General fractures

Question 1

How do you describe a fracture?

Answer 1

D - Demographics of patient, radiograph etc
P - Pattern of fracture
A - Anatomical location
I - Intra va Extra articular
D - Deformity
S - Soft tissues, specific fracture classification

Question 2

What are the different patterns of fracture?

Answer 2

Transverse
Oblique
Spiral
Multifragmentary/comminuted
Crush
Greenstick
Avulsion

Question 3

What are the different deformities of a fracture?

Answer 3

Translation
Angulation or tilt
Rotation
Impaction (→shortening) 
Dislocation 
Subluxation
*Always describe the distal portion in relation to the proximal portion*

Question 4

What do you describe in the soft tissues part of describing a fracture?

Answer 4

Open or closed
Neurovascular status
Compartment syndrome symptoms

Question 5

What are the 4 Rs of fracture management?

Answer 5

Resuscitate
Reduce
Restrict
Rehabilitate

Question 6

What are the 6 As of open fracture management?

Answer 6

Analgesia
Assessment of NV status, soft tissues, photograph
Antisepsis - Swab, remove debris
Alignment of fracture, splint
Anti tetanus - Check status
Antibiotics - Flucoxacillin and Benzylpenicillin OR Co-Amoxiclav OR Clindamycin if pen allergic

Question 7

What are the different methods of reduction?

Answer 7

Closed reduction/Manipulation

Open reduction, Internal fixation - especially good if open fractures or multiple fractures in one bone

Question 8

What are some of the methods of restriction?

Answer 8

Non rigid - Slings, elastic supports
Plaster - POP, in first 24-48 hours use back slab due to swelling increasing the risk of compartment syndrome
Function bracing - Joints free to move, but bones secured
External fixaction - K wires
Internal fixation - Pins, plates, screws, IM nails (Aid stability, perfect alignment,

Question 9

What are some of the rehabilitation methods?

Answer 9

Physiotherapy

Occupational therapy - Mobility aids, home modifications

Question 10

What are some of the general complications of fractures?

Answer 10

Tissue damage - Infection, Haemorrhage

Prolonged bed red - Chest infection, pressure sores, muscle wasting, DVT/PE

Question 11

What are some of the immediate specific complications of fractures?

Answer 11

NV damage

Visceral damage

Question 12

What are some of the early specific complications of fractures?

Answer 12

Compartment syndrome
Infection
Fat embolism

Question 13

What are some of the late specific complications of fractures?

Answer 13

Issues with union
AVN 
Growth disturbances
Post traumatic OA
CRPS

Question 14

What are the 6 Ps of Compartment syndrome?

Answer 14

Pain on passive muscle stretching/not responding to analgesia
Paraesthesia
Pallor
Paralysis
Pulselessness
Perishingly cold

Question 15

What is the pathophysiology of Compartment syndrome?

Answer 15

Fracture/Injury causes swelling and oedema = Increase in pressure causing decreased venous drainage. Build up of fluid in veins forced fluid into the surrounding tissues = Increased pressure
Compartment pressure > Capillary pressure = Ischaemia

Question 16

How do you manage a patient with Compartment syndrome?

Answer 16

Elevate limb
Remove any casts, splints
Reassess
If not improving;
Emergency fasciotomy to relieve pressure