Management of Specific Fractures

Question 1

What is the difference in healing time for upper vs lower limb fractures?

Answer 1

Lower limb fractures take twice as long to heal as upper limb fractures

Question 2

What is the difference in healing time for children vs adults?

Answer 2

Paediatric fractures heal twice as fast as adults

Question 3

What is non union?

Answer 3

Failure of bone healing within an expected time frame

Question 4

What are the 2 types of non union and how are they different?

Answer 4

Atrophic= healing completely stopped with no x ray changes, often physiological (smokers, diabetics, delayed presentation)
Hypertrophic= too much movement causing callus healing

Question 5

What is malunion?

Answer 5

Bone healing occurs but outside the normal parameters of alignment

Question 6

What is the main difference between malunion and non union

Answer 6

In non union the bone doesnt heal and the 2 parts are not touching
In maunion the 2 parts touch but they are misalinged and they have healed

Question 7

What are the 4 steps in management of a fracture?

Answer 7

Resuscitate
Reduce
Rest
Rehabilitation

Question 8

What are the 2 main methods by which fractures can be managed?

Answer 8

Conservative

Surgical

Question 9

What does conservative management of fractures involve?

Answer 9

First= rest, ice, elevation
Second=plaster/fibreglass cast or splint
Third= traction via skin or bone

Question 10

What does surgical management of fractures involve?

Answer 10

MUA and K-wire- extra cortical
ORIF= open reduction internal fixation- extra cortical
IM nail= intermedullary nail intra cortical
External fixation- mono or bi planar (can’t close the defect at the time of the procedure)

Question 11

When is MUA (manipulation under anaesthesia) and K wire useful in fracture management?

Answer 11

Good in kids as they have very thick periosteum and later the wires can be pulled out

Question 12

When is IM nail useful in fracture management?

Answer 12

Good for long fractures

Question 13

When is external fixation useful in fracture management?

Answer 13

If you can’t close the defect at the time of the procedure

Question 14

What most commonly causes shoulder dislocation?

Answer 14

Trauma

Question 15

What is important to consider when there is a shoulder dislocation?

Answer 15

Check if there is axillary nerve damage as the brachial plexus near the shoulder

Question 16

What are the 3 types of shoulder joint dislocation? Which is most common?

Answer 16

Anterior= most common, when the humeral head is not overlying the glenoid fossa
Posterior= associated with seizures or shocks, lightbulb sign is seen (humeral head looks like lightbulb on x-ray)
Inferior= arm is held above the head and the humeral head is not articulating

Question 17

What is the main method for treating shoulder dislocation?

Answer 17

Safest method is to use traction-counter traction +/- gentle internal rotation to disimpact humeral head

For pain relief: benzodiazepines and entonox

Could use stimson method- hanging weights off affected arm)

Question 18

In shoulder dislocation what is Hill Sach’s defect?

Answer 18

Top of humeral head is hit on the glenoid as its dislocated

Question 19

In shoulder dislocation what is Bankart lesion?

Answer 19

Damage to the labrum and/or glenoid (after hitting it on glenoid) - destabilizes shoulder joint
Can be soft or bony

Question 20

Typically who gets fracture of the proximal humerus?

Answer 20

Those with osteoporosis or the elderly

Question 21

How is proximal humerus fracture managed?

Answer 21

Collar and cuff if the fracture is 2 parts

If more can do an ORIF

Question 22

What physical action commonly causes a fracture of the proximal humerus?

Answer 22

Falling onto an outstretched hand

Question 23

What are the 2 types of distal radius fracture?

Answer 23

Extra and intra articular

Question 24

What are the 2 angulations possible in distal radius fractures?

Answer 24

Dorsal

Volar

Question 25

Why is it important to look out for carpal fractures?

Answer 25

Missing them can result in loss of wrist function as blood supply may become compromised

Question 26

What results in fractures when blood supply is lost?

Answer 26

Avascular necrosis

Question 27

What is the commonest carpal bone fracture?

Answer 27

Fracture of the scaphoid bone

Question 28

When should scaphoid bone fracture be considered?

Answer 28

In any distal radial injury but it commonly occurs because of a fall backwards onto the hand

Question 29

How are fractures of the scaphoid managed?

Answer 29

If undisplaced conservative management in a cast is sufficient
If displaced ORIF is usually undertaken

Question 30

How does dislocation of the lunate bone usually arise?

Answer 30

Progressive disruption to the ligament

Question 31

How does a shoulder dislocation present?

Answer 31

Painful
Restricted movement
Loss of normal shoulder contour

Question 32

What investigations would you do for a shoulder dislocation?

Answer 32

X-ray before any manipulation- identify the fracture

Scapular -Y (lateral shoulder) view

Question 33

How is a fracture of the distal radius managed?

Answer 33

Cast/ Splint: temporary treatment until definitive treatment or definite treatment if fracture is minimally displaced extra-articular fracture

MUA and K-WIRE: extra-articular but unstable fractures

ORIF: Displaced and unstable fractures or with extra-articular involvement

Question 34

What is a pathognomonic sign of.a joint fracture?

Answer 34

Lipohaemarthrosis

Fat and blood from bone marrow goes to surface - shows as a fluid line on x-ray

Question 35

What can cause a tibial plateau fracture and what is the significance?

Answer 35

Can be caused by extreme vulgaris force or axial loading across the knee
Impaction of the femoral condyles can cause soft bone of tibial plateau to depress or split

Question 36

What is the importance of the tibial plateau?

Answer 36

A key weight bearing surface as part of your knee joint

Question 37

What injuries can occur with a tibial plateau fracture?

Answer 37

Concomitant ligamentous or meniscal injury

Question 38

How is a tibial plateau fracture managed?

Answer 38

Non- operative: if fracture is nondisplaced with good line congruence seen on CT
Operative:
-most treatment will be operative
-Restore articular surface using plates and screws
-Bone graft or cement might need to be used to prevent depression after fixation

Question 39

How is an ankle fracture managed?

Answer 39

Non-operative:
-Non weight bearing below knee cast for 6-8 weeks -> walking boot -> physiotherapy

For:
Weber A- below syndesmosis so stable
weber B1- no evidence of instability

Operative:
- Soft tissue dependent- strict elevation to prevent swelling
ORIF +/- syndesmosis repair using screw or tightrope technique

For:
Weber B2 and B3
Weber C