General Trauma

Question 1

Fractures of which bones are particularly prone to developing AVN?

Answer 1

Femoral neck, scaphoid and talus

Question 2

An x-ray showing patchy osteopenia, greater than what would be expected for the condition, is suggestive of what complication of a fracture?

Answer 2

Complex regional pain syndrome

Question 3

In general terms, how are fractures which are undisplaced, minimally displaced or minimally angulated treated?

Answer 3

A period of splintage/immobilisation and then rehabilitation

Question 4

If compartment syndrome is left untreated, ischaemic muscles will necrose, resulting in poor function and fibrotic contracture known as what?

Answer 4

Volkmann’s ischaemic contracture

Question 5

Fractures with residual displacement or angulation are most associated with what complication?

Answer 5

Post-traumatic osteoarthritis

Question 6

What imaging method can be used to detect stress fractures?

Answer 6

Technetium bone scan

Question 7

Fractures involving a joint with a predictable poor outcome may be treated with what?

Answer 7

Joint replacement or arthrodesis

Question 8

What must be done both before and after reduction of a dislocation?

Answer 8

Assessment of neurovascular status

Question 9

During secondary bone healing, how long does it take for a) the soft callus, and b) the hard callus to form?

Answer 9

a) 2-3 weeks b) 6-12 weeks

Question 10

In cases of closed reduction and indirect internal fixation, what is used for internal fixation?

Answer 10

IM nails

Question 11

Which method(s) of managing unstable extra-articular diaphyseal fractures allow secondary bone healing to occur?

Answer 11

Closed reduction internal fixation and external fixation

Question 12

In what situations should a fracture reduction be performed before waiting for x-rays?

Answer 12

Grossly displaced, obvious fracture-dislocation or risk of skin damage

Question 13

What type of fracture is this describing: fractures due to torsional forces, i.e. a twisting injury; inter-fragmentary screws may potentially be used?

Answer 13

Spiral fractures

Question 14

Supracondylar fractures of the elbow are associated with injury to which nerve?

Answer 14

Median nerve (anterior interosseous branch)

Question 15

What is the term given to chronic pain, allodynia, swelling, stiffness and colour changes that occur after a fracture?

Answer 15

Complex regional pain syndrome

Question 16

What imaging method can be used to detect occult fractures where there is clinical suspicion but a normal x-ray?

Answer 16

MRI

Question 17

Humeral shaft fractures are associated with injury to which nerve?

Answer 17

Radial nerve

Question 18

Which type of fracture non-union occurs due to rigid fixation with a fracture gap and lack of blood supply to the affected site?

Answer 18

Atrophic non-union

Question 19

Fracture non-union is said to have occurred when there is no evidence of progression towards healing, clinically or radiologically, within what timeframe?

Answer 19

6 months

Question 20

Fractures where are most likely to result in complex regional pain syndrome?

Answer 20

Distal upper limb

Question 21

In the initial phase, what prophylaxis against infection should be given to individuals with open fractures?

Answer 21

IV antibiotics, tetanus injection and sterile/antiseptic soaked dressings

Question 22

What antibiotic prophylaxis is most commonly used in individuals with open fractures?

Answer 22

IV amoxicillin, gentamicin and metronidazole

Question 23

How are most fracture related nerve injuries managed?

Answer 23

Observation for recovery

Question 24

How is fat embolism treated?

Answer 24

ITU support for respiratory failure

Question 25

Describe the very initial management of a long bone fracture?

Answer 25

Analgesia (usually morphine), splintage/immobilisation and investigation (usually x-rays)

Question 26

After which types of fracture would a fat embolism be most likely to occur?

Answer 26

Pelvic or femur fracture

Question 27

If, after a fracture, a patient develops altered mental status, pyrexia, shortness of breath and a petechial rash, in association with hypoxia and tachycardia, what diagnosis is most likely?

Answer 27

Fat embolism

Question 28

Which method(s) of managing unstable extra-articular diaphyseal fractures allow primary bone healing to occur?

Answer 28

Open reduction internal fixation (ORIF) with plates and screws

Question 29

How should displaced, intra-articular fractures be treated?

Answer 29

ORIF with wires, plates and screws

Question 30

What type of fracture is this describing: fractures which usually occur from a shearing force (e.g. fall from height, deceleration) and tend to shorten and also may angulate; these are able to be fixed with an inter-fragmentary screw?

Answer 30

Oblique fractures

Question 31

How is complex regional pain syndrome managed?

Answer 31

Referral to pain management services

Question 32

Why is it important to monitor renal function and maintain hydration in patients with compartment syndrome?

Answer 32

Compartment syndrome can cause rhabdomyolysis which can lead to renal failure

Question 33

Supracondylar fractures of the elbow are associated with injury to which vascular structure?

Answer 33

Brachial artery

Question 34

Anterior shoulder dislocations are associated with injury to which nerve?

Answer 34

Axillary nerve

Question 35

The following statement is describing which type of nerve injury that may be associated with a fracture: this occurs from either a sustained compression or stretch, or from a higher degree of force; the axons regenerate at a rate of 1mm per day, meaning recovery is variable and full power or sensation may not be achieved?

Answer 35

Axonotmesis

Question 36

How soon after a fracture is a fat embolism likely to occur?

Answer 36

2-3 days

Question 37

Knee dislocations are associated with injury to which vascular structure?

Answer 37

Popliteal artery

Question 38

What type of fracture is this describing: fractures with three or more fragments, generally indicative of a high energy injury (or poor quality bone); these are very unstable and tend to require surgical stabilisation?

Answer 38

Comminuted fractures

Question 39

Posterior dislocations of the hip are associated with injury to which nerve?

Answer 39

Sciatic nerve

Question 40

Which type of fracture non-union occurs due to instability and excessive motion at the fracture site?

Answer 40

Hypertrophic non-union

Question 41

The following statement is describing which type of nerve injury that may be associated with a fracture: this is complete transection of a nerve, which commonly occurs in penetrating injuries; no recovery will occur unless the affected nerve is surgically repaired?

Answer 41

Neurotmesis

Question 42

The following statement is describing which type of nerve injury that may be associated with a fracture: this occurs when the nerve has a temporary conduction defect from compression or stretch- this will resolve over time with full recovery, but can take up to 28 days?

Answer 42

Neurapraxia

Question 43

What prophylaxis is given against VTE in patients undergoing surgery for a fracture?

Answer 43

Enoxaparin 12-24 hours post-op, and continued for at least 7-10 days

Question 44

What type of fracture is this describing: fractures which occur with pure bending force, these may not shorten but may angulate or result in rotational malalignment?

Answer 44

Transverse fractures

Question 45

Colles' fractures are associated with injury to which nerve?

Answer 45

Median nerve

Question 46

What complication can result in delayed union, and both types of non-union of a fracture?

Answer 46

Infection

Question 47

What imaging method can be used to assess fractures of complex bones, and can help determine the degree of articular damage and help surgical planning for complex intra-articular fractures?

Answer 47

CT

Question 48

Displacement or angulation of a fracture describe the direction of translation of what fragment of the bone?

Answer 48

The distal fragment

Question 49

What feature of compartment syndrome is a feature of end-stage ischaemia and an indication that the diagnosis has been made too late?

Answer 49

Loss of pulses

Question 50

Which type of fracture is most likely to result in compartment syndrome?

Answer 50

Tibial shaft fracture

Question 51

Primary bone healing occurs where the fracture gap is less than what?

Answer 51

1mm

Question 52

Trauma to the shoulder can be associated with injury to which vascular structure?

Answer 52

Axillary artery

Question 53

If someone presents with an open fracture and has not been vaccinated against tetanus, what should be given?

Answer 53

Tetanus immunoglobulin

Question 54

After a fasciotomy for compartment syndrome, how long should the wound be left open for?

Answer 54

A few days

Question 55

What investigations are the gold standard for fracture assessment?

Answer 55

AP and lateral x-rays

Question 56

How is compartment syndrome treated?

Answer 56

Removal of any tight bandages/casts and emergency fasciotomy

Question 57

In those with compartment syndrome, pain will be increased on what movement?

Answer 57

Passive stretching (extension) of an involved muscle

Question 58

What type of fracture is this describing: the bone is fractured in two different places; these injuries are very unstable and require stabilisation with long rods or plates?

Answer 58

Segmental fractures

Question 59

Severe pain outwith the anticipated severity of the clinical context is a classic sign of what complication of a fracture?

Answer 59

Compartment syndrome