ortho

Question 1

types of fractures

Answer 1

simple fracture
compound fracture
stable fracture
pathological

Question 2

terms used to describe in what way a bone breaks:

Answer 2

transverese
oblique
spiral
greenstick
buckle
comminuted
Compression fractures (affecting the vertebrae in the spine)
Salter-Harris (growth plate fracture)

Question 3

colle’s fracture

Answer 3

transverese fracture of distal radius causing dorsal displacement of radius (dinner fork deformity) usually caused by fall onto an outstretched hand.

Question 4

FOOSH risk?

Answer 4

scaphoid fracture can be caused by FOOSH - tenderness in the anatomical snuffbox. scaphoid has a retrograde blood supply - avascular necrosis and non-union.

Question 5

key bones have vulnerable blood supplies

Answer 5

scaphoid, femoral head, humeral head, talus, navicular and 5th metatarsal - can lead to avascular necrosis, non-union and impaired healing

Question 6

what is used to describe fractures of the lateral malleolus (distal fibula)

Answer 6

Weber classification
in relation to tibiofibular syndesmosis

Type A – below the ankle joint – will leave the syndesmosis intact
Type B – at the level of the ankle joint – the syndesmosis will be intact or partially torn 
Type C – above the ankle joint – the syndesmosis will be disrupted

Question 7

Pelvic Ring Fractures key points

Answer 7

When one part of the pelvic ring fractures, another part will also fracture
Pelvic fractures often lead to significant intra-abdominal bleeding, either due to vascular injury or from the cancellous bone of the pelvis.needs emergency resuscitation and trauma management.

Question 8

bisphosphonates MOA

Answer 8

reduce activity of osteoclasts and hence reduce bone resorption. denosumab alternative if CI and these block activity of osteoclasts

Question 9

fracture mx

Answer 9

A-E as required
analgesia
VTE prophylaxis as required
alignment - open vs closed reduction
 relative stability - internal or external fixation

    External casts (e.g., plaster cast)
    K wires
    Intramedullary wires
    Intramedullary nails
    Screws
    Plate and screws

Question 10

complications of fractures:

Answer 10

early - damage to local structures - tendons, mucles, nerevs, blod vessels
haemorrhage and subsequent shock
compartment syndrome
fat embolism
VTE

long term - 
chronic pain
delayed union
malunion
non-union
complex regional pain syndrome
avascular necrosis
osteomyelitis
contractures
joint instability
arthritis

Question 11

fat embolism syndrome

Answer 11

fat embolism causing SIR
typically 24-72 hrs post fracture
Gurd’s criteria:
major criteria - resp distress, petechiae, cerebral involvement
minor criteria - thrombocytopaenia, jaundice, tachycardia, fever

Operating early to fix the fracture reduces the risk of fat embolism syndrome.

It can lead to multiple organ failure. Management is supportive while the condition improves. The mortality rate is around 10%.

Question 12

hip fracture types and mx

Answer 12

intra capsular and extra capsular
Intra-capsular fractures involve a break in the femoral neck, within the capsule of the hip joint. This affects the area proximal to the intertrochanteric line. Garden classification is used for intra-capsular neck of femur fractures. risk of avascular necrosis. esp if displaced fracture then definite and needs joint replacement.

Extra-capsular fractures leave the blood supply to the head of the femur intact. Therefore, the head of the
femur does not need to be replaced. Intertrochanteric fractures - dynamic hip screw. Subtrochanteric fractures - intramedullary nail

Due to the morbidity and mortality with hip fractures, they are generally prioritised on the trauma list with the aim to perform surgery within 48 hours

Question 13

x-ray what to look for in ?NOF fracture

Answer 13

AP x-ray - Disruption of Shenton’s line is a key sign of a fractured neck of femur (NOF).