Fractures Symposium

Question 1

What is an open fracture?

Answer 1

When there is direct communication between the external environment and the fracture. This is usually, but not always through a break in the skin

Question 2

What are the possible complications of an open fracture?

Answer 2

Infections
Soft tissue complications
Long term morbidity

Question 3

What bones are most commonly affected by open fractures?

Answer 3

Tibial shaft

Fingers

Question 4

How are open fractures classified?

Answer 4

Type 1- Low energy, wound <1cm, clean, often bone piercing skin from inside
Type 2- Moderate soft tissue damage, wound <10cm, no soft tissue flap or avulsion
Type 3- High energy, extensive soft tissue damage, severe fracture, wound >10cm, includes gunshot fractures/crush injuries. Subdivided:
• 3a- extensive soft tissue damage but not grossly contaminated
• 3b- periosteal stippling, extensive muscle damage, heavy contamination
• 3c- associated neurovascular complication

Question 5

What are most common groups of open tibial shaft fractures?

Answer 5

3B> 1 > 2 = 3A > 3C

Question 6

What are the basic steps in the management of open fractures?

Answer 6

Tetanus and antibiotic prophylaxis
Surgery
Stabilise limb
Radiographs

Question 7

What are the indications for urgent emergency surgery for open fractures and when should this be done by?

Answer 7

Polytraumatised patient
Marine, sewage or farmyard environment
Gross contamination
Neurovascular compromise
Compartment syndrome
The aim is to have these patients operated on within 6 hours of injury. Otherwise, patients with an open fracture should be operated on within 24 hours of injury

Question 8

What is a dislocation?

Answer 8

Refers to complete joint disruption

Question 9

What is partial dislocation known as?

Answer 9

Subluxation

Question 10

What deformity is associated with an anterior shoulder dislocation?

Answer 10

Squared off appearance

Question 11

What deformity is associated with a posterior shoulder dislocation?

Answer 11

Locked in internal rotation

Question 12

What deformity is associated with a posterior elbow dislocation?

Answer 12

Olecranon process prominent posteriorly

Question 13

What deformity is associated with a posterior hip dislocation?

Answer 13

Leg is short, flexed, internally rotated and adducted

Question 14

What deformity is associated with a knee dislocation?

Answer 14

Loss of normal contour, extended

Question 15

What deformity is associated with a lateral ankle dislocation?

Answer 15

Externally rotated, prominent medial malleolus

Question 16

What deformity is associated with a lateral subtalar dislocation?

Answer 16

Laterally displaced

Question 17

What system is used to classify open fractures?

Answer 17

Gustilo system