Orthopaedics

Question 1

What are the main anatomical sites of hip fractures

Answer 1

• Intracapsular
  
  • Subcapital
  • Transcervical
  • Basicervical
• Extracapsular
  
  • Intertrochanteric
  • Subtrochanteric

(AS)

Question 2

How are intracapsular hip fractures classified?

Answer 2

Gardner Classification

• Type 1: incomplete #, undisplaced
• Type 2: complete #, undisplaced
• Type 3: complete #, partially displaced
• Type 4: complete #, completely displaced

Question 3

What are the basic principles of fracture management

Answer 3

• Resuscitate: ATLS
• Reduce (open, closed)
• Hold (ie with metal)
• Rehabilitate (move)

(lecture)

Question 4

What are the options when reducing a fracture

Answer 4

• Closed (+ local, regional, general anaesthetic)
  
  • Manipulation
  • Traction
    
    • Skin (pull bone back in place)
    • Skeletal (ie pin into the bone allows you to pull harder)
• Open (for intraarticular / multiple / open #s)
  
  • Mini-incision
  • Full exposure

(lecture, AS)

Question 5

What are the options for holding a fracture?

Answer 5

• Closed
  
  • Plaster
  • Traction: eg collar-and-cuff
• Open = fixation
  
  • External fixation: Ex-Fix, less risk of bone infection, useful in open fractures.
    
    • Monoplanar
    • Multiplanar
  • Internal fixation: increased stability, aids early mobilisation
    
    • Intermedullary: pins, nails
    • Extramedullary: plates, screws, pins

(lecture)

Question 6

Outline resuscitation managment in a patient with a fracture

Answer 6

ATLS + 6As

• Analgesia (morphine + metaclopromide)
• Assess: neurovasculature, soft tissues, photograph
• Antisepsis: wound swabs, irrigate, betadine-soaked dressing
• Alignment: align + splint
• Anti-tentanus: booster last 10y
• Antibiotics: flucloxacillin + benzylpenicillin

(AS)

Question 7

What are the principles of rehabilitation in fracture management?

Answer 7

Use –> Move –> Strengthen –> Wt bare

Analgesia

Physiotherapy

(lecture)

Question 8

What are the possible complications of fractures?

Answer 8

• Immediate
  
  • NV compromise, soft tissue injury
  • Haemorrhage
• Early
  
  • Compartment Syndrome
  • Local infection –> systemic
  • Fat embolism –> ARDS
• Late: ‘IC MAD’
  
  • Immobility: DVT, muscle wasting, sores, pneumonia
  • Complex regional pain syndromes
  • Malunion –> deformity
  • AVN
  • Degenerative change

(lecture, AS)