Orthopedics

Question 1

What is a fracture?

Answer 1

A break in the structursl continuity of a bone due to forces exerted beyond that which the structural component can withstand

Question 2

How can fractures be classified?

Answer 2

According to:

1. Aetiology
2. Pattern
3. Site
4. Extent (complete/incomplete)
5. Relationship of fracture fragments to each other (displaced, angulated)
6. Relationship of fracture to environment (Open vs closed)
7. Relationship of the fracture to the joint (Intra- vs Extra- articular)
8. Presence/absence of complications
9. Mechanism of Injury

Question 3

What causes stress fractures?

Where are they most commonly seen?

Answer 3

Repetitive stress of normal degree persisting to the point of mechanical fatigue.

Most commonly seen in tibia, fibula, metatarsals in athletes, dancers, soldiers

Question 4

What is a pathological fracture?

Answer 4

Fracture due to normal stress acting on abnormally weakened bone

Question 5

What is a traumatic fracture?

Answer 5

Fracture due to sudden & excessive force.

May be direct or indirect

Question 6

Which patterns of fractures are stable vs unstable?

Answer 6

Stable: Transverse
Unstable: Spiral, Oblique, Comminuted

Question 7

What are the different patterns of complete fractures?

Answer 7

Transverse, Spiral, Oblique, Comminuted, Segmental, Impacted

Question 8

What patterns of fractures can be seen in incomplete fractures?

Answer 8

Greenstick fracture, Stress fracture, compression fracture, Buckle/Torus, Hairline fracture

Question 9

What is the Salter Harris Classification?

Answer 9

Grade 1: Fracture straight through growth plate (physis)
Grade 2: Fracture through metaphysis and along physis (most common)
Grade 3: Fracture through epiphysis and along physis
Grade 4: Fracture through epiphysis, physis & metaphysis
Grade 5: Crush injury of growth plate

Question 10

What is an open fracture?

Answer 10

A fracture in which the skin or a body cavity is breached by the ends of the fracture such that there is direct communication between the fracture and the external environment/body cavity; it is more prone to contamination & infection

Question 11

What is a closed fracture?

Answer 11

A fracture with no communication between the skin/body cavity and the fractured bone ends

Question 12

What classification is used for Open fractures?

Answer 12

The Gustillo & Anderson Classification

Grade 1: wound <1cm; little soft tissue damage; minimal contamination (Rate of infection 0-2%)

Grade 2: wound 1-10cm; moderate soft tissue damage; moderate contamination (Rate of infection 2-7%)

Grade 3A: >10cm; Extensive soft tissue damage; Adequate soft tissue to cover fracture; Severe contamination (7-10%)

Grade 3B: >10cm; Extensive soft tissue damage; Significant periosteal stripping; Requires flap coverage; Mass contamination (10-25%)

Grade 3C: Any open fracture associated with arterial injury that must be repaired for survival of the limb regardless of soft tissue injury (25-80%)

Question 13

What complications can be seen with fractures?

Answer 13

Immediate: Haemorrhage, Damage to surrounding tissue

Early: Compartment Syndrome, DVT, Fat Embolism

Late: Muscle Atrophy, Joint Stiffness, Abnormal Union, Non-Union, Infection, Post-traumatic arthritis, Osteopenia, CRPS

Question 14

What stages are involved in the healing of tubular bone?

Answer 14

1. Haematoma formation
2. Subperiosteal & endosteal cellular proliferation
3. Callus formation
4. Consolidation
5. Re-modelling