequate soft tissue coverage
b) Inadequate soft tissue coverage
c) Associated arterial injury

Question 8

Displaced, undisplaced or angulated fractures?

Answer 8

• Displaced: bone hasn’t moved
• Undisplaced: bone has moved
• Angulated: medial or lateral (varus or valgus), anterior or posterior (palmar/planter or dorsal), or rotary

Question 9

Simple vs comminuted fractures?

Answer 9

• Simple: 2 fragments
• Comminuted: >2 fragments

Question 10

Fracture aetiology?

Answer 10

• Acute: sudden overload of force on healthy bone
• Stress: gradual overload of force on previously healthy bone that exceeds the bone’s reparability
• Pathological: occurs in bone without sufficient stress due to disease process

Question 11

What are the types of fracture according to bone damage?

Answer 11

• Oblique
• Spiral: twists down the bone, severe oblique fracture with rotation along long axis of the bone (usually due to abuse)
• Transverse: broken horizontally/perpendicular to the bone
• Avulsion: piece of bone pulled away by attached soft tissues
• Segmental: floating piece of bone between 2 ends (more than 1 fracture)
• Buckle (torus): bone ends driven together
• Greenstick: incomplete fracture of immature bone following ambulatory force when one side is compressed and another is under tension
• Comminuted: >2 segments
• Hairline: barely visible with no displacement
• Salter-Harris: growth plate fracture