Orthopaedics unit 5 Common fractures - deck 2

Question 1

What must be done once a fracture has been diagnosed ?

Answer 1

A description of the fracture must be noted

Question 2

Why is it important to describe the shape and degree of fragmentation of a fracture ?

Answer 2

Because these features indicate the amount of energy which has caused the injury, and so help us to understand it and how we may treat it.

Question 3

What questions must be asked and answered in order to accurately describe a fracture ?

Answer 3

1. Which bone is broken and on which side?
2. Is the fracture open or closed?
3. Where on the bone is it broken?
4. What shape is the fracture ?
5. How many fragments of bone?
6. What is the position of the distal fragment ?
7. Could it be a pathological fracture ?
   8.

Question 4

Define what is meant by both open and closed fractures

Answer 4

• Open fracture = a fracture in which the skin is broken
• Closed fracture = a fracture in which the skin is still intact

Question 5

What are the 5 main locations in a bone that it can be broken?

Answer 5

1. Intra-articular (in the joint)
2. Mid-shaft
3. Proximal third
4. Middle third
5. Lower third

Question 6

What are the 3 main shapes a fracture could be described as?

Answer 6

1. Spiral
2. Oblique
3. Transverse

Question 7

How do spiral fractures occur ?

Answer 7

Through twisting forces, it is a common low energy mode of injury.

Question 8

Describe the associated damage to the other structures (other than the bone) in a spiral fracture

Answer 8

They are usually associated with little soft tissue damage, so the blood supply to the bone is preserved and healing is unlikely to be a problem.

Question 9

What type of injuries are oblique and transverse fractures caused by ?

Answer 9

They are caused by buckling or direct injury to the bone

Question 10

Describe the associated damage to the other structures (other than the bone) in an oblique or transverse fracture

Answer 10

• These fractures involve a lot of energy, resulting in soft tissue stripping and damage to the blood supply.
• Such injuries will require a lot more consideration when the choice of treatment is being made and usually take longer to heal.

Question 11

What are the 3 descriptions for how many fragments of bone are present in a fracture ?

Answer 11

1. Simple
2. Butterfly
3. Comminuted

Question 12

Describe what each of the following terms mean in terms of how many fragments of bone there is in the fracture:

1. Simple
2. Butterfly
3. Comminuted

Answer 12

1. Simple - there is a proximal and distal fragment
2. Butterfly - The term is commonly used in orthopaedic surgery, and results from two oblique fracture lines meeting to create a large triangular or wedge-shaped fragment located between the proximal and distal fracturefragments, and resembles a butterfly.
3. Comminuted - fractures with 3 or more fragments (think butterfly is technically a sub-type of comminuted)

Question 13

How should fragments be described in relation to each other ?

Answer 13

The distal fragment should be described in relation to the proximal fragment

Question 14

Why should the distal fragment of a fracture be described in relation to the proximal fragment ?

Answer 14

Because the proximal fragment takes up a position determined by the new muscle balance and so treatment must be aimed at repositioning the distal fragment.

Question 15

What 3 things should the position of the distal fragment of a fracture be described by ?

Answer 15

1. Displacement
2. Angulation
3. Rotation

Question 16

Define what is meant by the displacement of the distal fragment of a fracture and list the different ways in which the fragment can be displaced

Answer 16

This describes the direction of translation of the distal fragment and is described using anatomic terms.

Fractures can be described as anteriorly or posteriorly displaced and medially or laterally displaced.

Question 17

Define what is meant by the angulation of the distal fragment of a fracture and list the different ways in which the fragment can be displaced

Answer 17

This describes the direction in which the distal fragment points towards and the degree of this deformity

Angulation may be described as anterior, posterior, varus (medial) or valgus (lateral)

Question 18

What are the 2 different ways in which the distal fragment of a fracture may be rotated ?

Answer 18

Internally or externally

Question 19

Define what a pathological fracture is and what it suggests

Answer 19

• A pathological fracture is one in which the fracture seems out of proportion to the violence of the injury.
• This suggests that the bone is weak as a result of osteoporosis or other diseases such as cancer.

Question 20

What are the 2 main ways in which pain relief from a fracture is achieved ?

Answer 20

• Use of pain-killing drugs
• Splintage

Question 21

What type of pain killers of often necessary following a fracture ?

Answer 21

Strong pain-killing injections of morphine or pethidine are usually necessary.

Question 22

Define what a splint is

Answer 22

A splint is a device which holds a fracture steady

Question 23

What is the benefit of when a splint can often be applied in the treatment of a fracture ?

Answer 23

It can often be applied before arriving at hospital, which this alone can relieve pain

Question 24

In general what should a splint immobilise/stabilise ?

Answer 24

The joint above and below the injury

Question 25

Simple measures aiming at splinting an injury such as binding the arm to the chest, with or without a sling, or simply binding the legs together are often sufficient - T or F ?

Answer 25

True

Question 26

The splint may need to be removed for definitive examination and radiographs - what should be avoided however ?

Answer 26

Repeated removal for innumerable doctors to examine the injured person

Question 27

What is an alternative method to splintage and why is it sometimes used?

Answer 27

Traction

It may be used early in treatment to relieve muscle spasm, which is a major component of post-fracture pain.

Question 28

Define what traction is

Answer 28

Traction refers to the practice of slowly and gently pulling on a fractured or dislocated body part. It’s often done using ropes, pulleys, and weights. The purpose of traction is to guide the body part back into place and hold it steady.

Question 29

What specific fracture is traction particularly useful for and why?

Answer 29

Fractures of the femoral neck because splintage is almost impossible to apply.

Question 30

For most upper limb and peripheral lower limb fractures, blood loss is in itself not too serious and is tolerated even by an elderly person. - T or F?

Answer 30

True

Question 31

In what fractures should you be concerned about major blood loss becoming a problem?

Answer 31

In major long bone fractures, particularly of the femur and to a lesser extent the tibia, blood loss is significant

Question 32

in general how much blood will a person with a femoral fracture lose?

Answer 32

Between 2-3 units of blood into the soft tissues

Question 33

How many ml of blood is in one unit ?

Answer 33

450ml or one pint

Question 34

How much blood may be lost in a tibial fracture ?

Answer 34

1 unit - which is in itself tolerable but when combined with other injuries may become significant

Question 35

Along with long bone fractures what other area when fractured is associated with major blood loss?

Answer 35

Pelvic fractures, esp if unstable are associated with major bleeding

Question 36

Where does the blood loss in a pelvic fracture come from ?

Answer 36

Major venous bleeding from the pelvic plexuses

Question 37

How much blood loss can occur in a pelvic fracture ?

Answer 37

Up to 6 units or so

Question 38

If pelvic fractures are combined with other skeletal injuries what could happen to the patient ?

Answer 38

They could die as the level of blood loss may be lethal, unless the fluid is replaced preferably with blood

Question 39

In general what should be done for the management of all patients with major long bone fractures to combat the blood loss ?

Answer 39

• They should be cross-matched for blood
• A good-sized venous line for blood transfusion should be established

Question 40

In general what should be done for the management of all patients with pelvic fractures to combat the blood loss ?

Answer 40

• Cross-matched for blood
• 2 good-sized venous lines may be needed and a central venous line should be established to ensure that transfusion is keeping up with loss.

Question 41

What is another name for an open fracture ?

Answer 41

Compound fracture

Question 42

What sort of injuries do open fractures tend to occur in ?

Answer 42

More violent injuries

Question 43

What is the important thing to remember about all open fractures and how this then relates to its management

Answer 43

• In all open fractures the bone/wound is contaminated by bacteria from the environment
• The treatment strategy is to clean them out and remove all dead tissue as soon as possible, to prevent a contamination becoming an infection.

Question 44

An open fracture is a surgical emergency, when should the patient be taken to the operating theatre?

Answer 44

ASAP provided that the patient’s general condition permits

Question 45

When in surgery what is done to clean out the wound of an open fracture ?

Answer 45

The wound can be extended surgically and all debris and suspected dead tissue removed.

Question 46

Why is it important to ensure These will only be discovered if a wide incision is made and exploration down to the bone is performed even in small open fracture wounds ?

Answer 46

Even in small wounds, bits of clothing which (inevitably have bacteria on them), dirt and fragments of wood or metal can be found.

Question 47

When is it better to leave a wound open following debridment for an open fracture ?

Answer 47

If there is any doubt that closure can be achieved without any tension on the skin

Question 48

The vast majority of wounds following debridment of an open fracture should be left open and closed either as a secondary procedure after a few days or left to heal spontaneously. - T or F?

Answer 48

True

Question 49

For patients whos wound following debridment of an open fracture is left open, what additional treatment is needed to prevent infection still occurring ?

Answer 49

Broad spectrum antibiotics and some form of tetanus protection