Fractures profoma

Question 1

Epidemiology of fractures?

Answer 1

More common in young men- as more likely to be exposed to trauma

More common in older women- due to menopause & lack of protective effect of oestrogen

Question 2

Presentation of fractures?

Answer 2

Localised pain- worsened by movement

deformity

Crepitus

abnormal movement of limb

Examination: leg externally rotated & shortened

patient has clear history- Use AMPLE
- A- allergies
- M- medications
- P- past medical history
- L- last meal
- E- events- what happened

Question 3

Investigations for fractures?

Answer 3

X-ray from 2 planes at 90 degrees from each other
- Include whole bone- joint above & below

CT for complex fractures

MRI for soft tissue injuries

Question 4

Management for fractures?

Answer 4

1. Analgesia e.g. diamorphine
2. reduce fracture- control bleeding, cover wounds
3. reassess neuromuscular status- pulse, sensation, movement
4. Antibiotic & tentas prophylaxis
5. Surgery if needed
6. Plaster or splint for 4-6 weeks- stabalisation- screws or plates

Question 5

Complications of fractures?

Answer 5

Nerve palsy

Haemorrhage

Hypovalaemic shock- blood loss

Infection

non-union- failure of a fractured bone to heal & mend after an extended period of time

malunion- fracture that has healed in a deformed position, or w/ shortening or rotation of the limb.

Avascular necrosis

deformity

OA

fat embolism

Question 6

Prognosis of fractures?

Answer 6

Depends on bone broken, location of fracture, presence of complications or underlying medical condition

Can take up to 18 months for fracture to heal

If patient complains about progressive pain on walking years after fracture but w/ no systemic symptoms= acetabular wear

Question 7

Why do fractures in some patients heal slowly?

Answer 7

• Bone type: cancellous bone heals faster than cortical
• type: transverse takes longer than spiral
• Blood supply: poor circulation delays healing
• Diet: deficiency in Ca and Vit D will delay healing
• Age: children heal twice as fast as adults, once growth plates fuse healing rate is constant at all ages
• Smoking: adversely affects rate and quality of union
• Causes of non union: poor fixation (disrupts callus formation), insertion of soft tissue between # fragments, severe soft tissue damage, infection, abnormal bone