Management of Fractures

Question 1

Define DISLOCATION. Give examples.

Answer 1

When there is no articulation between two bone when there normally is one.

• Humeral head and glenoid fossa
• Femoral head and acetabulum

Question 2

What are the degrees impact, and give examples

Answer 2

1) Low energy impact - ankle sprain
2) High energy impact - sports injury
3) Extreme energy impact - traffic accident

Question 3

How to examine, and take a facture/dislocation history.

Answer 3

EXAMINATION

1) LOOK
2) FEEL (assess blood supply and nerve)
3) MOVE

HISTORY - AMPLE 
Allergies
Medication 
Past medical history 
Last meal  
Event

Question 4

What are the main nerves of the shoulder? and what do they supply?

Answer 4

1) Median -> abductor pollicis brevis
2) Ulnar (from back) -> half of 4th, and 5th finger, and interossei
3) Radial ->
4) Axillary -> deltoid muscles, and regimental badge area

Question 5

INVESTIGATIONS for fractures and dislocations.

Answer 5

1) X-Rays

2) CT scans (if the underlying cause is unknown)

Question 6

MANAGEMENT of dislocations.

Answer 6

1) Assess blood supply and nerve
2) Analgesia (e.g. diamorphine hydrochloride)
3) Reduction of dislocation
4) Reassess blood supply and nerve
5) Plaster (if needed)

Question 7

How is a SHOULDER DISLOCATION reduced?

Answer 7

1) Diamorphine hydrochloride

2) Kocher method

Question 8

What are the two types of wrist fractures?
How are they managed?
What happens if reduced position is lost or can’t be achieved?

Answer 8

1) Colle’s fracture (outwards)
2) Smith’s fracture (inwards)

MANAGEMENT - hematoma block

• assess blood supply and nerve
  1) Put needle into hematoma at fracture site
  2) Inject local anaesthetic (e.g. lidocaine)
  3) Reduction manoeuvre
• reassess blood supply and nerve
  4) Plaster (4-6 weeks)

ALTERNATIVE
Open reduction, internal fixation

Question 9

Give an example of an elbow fracture most common in 5-7yos.

Give its mechanism, location, and translation.

Answer 9

Supracondylar humeral fracture

• transverse or oblique
• fracture in distal end of humerus, above the elbow joint
• humerus translated anteriorly, and distal humerus translated posteriorly

Question 10

What are the main nerves going through the elbow? and what do they supply?

Answer 10

1) Median
2) Ulnar
3) Radial
4) Brachial

Question 11

Management of SUPRACONDYLAR HUMERAL FRACTURES

Answer 11

1) Assess blood supply and nerve
2) Reduction
3) Kirschner wire (to provide stability following reduction)
4) Reassess blood supply and nerve
5) Plaster (6-8 weeks)

Question 12

What type of ANKLE FRACTURES require plaster vs. operation

Answer 12

PLASTER - Below syndesmosis

• Lateral malleolar fracture
• Medial malleolar fracture
• Supra malleolar fracture

OPERATION (reduction, internal fixation)

• bimalleolar fracture (lateral and medial)
• trimalleolar fracture (lateral, medial, and posterior)

Question 13

What is the most common type of hip dislocation? and why is this serious?

Answer 13

Posterior hip dislocation - sciatic nerve runs behind the femoral head