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Question 1

Complications related to the fracture itself

Answer 1

• Infection
• Delayed union
• Non-union
• Avascular necrosis
• Mal-union
• Shortening

Question 2

Complications attributable to associated injury

Answer 2

• Injury to major blood vessels
• Injury to nerves
• Injury to viscera
• Injury to tendons
• Fat embolism
• Compartment syndrome
• Injuries and post-traumatic affections of joints

Question 3

COMPARTMENT SYNDROME

Answer 3

clinical condition characterized by an elevation of intra-compartmental pressure, resulting in a decreased blood supply of the muscles and nerves within it; causing ischemic damage which may progress into necrosis of both muscles and nerves.

Question 4

Classical features of ischemia or Volkmann’s ischemia contracture

Answer 4

5P:
1. Pain
2. Pallor
3. Paresthesia
4. Paralysis
5. Pulselessness.

Question 5

Injury to nerves

Answer 5

Neurapraxia: the damage is slight and causes only a transient physiological block

Axonotmesis : the internal architecture of the nerve is preserved, but the axons are so badly damaged that peripheral degeneration occurs

Neurotmesis: the structure of the nerve is destroyed by actual division or severe scarring

Question 6

POST-TRAUMATIC OSSIFICATION

Answer 6

Blood collects under the stripped soft tissues, forming a large hematoma about the joint. Instead of being absorbed, the hematoma is invaded by osteoblasts and becomes ossified

Question 7

REFLEX SYMPATHETIC DYSTROPHY (Sudeck‘s atrophy; Sudeck’s post-traumatic osteodystrophy; post-traumatic painful osteoporosis; Complex regional pain syndrome)

Answer 7

Clinical condition prolonged disability after fractures or other injuries of the limbs
is characterized by pain, swelling and marked joint stiffness in the hand or foot of the injured limb. The cause and exact nature of the condition are unknown, but it probably results from ( disturbance of centrally mediated autonomic regulation with consequent increased stimulation of sympathetic and motor efferent fibers).

Question 8

Isolated fractures(stable with no disruption of the pelvic ring )

Answer 8

1] Fracture of superior ischio-pubic ramus
[2] Fracture of inferior ischio-pubic ramus
[3] Fracture entering wall of acetabulum
[4] Fracture of wing of ilium
[5] Avulsion fractures of anterior inferior iliac spine, anterior superior iliac spine, or ischial tuberosity.

Question 9

Fractures with disruption of the pelvic ring (unstable)

Answer 9

1] Combination of anterior and posterior fractures of the pelvic ring
2] Disruption of pubic symphysis and posterior sacro-iliac joint

Question 10

Only three types of dislocation and fracture- dislocation of the hip need be considered:

Answer 10

1.Posterior dislocation or fracture-dislocation
2.Anterior dislocation
3.Central fracture-dislocation

Question 11

Iliac apophysitis

Answer 11

pain and swelling (inflammation) of the growth plate along the side of the hip (iliac crest). The growth plate is an area of weakness, and injury to it occurs because of repeated stress or forceful exercise.

creating stress on the attachment site of the gluteus medius and tensor fascia latae on the iliac crest

Question 12

Apophysitis

Answer 12

is due to long bones such as the femur (thigh bone)
growing more quickly than the muscles of the thigh or hip

Question 13

Avulsion Fracture

Answer 13

always occurs in response to a large, rapid force where the muscle is in a position of stretch and contracting very hard, pulling on the growth center

Question 14

Factors related to the development of apophysitis

Answer 14

Muscle tightness

Rapid growth spurts

Being male

High activity levels

Type of activity

Question 15

apophysitis injuries which commonly occur in children are:

Answer 15

*Osgood Schlatter’s disease occurs at the top of the shin bone, at the front and just below the knee.

*Sinding-Larsen-Johansson (jumper’s knee) causes pain at the bottom of the patella (kneecap), like Patellar tendonitis. Affect the proximal end of patellar tendon

*Sever’s disease– causes pain at the back of the heel, where the Achilles tendon inserts.

Question 16

Sacroiliitis

Answer 16

Is due to excessive mobility, large forces are transferred to the sacroiliac joint, producing an inflammation of the joint

• Sacroiliitis can cause pain in the buttocks or lower back and can extend down one or both legs.
• Prolonged standing or stair climbing, running can worsen the pain.

Question 17

Iliotibial band syndrome

Answer 17

It is due to excess adduction and internal rotation movements, also due to excess tension in the tensor fascia latae in abducting the hip in single- stance weight bearing which seen in dancers and distance runners .

Question 18

Causes of ITBS:

Answer 18

1-Excessive foot pronation
2-Hip abductor weakness
3-Internal tibial torsion
4-Medial compartment arthritis leading to genu varum
5-Preexisting iliotibial band tightness (congenital)

Question 19

Snapping hip syndrome

Answer 19

a click as the hip capsule moves or the iliopsoas tendon snaps over a bony surface. which seen in dancers and distance runners .

Question 20

Piriformis syndrome

Answer 20

Piriformis syndrome usually starts with pain, tingling, or numbness in the buttocks.
• Pain can be severe and extend down the length of the sciatic nerve (called sciatica).
• The pain is due to the piriformis muscle compressing the sciatic nerve, such as while sitting on a car seat or running.

Question 21

Anterior knee pain ( chondromalacia)

Answer 21

1- Overuse (vigorous physical activities that put repeated stress on the knee, such as jogging, squatting, and climbing stairs.
2-Patellar Malalignment (abnormal tracking of the kneecap in the trochlear groove)
3- Iliotibial band tightness
4- Muscle imbalance
5- Hip problems
6- Tight quadriceps and hamstring muscles
7-Problems with alignment of the legs between the hips and the ankles
8- Pes Planus (Flat Feet)

Question 22

DELAYED UNION happed because

Answer 22

the fracture is still freely mobile 3 or 4 months after the injury.

Question 23

Surgical treatment for delayed union

Answer 23

1-Bone grafting operation offers the best prospect of promoting union.
2- Rigid internal fixation alone, without bone grafting, may be adequate.

Question 24

Sites for AVASCULAR NECROSIS

Answer 24

1-Head of the femur
2- Proximal half of the scaphoid bone
3-Body of the talus
4-lunate bone.

Question 25

Treatment for AVASCULAR NECROSIS by

Answer 25

arthroplasty or to stabilize it by arthrodesis.

Question 26

Treatment for MAL-union

Answer 26

Correct the deformity and, after correction has been gained, fixing the fragments by the
appropriate means.

Question 27

Shortening of a bone after fracture may arise from three
causes:

Answer 27

1.Mal-union, the fragments being united with overlap or with marked angulations
2-Crushing or actual loss of bone, as in severely comminuted compression fractures or in gunshot wounds when a piece of bone is shot away
3-In children, interference with the growing epiphyseal cartilage (growth plate).

Question 28

Axillary artery complicating dislocation or fracture dislocation of

Answer 28

the shoulder

Question 29

Brachial artery from supracondylar fracture of the humerus or dislocation of

Answer 29

the elbow

Question 30

Popliteal artery from dislocation of the knee or displaced fracture of the upper end of

Answer 30

the tibia

Question 31

Middle meningeal artery from fracture of the temporoparietal region of

Answer 31

the skull

Question 32

The muscles are eventually replaced by fibrous tissue, which
threatens to produce a disabling contracture

Answer 32

Volkmann’s ischemic contracture) seen most often in the flexor muscles
of the forearm or lower leg.

Question 33

The contractures in the compartment syndrome called

Answer 33

Volkmann’s ischemic contracture

Question 34

Treatment of compartment syndrome

Answer 34

immediate operation to
decompress the whole length of
the affected compartment or
compartments by fasciotomy.

Question 35

Treated by general surgical principles.

Answer 35

INJURY TO VISCERA

Question 36

Treatment is by surgical reconstruction.

Answer 36

INJURY TO TENDONS

Question 37

Clinical features of REFLEX SYMPATHETIC DYSTROPHY (Sudeck‘s atrophy; Sudeck’s
post-traumatic osteodystrophy; post-traumatic painful osteoporosis; Complex regional pain syndrome’s)

Answer 37

1-The function of the limb is not regained with active use and exercises.
2-Severe pain in the affected hand or foot when attempting to use it.

Question 38

On examination of post traumatic painful osteoporosis

Answer 38

The extremity is swollen and may be hyperemic.

The skin creases are obliterated, giving the surface a glossy appearance.

5-The nails and hair of the hand or foot are atrophic.

6-The palmar aponeurosis may be thickened.

7-Joint movements are severely impaired, especially the metacarpo-phalangeal and interphalangeal joints in the case of the hand (frozen hand’).

8-Radiographs show spotty osteoporosis

Question 39

small vessels has its most significant effects in the
lungs and brain and skin. This leads to hypoxemia definition of

Answer 39

Fat embolism syndrome