Management of Fractures Flashcards
What four factors can help predict most orthopaedic injuries?
Chief complaint, age of the patient, mechanism of injury, and energy of trauma.
What should you do if a fracture is suspected clinically but X-rays are negative?
Treat it as a fracture and reassess clinically and radiographically in 7–10 days.
When should radiographic studies be performed in fracture care?
Before attempting most reductions, unless delay would be harmful.
What neurovascular checks are essential in fracture management?
Neurovascular status must be checked and documented before and after reductions and immobilisation.
What’s the difference between a closed and open fracture?
Closed: Skin is intact; Open: Bone is exposed to the outside environment.
How should fracture location be described?
Using the name of the bone, side (left/right), and specific reference points (e.g., distal third of the right radius).
What terms describe the direction of fracture lines?
Transverse, oblique, spiral.
What is a comminuted fracture?
A fracture with more than two bone fragments.
How is displacement described in fractures?
Based on the position of the distal fragment relative to the proximal.
What does angulation refer to in fractures?
Deviation in the longitudinal axis, described by the apex direction.
What is an avulsion fracture?
A fragment pulled away by tendon or ligament force.
What is an impaction fracture?
One bone fragment is forcefully driven into another.
What is a pathologic fracture?
Fracture through weakened bone due to disease (e.g., malignancy, osteomalacia).
What is a stress fracture?
A fracture from repetitive low-intensity forces (aka fatigue or March fracture).
What is a greenstick fracture?
Incomplete fracture causing angulation, common in children.
What is a torus fracture?
Incomplete fracture with buckling of the cortex.
What is the Salter-Harris classification used for?
Describing epiphyseal (growth plate) fractures.
Describe Salter-Harris Type I injury.
A slip of the growth plate only.
What is a Type V Salter-Harris fracture?
Crushing injury to the growth plate.
What is the primary imaging modality for fractures?
Plain X-ray.
How many views are mandatory in long bone X-rays?
At least two perpendicular views (AP and lateral).
What imaging is helpful for detecting stress fractures early?
MRI or bone scans.
When should CT be used in fracture diagnosis?
To assess alignment, displacement, or confirm complex fractures.
What is the sequence of fracture healing?
Haematoma → Inflammation → Callus formation → Ossification → Remodelling.
How long does a femur fracture typically take to heal in a healthy adult?
Around 4 months.
What type of fractures heal faster: oblique or transverse?
Oblique fractures.
What factors can delay healing?
Corticosteroids, hyperthyroidism, chronic hypoxia, and poor alignment.
What is delayed union?
Healing that takes longer than expected.
What is malunion?
Fracture heals with deformity.
What is nonunion?
A fracture fails to unite.
What is pseudarthrosis?
A false joint formed due to nonunion.
What are the 5 Ps of vascular injury?
Pain, pallor, pulselessness, paraesthesia, paralysis.
What is the hallmark sign of compartment syndrome?
Pain out of proportion to the injury.
What is the treatment for compartment syndrome?
Complete fasciotomy.
What bones are prone to avascular necrosis?
Femoral head, talus, scaphoid, lunate, capitate.
What is fat embolism syndrome associated with?
Long bone or pelvic fractures, especially in young adults.
What are early signs of fat embolism syndrome?
Respiratory distress and hypoxaemia.
What is a sprain?
Injury to ligament fibres due to abnormal joint motion.
What is tendinitis?
Inflammation at a tendon’s insertion, often from overuse.
What is bursitis?
Inflammation of a bursa, commonly at joints like elbow, knee, and shoulder.
What is a subluxation?
Partial loss of joint surface contact.
What is a dislocation?
Complete loss of joint congruity.
What is a fracture dislocation?
A fracture occurring along with a joint dislocation.
What are the first priorities in managing trauma with orthopaedic injury?
Life- and limb-threatening injuries (ABCDE of trauma).
What are the mainstays of orthopaedic treatment?
Pain control, reduction, immobilisation, surgery, and rehabilitation.
What are common methods of immobilisation?
Splints, braces, casts, bandages.
How are long bone fractures classified by location?
Diaphyseal (shaft), metaphyseal, and epiphyseal (end of bone).
What is the difference between simple and complex (comminuted) fractures?
Simple: two bone fragments; Comminuted: more than two fragments.
What is an intra-articular fracture?
A fracture that extends into the joint space.
What is an extra-articular fracture?
A fracture that does not involve the joint space.
What injury type is typically caused by a twisting mechanism?
Spiral fracture.
What injury is common in elderly women after low-energy trauma (like a fall)?
Colles’ fracture (distal radius).
What kind of trauma often causes pelvic fractures?
High-energy trauma (e.g., MVCs, falls from height).
What fracture type is associated with repetitive loading (like in runners)?
Stress fracture (fatigue fracture).
What is Volkmann’s ischemic contracture?
Contracture of the forearm muscles due to untreated compartment syndrome.
What is myositis ossificans?
Bone formation within muscle tissue after trauma.
What is reflex sympathetic dystrophy (RSD) aka complex regional pain syndrome?
Pain, swelling, and skin changes following an injury without nerve damage.
What is the most common nerve injury in a midshaft humeral fracture?
Radial nerve injury.
What nerve is commonly injured in a posterior hip dislocation?
Sciatic nerve.
Name systemic factors that impair fracture healing.
Smoking, diabetes, corticosteroid use, malnutrition, hypothyroidism.
What vitamins are essential for fracture healing?
Vitamin D and Vitamin C.
How does smoking affect bone healing?
Reduces blood flow and oxygenation, delaying healing.
What fracture might be missed on X-ray and seen only on MRI or bone scan?
Stress fracture.
What imaging is most sensitive for detecting occult hip fractures?
MRI.
What is the radiologic hallmark of a nonunion?
Persistent fracture line with no signs of bridging callus.
What are the radiographic signs of healing?
Bridging callus, obliteration of fracture line, and cortex continuity.
What is the goal of reduction in fracture care?
To restore anatomic alignment and joint function.
When should open reduction be considered?
When closed reduction fails, or in cases of intra-articular or unstable fractures.
What is internal fixation?
Stabilisation using plates, screws, or rods inside the body.
What is external fixation?
Use of external frames with pins or wires to stabilise fractures.
What is traction used for in fracture treatment?
To realign bones, reduce muscle spasm, and maintain length.
What is a pathological fracture?
A fracture through bone weakened by disease (e.g., cancer, osteoporosis).
What is the most common site of pathological fractures?
Vertebrae (spine) and proximal femur.
What test is used to detect fat embolism?
Chest imaging and ABG (hypoxemia is often present), clinical triad is key: petechiae, hypoxia, altered mental status.
