Orthopaedics

Question 1

What should you include when describing a fracture? (6)

Answer 1

Where the fracture is
Type of fracture (transverse, spiral, oblique)
Simple or comminuted?
Any displacement?
Any angulation?
Is the bone of normal consistency?

Question 2

What are the principles of managing a fracture? (4)

Answer 2

Reduction
Stabilise fragments
Maintain neurovascular supply
Encourage early rehabilitation

Question 3

What is the initial management of an open fracture? (5)

Answer 3

Cover wound in saline-soaked gauze
Place in backslab 
IV antibiotics
Continuous assessment of neurovascular supply
Debridement in 24 hours

Question 4

What are the complications of fractures?

1. Immediate (4)
2. Later- Local (4)
3. Later - General (3)

Answer 4

1. Bleeding, nerve damage, vessel damage, organ damage
2. Infection, delayed union, necrosis, compartment syndrome
3. Venous or fat embolism, pneumonia, arthritis

Question 5

What are the types of hip fracture?

Answer 5

Intracapsular, Intertrochanteric, subtrochanteric

Question 6

What is the management for intracapsular fractures?

Answer 6

Garden I and II undisplaced = screw

Garden III and IV displaced = total arthroplasty or hemiarthroplasty

Question 7

What is important to rule out when someone presents with back pain? (4)
When is mechanical back pain most likely to resolve?

Answer 7

cancer, infection, fracture, cauda equina

6-12 weeks

Question 8

When does transient synovitis tend to present?
What signs will be elicted upon examination?
When should it resolve?

Answer 8

4-10 years
Pain on extremities of movement
Within a few days

Question 9

When does Perthes’ disease tend to present?
What signs will be elicted upon examination?
What will be seen on imaging?

Answer 9

4-7 years
Limited internal rotation and abduction
Joint space widening

Question 10

When does slipped upper femoral epiphysis tend to present?
How does it present?
What will you find on examination?
What are the complications if untreated?

Answer 10

10-16 years
Pain after minor injury extending to anterior thigh and knee
Most able to weight bear; limited flexion and abduction and internal rotation
Avascular necrosis of head

Question 11

What movement is prevented in septic arthritis of the hip?

Answer 11

Internal rotation

Question 12

Under what circumstances would you urgently refer a painful hip in a child? (6)

Answer 12

Suspect ALL e.g. weight loss, sweats
High fever = septic arthritis, osteomyelitis
Changeable history = NAI
<3 years
>9 with painful or restricted internal rotation = SUPE
Reduced pulses = neurovascular compromise

Question 13

What fractures may you see in children that you would not see in adults?

Answer 13

Greenstick fracture - fracture on one side
Buckle fracture - compression, bone sticks out on either side
Salter-Harris fracture - growth plate fracture

Question 14

How long does it take fractures to heal in children?

1. Upper limb
2. Lower limb

Answer 14

1. 4 weeks

2. 6-8 weeks