Principles of fracture management

Question 1

When examining a fracture there are 3 basic principles that should be used when performing an examination. What are these 3 things?

1 - look, feel, scan
2 - look, scan, treat
3 - feel, move, scan
4 - look, feel, move

Answer 1

4 - look, feel, move

Question 2

When treating a fracture there are 3 basic principles that should be used. What are these 3 things and what order?

1 - reduce, hold, move
2 - hold, move, reduce
3 - hold, reduce, move
4 - move, reduce, hold

Answer 2

1 - reduce, hold, move
1 - reduce range of movement
2 - hold injury in position it can heal
3 - move injured limb to regain range of movement

Question 3

What is the definition of a bone fracture?

1 - gap in bone on imaging
2 - a gap in the continuity of the bone
3 - bone colour change
4 - deformity of bone

Answer 3

• a gap in the continuity of the bone

Question 4

What is the morphology of a bone fracture?

Answer 4

• the pattern or shape of the fracture

Question 5

What does the severity of a bone fracture relate to?

1 - how many bones are fractures
2 - how big the fractures bone is
3 - how involved surrounding tissue is
4 - how the fracture occurred

Answer 5

3 - how involved surrounding tissue is

Question 6

When talking about displacement in terms of a bone fracture, what does displacement mean?

1 - if bones at joints are displaced
2 - if ligaments are displaced from bones
3 - if tendons are displaced from bones
4 - if 2 ends of a bone are displaced from one another

Answer 6

4 - if 2 ends of a bone are displaced from one another

Question 7

What is a traumatic bone fracture?

1 - abnormal force placed on a bone
2 - abnormal trauma placed on the patient
3 - abnormal number of bones fractured
4 - abnormal type of accident

Answer 7

1 - abnormal force that is place on a bone

Question 8

What is a pathological bone fracture?

1 - bone disease
2 - force that would not normally cause a fracture, but due to bone disease it does
3 - fracture is cause by another disease
4 - fracture is cause by disease to the bone

Answer 8

2 - force that would not normally cause a fracture, but due to bone disease it does
- someone with osteoporosis for example

Question 9

What is a fatigue bone fracture?

1 - bones osteoblasts are tired and cannot lay down new bone
2 - bones osteoclasts are tired and cannot degrade bone
3 - repetitive stress on same bone, resulting in a fracture
4 - patients fracture occurred as muscle around bone were tired

Answer 9

3 - repetitive stress on same bone, resulting in a fracture

- essentially repetition, like a marathon runner may fracture their metatarsal

Question 10

What sort of force on a bone results in a transverse and oblique fractures?

1 - bending forces
2 - rotational forces
3 - twisting forces
4 -

Answer 10

• bending forces

Question 11

What sort of force on the bone results in a spiral fractures?

Answer 11

• rotation or twisting forces

- twisting of the ankle for example

Question 12

When we describe the severity of the fracture, we can use various terms. What is an open and closed fracture?

Answer 12

• open = skin has pierced the skin

- closed = skin has not be broken by bone

Question 13

When we are looking at someone with a suspected fracture, what are the 4 basic things we are looking for?

Answer 13

1 - swelling (localised or diffuse)
2 - bruising
3 - abrasions, lacerations and wounds
4 - deformities

Question 14

When we are feeling someone with a suspected fracture, what are the 3 basic things we are looking for?

1 - temperature, swelling, tenderness
2 - tenderness, swelling, bony prominence
3 - tenderness, temperature, bony prominence
4 - temperature, symmetry, swelling

Answer 14

2 - tenderness, swelling, bony prominence

Question 15

When we are assessing movement of the injured area in the patient, what 2 basic things do we need to do and what order?

1 - passively move patient the.Mon ask patient to move
2 - assess reflexes and then ask the patient to move
3 - ask the patient to move the assess sensations
4 - ask patient to move then passively move the patient

Answer 15

4 - ask patient to move then passively move the patient

• ask the patient to actively move the joint/limb
• tell the patient you will passively move the limb joint

Question 16

When examining someone in terms of neurovascular assessment and compartment syndrome we use the 5 Ps. What are the 5 Ps?

Answer 16

1 - Pain
2 - Pulse
3 - Pallor
4 - Parasthesia (can they feel the touch)
5 - Paralysis (can they move this)

Question 17

When we need to assess a patients pulse, we must always start distally, and if we cannot feel it we move proximally. What is the 1st pulse we should take in the foot?

1 - dorsalis pedis
2 - posterior tibial
3 - anterior tibial
4 - peroneal

Answer 17

1 - dorsalis pedis

Question 18

The dorsalis pedis is the first pulse that we feel in the foot in a peripheral examination. What are the 2 landmarks that can help find the dorsal pedis pulse?

Answer 18

• extensor hallucis longus (essentially tendon of big toe)

- extensor digitorum longus (one of tendons to toe number II)

Question 19

When we need to assess a patients pulse, we must always start distally, and if we cannot feel it we move proximally. The first pulse in the lower extremities is the dorsalis pedis. What would be the second location to assess pulse if the pulse cannot be found at the dorsalis pedis?

1 - cutaneous
2 - posterior tibial
3 - anterior tibial
4 - peroneal

Answer 19

2 - posterior tibial

- located posterior to medial malleous

Question 20

The tibialis posterior is the second pulse that we feel in the foot in a peripheral examination. What landmarks that can help find the tibial posterior pulse?

Answer 20

• posterior to malleous bone

Question 21

Generally in someone has a suspected fracture, what is the first imaging modality used?

1 - ultrasound
2 - CT
3 - X-ray
4 - MRI

Answer 21

3 - X-ray

Question 22

When imaging patients with a suspected fracture, we use the rules of 2s. The first rule is the number of images that we ask for is 2 orthogonal views. What are orthogonal views?

1 - 2 images taken side by side
2 - image of each limb taken
3 - images taken at 2 distances
4 - images taken at 90 degrees to one another

Answer 22

4 - images taken at 90 degrees to one another

• anterior view and then anteriorlateral view
• MAY NOT SEEN FRACTURE IN ONE PLANE

Question 23

When imaging patients with a suspected fracture, we use the rules of 2s. The 2nd rule relates to where we would image. So if there is a suspected fracture of the humerus, we would want to look at the joint above and below the suspected fracture. What 2 other joints would we image?

Answer 23

• knee and hip

Question 24

When imaging patients with a suspected fracture, we use the rules of 2s. The 3rd rule relates to pre and post intervention. Why is this important?

Answer 24

• pre intervention

- post intervention to see if fracture is healing

Question 25

When imaging patients with a suspected fracture, we use the rules of 2s. The 4th rule relates to 2 limbs. This is important in congenital anomalies. Why is this important?

Answer 25

• compare changes in opposite limbs

Question 26

What is the most effective pain relief for patients with a suspected fracture?

1 - immobilisation and morphine
2 - splint and morphine
3 - morphine
4 - splint and immobilisation

Answer 26

4 - splint and immobilisation

Question 27

When managing a suspected fracture what are the 3 considerations to take?

Answer 27

1 - is current position going to allow the fracture to heal
2 - is the fracture stable or does it require holding
3 - when to use the limb and move

Question 28

What are the 3 key principles of fracture management?

Answer 28

1 - Reduce
2 - Hold
3 - Move

Question 29

When looking to reduce a fracture we can use direct (open) or indirect (closed) approaches. What is the direct approach?

1 - treatment directed to treat fracture immediately
2 - direct treatment based on imaging only
3 - direct treatment based on imaging and symptoms
4 - open (direct! surgery is required to visualise the fracture

Answer 29

4 - open (direct! surgery is required to visualise the fracture

Question 30

When looking to reduce a fracture we can use direct (open) or indirect (closed) approaches. What is the indirect approach?

1 - treatment is indirectly related to the fracture
2 - direct treatment based on imaging only
3 - treatment based on imaging and symptoms
4 - surgery is not required to visualise the fracture

Answer 30

• no surgical intervention is required

- fracture can be reduced externally, for example a cast

Question 31

When we look to hold a fracture in place we can use conservative (non-surgical) and surgical. What are the conservative approaches?

1 - pain medication
2 - splint/cast
3 - taping
4 - compression sock

Answer 31

2 - splint/cast

Question 32

When we look to hold a fracture in place we can use conservative (non-surgical) and surgical. What are the 2 surgical approaches?

1 - cast and bone removal
2 - internal fixation (screws) and cast
3 - internal fixation (screws) and external fixation (brace)
4 - cast and external fixation (external brace)

Answer 32

3 - internal fixation (screws) and external fixation (brace)

GENERALLY USE EXTERNAL AND THEN USE INTERNAL