pathological fracture

Question 1

main thing to be aware of

Answer 1

history of malignancy

patients with ‘well controlled’ cancer

Question 2

what is pathological fracture

Answer 2

fracture in an abnormally weakened bone

fracture from low energy injury

Question 3

when to suspect pathological fracture

Answer 3

low trauma
pain before trauma
history of cancer

Question 4

sunburst matrix

codmans triangle

Answer 4

osteosarcoma

Question 5

score for fracture risk in metastatic bone disease

Answer 5

mirels score

>9 operate

Question 6

what is plasmacytoma

Answer 6

solitary myeloma

Question 7

management of plasmacytoma

Answer 7

WLE and reconstruction

Question 8

early complications of fracture

Answer 8

bleeding
infection
shock
compartment syndrome
fat embolism
neurovascular damage

Question 9

late complications fracture

Answer 9

DVT or PE
chest infection
non / mal union
pressure sore
AVN
stiffness

Question 10

treatment of shock

Answer 10

IV fluids
blood transfusion
coagulation
surgery

Question 11

risk factors DVT

Answer 11

prolonged immobility
pelvis limb fracture
venous stasis
hyper coagulable state
smoking
dehydration
previous DVT

Question 12

diagnosis of DVT

Answer 12

Doppler US veins

PE = VTPA

Question 13

DVT symptoms

Answer 13

red swollen calf

Question 14

prevention of DVT

Answer 14

TED stockings

LMWH eg enoxaparin

Question 15

treatment DVT

Answer 15

LMWH at therapeutic dose

long term warfarin

Question 16

symptoms fat embolism

Answer 16

hypoxia 
tachycardia
tachypnoea
pyrexia
dyspnoea
petechial rash (late)

Question 17

prevention of fat embolus

Answer 17

long bones eg femur
high flow oxygen
rapid splint age
maintain fluids
urgent stabilisation of fracture

Question 18

treatment fat embolism

Answer 18

supportive
respiratory support
early ICU 
high flow oxygen
resuscitation with fluids
corticosteroids

Question 19

what is compartment syndrome

Answer 19

haematoma and oedema from fracture raises pressure within osteofascial compartment resulting in decreased perfusion of tissues and muscle ischaemia

Question 20

symptoms compartment syndrome

Answer 20

PAIN!!!!!!!!!!!!!! UNCONTROLLABLE PAIN!!!!!!!!!!!!!

not 5ps

Question 21

treatment compartment syndrmoe

Answer 21

urgent fasciotomy
analgesia
high flow oxygen
contact senior

Question 22

factors affecting fracture healing

Answer 22

smoking
NSAIDs
diabetes
steroids 
poor nutrition