Fractures (lecture)

Question 1

When perfoming a clinical exam of a fracture, what is important to check? [1]

Answer 1

Check distal pulse and nerve function

Question 2

What are the three types of bone injury that can cause fractures? [3]

Answer 2

Trauma - XS force applied to bone
Stress - repetitive low velocity injury
Pathological

Question 3

Describe different types of fractures that exist [5]

Answer 3

Oblique fracture
- Fracture lies obliquely to long axis of bone

Comminuted fracture
- >2 fragments

Segmental fracture
- More than one fracture along a bone

Transverse fracture
- Perpendicular to long axis of bone

Spiral fracture
- Severe oblique fracture with rotation along long axis of bone

Question 4

It is also important to distinguish open from closed injuries. The most common classification system for open fractures is the Gustilo and Anderson classification system

Describe the different grades within this classification window [5]

Answer 4

1: - Low energy wound < 1cm

2 - Greater than 1cm wound with moderate soft tissue damage

3 High energy wound > 1cm with extensive soft tissue damage
* 3 A (sub group of 3) - Adequate soft tissue coverage
* 3 B (sub group of 3) - Inadequate soft tissue coverage
* 3 C (sub group of 3) - Associated arterial injury

Question 5

If you have open injuries, what general type of Abx do you want to give? [1]

Answer 5

IV broad spectrum antibiotics for open injuries

Question 6

Describe what is meant by a fat embolism? [1]

What is Gurd’s major criteria for dx? [3]

Answer 6

Fat globules are released into the circulation following a fracture (possibly from the bone marrow).

These globules may become lodged in blood vessels (e.g., pulmonary arteries) and cause blood flow obstruction.

Gurd’s major criteria:
* Respiratory distress
* Petechial rash
* Cerebral involvement

Question 7

Salter-Harris classification

Question 8

Schatskaer