PRINCIPLES OF DIAGNOSIS AND MANAGEMENT OF FRACTURES AND SOFT TISSUE INJURIES

Question 1

in what situation should you attempt a manipulation/reduction before radiographic studies?

Answer 1

if there is a risk of neurovascular damage or haemodynamic instability

Question 2

what is a fracture?

Answer 2

a break in the continuity of bone or cartilage

Question 3

what is the common clinical presentation of a fracture/

Answer 3

loss of function
pain
tenderness
swelling
abnormal motion
visible deformity in the area

Question 4

what are some ways in which we describe fractures?

Answer 4

open vs closed
exact anatomical location
orientation of fracture line
simple or comminuted
position
complete vs incomplete
involvement of articular surface
avulsion
impaction
pathologic?
stress?

Question 5

whats the difference between an open and a closed fracture?

Answer 5

in a closed fracture the skin and soft tissue overlying the site is intact but in an open fracture there is exposure to the outside environment

Question 6

how do we describe the orinentation of the fracture line?

Answer 6

spiral
oblique (on an angle)
transverse
comminuted (more than 2 pieces)

note: you describe the fragmented pieces relative to their normal position

Question 7

how do we describe position of a fracture?

Answer 7

displacement is when the fragments are deviated away from their normal position
alignement refers to the relationship of the longitudinal axis of one fragment to another - deviation from normal alignment is angulation

Question 8

whats the difference between complete and incomplete fractures?

Answer 8

a fracture is termed complete if it interrupts both cortices of the bone and incomplete if it only interrupts 1

Question 9

what is an inter-articular fracture?

Answer 9

a fracture that crosses the joint surface

Question 10

what is an avulsion fracture?

Answer 10

when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone

Question 11

what is a pathologic fracture?

Answer 11

when a fracture occurs from a seemingly trivial trauma so it is liely that a disease has caused a structural weakness predisposing them to an injury e.g. osteomalacia or scurvy etc

Question 12

what are stress fractures?

Answer 12

tiny cracks in the bones caused by repeated low intensity forces e.g. running long distances

Question 13

outline the stages of fracture healing

Answer 13

1. haematoma caused by the rupturing of vessels across the fracture line
2. inflammation when granulation tissue forms
3. resoprtion of haematoma and pro-callus formation (fibrocartilage)
4. remodelling to form callus due to mineralisation by calcium phosphate deposits
5. callus is resorbed

Question 14

in which types of bones may there not be any callus formation?

Answer 14

bones that have deficient periosteum e,g, skull and neck of femur

Question 15

in a healthy adult, how long from injury should it take for consolidation?

Answer 15

2 months on bone slike the hmerus and 4 months on larger bones i.e. femur

Question 16

what affects the rate of fracture healing?

Question 17

what affects the rate of fracture healing?

Answer 17

type of fracture (e.g. oblique fractures heal faster than transverse)
age- faster in younger ages
type of bone affected
degree of fracture
systematic states e.g. hyperthyroidism or corticosteroidism
exercise vs chronic hypoxia

Question 18

what is delayed union?

Answer 18

when fracture healing takes longer than usual for that particular location

Question 19

what is malunion?

Answer 19

when a residual deformity exists

Question 20

what is nonunion?

Answer 20

failure of the fracture to unify - can result in pseudoarthroses

Question 21

what are pseudoarthroses?

Answer 21

a joint formed by fibrous tissue bridging the gap between the two fragments of bone due to nonunion

Question 22

what are greenstick fractures?

Answer 22

bone cracks on one side only, not all the way through the bone. - common in children

Question 23

what are torus fractures?

Answer 23

incomplete fractures characterised by a buckling/wrinkling of the cortex - common in children

Question 24

how are epiphyseal injuries classified?

Answer 24

Salter Harris classification

Question 25

describe the Salter Harris classification?

Answer 25

normal type 1 - straight across physis type 2 - fracture extends into metaphysis type 3 -intra-articular fractures and only extends to physis type 4 - fracture extends across metaphysis, physis and epiphysis type 5 - crushing injuries of the epiphyseal plate

Question 26

when you request an x-ray for a suspected fracture, why should you make sure to get 2 views?

Answer 26

because the fracture line is most visible when it is parallel to the x-ray beam and invisible when perpendicular

Question 27

if a fracture is suggested but not visible on x-ray what should you do?

Answer 27

treat it as a fracture and re-examine it clinically and radiographically in 7-10 days

Question 28

what are some complications of fractures?

Answer 28

``` infections - osteomyelitis or septic arthritis haemorrhage vascular injuries nerve injuries compartment syndrome avascular necrosis complex regional pain syndrome fat embolism syndrome fracture blisters (complications from immobolisation may include pneumonia, DVT, PE, UTI, wound infections, ulcers, muscular atrophy, stress ulcers, GI haemorrhage, psychiatric disorders) ```

Question 29

would should you do if an infection such as osteomyelitis or septic arthritis is suspected after a fracture?

Answer 29

vigorous irrigation debridement of wound antibiotics sometimes tetanus booster

Question 30

which fractures have a greater risk of haemorrhage?

Answer 30

pelvic fractures and shaft of femur fractures | as they have richer circulations

Question 31

which fractures have the highest risk of vascular injury?

Answer 31

Displaced fractures of the distal femur and proximal tibia and particularly dislocation of the knee due to popliteal artery in knee

Question 32

what is neuropraxia?

Answer 32

The mildest form of traumatic peripheral nerve injury. It is characterized by focal segmental demyelination at the site of injury without disruption of axon and surrounding connective tissues. = blockage of nerve conduction and transient weakness or paresthesia

Question 33

what is axonotmesis

Answer 33

medium severity injury to nerve fibres

Question 34

what is Neurotmesis?

Answer 34

the severing of a nerve so all functions are absent - requires surgery

Question 35

what is compartment syndrome?

Answer 35

condition in which increased pressure within one of the body's anatomical compartments results in insufficient blood supply to tissue within that space

Question 36

what are the signs and symptoms to look out for for compartment syndrome?

Answer 36

``` intense pain that seems disproportionate and worsens on stretching tenderness in the affected area. tightness in the muscle a tingling or burning sensation. in severe cases, numbness or weakness ```

Question 37

how do we treat compartment syndrome?

Answer 37

emergency fasciotomy. The doctor or surgeon makes an incision to cut open your skin and fascia surrounding the muscles to immediately relieve the pressure inside the muscle compartment.

Question 38

what is complex regional pain syndrome?

Answer 38

a form of chronic pain after injury and the pain seems disproportionate to injury

Question 39

what is fat embolism syndrome?

Answer 39

when a fat embolism enters the blood stream

Question 40

what are signs and symptoms of fat embolim syndrome?

Answer 40

``` SOB fast breathing mental confusion lethargy coma pinpoint rash fever anaemia 1-3 days after injury ```

Question 41

what are fracture blisters?

Answer 41

where skin adheres tightly to bone with little subcutaneous fat cushioning. The blister that results resembles that of a second degree burn.

Question 42

what are subluxations?

Answer 42

partial loss of continuity between 2 articulating surfaces | partial dislocation

Question 43

what are dislocations?

Answer 43

total loss of continuity between 2 artiuclating surfaces

Question 44

what are the signs and symptoms of dislocation?

Answer 44

``` Joint is visibly deformed or out of place. Numbness or tingling at the joint. Swollen or discolored. Limited ability to move. Intense pain. ```

Question 45

what are 3 exampkes of soft tissue injuries?

Answer 45

sprains tendinitis bursitis

Question 46

what are sprains?

Answer 46

injuries to the fibres of a supporting ligament of a joint resulting from an abnormal joint motion

Question 47

what are the signs and symptoms of sprains?

Answer 47

Pain. Swelling. Bruising. Limited ability to move the affected joint. Hearing or feeling a "pop" in your joint at the time of injury.

Question 48

what is tendinitis?

Answer 48

inflammation or irritation of a tendon

Question 49

what are signs and symptoms of tendinitis?

Answer 49

Pain often described as a dull ache, especially when moving the affected limb or joint. Tenderness. Mild swelling.

Question 50

what is bursitis?

Answer 50

inflamation or iritation of a bursa

Question 51

what are signs and symptoms of bursitis?

Answer 51

dull ache/Pain. Localized tenderness. Limited motion. Swelling and redness if the inflamed bursa is close to the surface of the skin. (may have more swelling than tendonitis)