Fracutres

Question 1

what is a compound fracture?

Answer 1

when skin is broken and the broken bone is exposed to the air / punctures through the skin

Question 2

what is a stable fracutre

Answer 2

when the section of bone remains in alignment at the fracture

Question 3

what is a pathological fracture?

Answer 3

when the bone breaks due to an abnormality with the bone

Question 4

pelvic ring fractures

Answer 4

when one part of the pelvic ring fractures another part will also fracture

can lead to signifcant intra abdominal bleeding!

Question 5

pathological fractures (‘portable’

Answer 5

neumonic ‘portable’
due to an underying disease of the bone i.e tumor, osteopersosis, PAgets.

Prostate
Renal
Thyroid
Breast
Lung

Question 6

fragility fractures

Answer 6

due to weakness in the bone (osteoperosis) and occur without the appropriate trauma typically required. i.e fractured femur after a minor fall

Question 7

what is the FRAX tool

Answer 7

calculates the risk of a pt to sustain a fragility fracutre in the next 10 nears.

DEXA scan- measure bone mineral density.
more than -1 = normal
-1 to -2.5 ostopenia (soft)
<-2.5 osteopersois
<-2.5 plus a fracture (severe osteopersois)

Question 8

medical tx for risk of fragility fractures

Answer 8

calcium
vitamin D
bisophosphonate (alendronic acid)

Question 9

MOA of bisphosphoantes

Answer 9

interefere with osteoclast activity- educe their ability to reabsorb the bone

Question 10

bisphosphonates side effects

Answer 10

Reflux and oesophageal erosions (oral bisphosphonates are taken on an empty stomach sitting upright for 30 minutes before moving or eating to prevent this)
Atypical fractures (e.g. atypical femoral fractures)
Osteonecrosis of the jaw
Osteonecrosis of the external auditory ca

Question 11

Denosumab

Answer 11

monoclonal antibody that works by blocking the activity of osteoclasts. It is an alternative to bisphosphonates where they are contraindicated, not tolerated or not effective.

Question 12

imaging for fractures

Answer 12

-Xrays (two views/angles)
CT scan

Question 13

management of fractures

Answer 13

achieve mechanical alignment by:

1. closed reduction (manipulation of the limb)
2. open reduction (surgery)

relative stability (allow healing) by fixing thebone in the correct position:

External casts (e.g., plaster cast)
K wires
Intramedullary wires
Intramedullary nails
Screws
Plate and screws

Question 14

management of straight forward fractures

Answer 14

manage in A+E (colles in YA)

closed reduction
plaster cast
fracture clinic

Question 15

compelx fractures management

Answer 15

(hip fractures) (T+O)

nil by mouth (op)
trauma meeting

Question 16

complications of fractures

Answer 16

Damage to local structures (e.g., tendons, muscles, arteries, nerves, skin and lung)
Haemorrhage leading to shock and potentially death
Compartment syndrome
Fat embolism (see below)
Venous thromboembolism (DVTs and PEs) due to immobility

Question 17

long term complications of fractures

Answer 17

Delayed union (slow healing)
Malunion (misaligned healing)
Non-union (failure to heal)
Avascular necrosis (death of the bone)
Infection (osteomyelitis)
Joint instability
Joint stiffness
Contractures (tightening of the soft tissues)
Arthritis
Chronic pain
Complex regional pain syndrome

Question 18

fat embolism

Answer 18

can occur following (23-72’) fracutre of long bones. fat globules are releaed in to the circulation after a fracture (from bone marrow) can become lodged in blood vessels.

can cause SIRS- fat embolism syndrome.