Principles of Fracture Management

Question 1

What is a Compound Fracture?

Answer 1

When the skin is broken and the broken bone is exposed to the air (broken bone can puncture through skin).

Question 2

What is a Stable Fracture?

Answer 2

Sections of bone remain in alignment at the fracture.

Question 3

What is a Pathological Fracture?

Answer 3

A bone breaks due to an abnormality within the bone.

Question 4

Types of Fracture (9).

Answer 4

1. Transverse.
2. Oblique.
3. Spiral.
4. Segmental.
5. Comminuted (Multiple Fragments).
6. Compression (Affecting Vertebrae).
7. Greenstick - kids >.
8. Buckle (Torus) - kids >.
9. Salter-Harris (Growth Plate) - kids ONLY.

Question 5

Aetiology of Fracture (3).

Answer 5

1. Trauma - Excessive Force Applied to Bone.
2. Stress-Related - Repetitive Low-Velocity Injury.
3. Pathological - Abnormal Bone which Fractures during Normal Use/Following Minimal Trauma.

Question 6

Which bones are most at risk of an Open Fracture?

Answer 6

1. Tibia.

2. Phalanges.

Question 7

Investigations in Fractures (2).

Answer 7

1. Initial - X-Ray (2 views from different angles).

2. CT Scans - detailed (if X-ray is inconclusive).

Question 8

What is the First Principle of Fracture Management?

Answer 8

Achieve mechanical alignment of the fracture by :

1. Closed Reduction (Manipulation of the Limb).
2. Open Reduction (Surgery).

Question 9

What is the Second Principle of Fracture Management?

Answer 9

Provide relative stability for some time to allow healing to occur - fixing the bone in the correct position while it heals.

Question 10

Methods of Second Principle of Fracture Management (6).

Answer 10

1. External Casts e.g. Plaster Cast.
2. K Wires.
3. Intramedullary Wires.
4. Intramedullary Nails.
5. Screws.
6. Plate and Screws.

Question 11

Immediate Management of Fracture (2B).

Answer 11

1. Pain Management.
   2A. If Straightforward : Principles + Discharge with Follow-Up to Fracture Clinic.
   2B. If Not Straightforward : Refer to On-Call T&O Team –> Admit + NBM –> MDT.
2. Immobilise Fracture including Proximal/Distal Joints + Monitor Neuromuscular Status.

Question 12

Management of Open Fractures (4).

Answer 12

1. Tetanus Prophylaxis + IV Broad-Spectrum Antibiotics.
   2, Thorough Debridement + Avoid Internal Fixation Devices.
2. Emergency - Debride and Lavage within 6 Hours of Injury : remove foreign material and devitalised tissue.
3. Irrigate with 6 litres of Saline and keep wound open.

Question 13

Early Complications of Fractures (5).

Answer 13

1. Damage to Local Structures.
2. Haemorrhage - Shock.
3. Compartment Syndrome.
4. Fat Embolism.
5. VTE (Immobility).

Question 14

Later Complications of Fractures (10).

Answer 14

1. Delayed Union (Slow Healing).
2. Malunion (Misaligned Healing).
3. Non-Union (Failure to Heal).
4. Avascular Necrosis (Death of Bone).
5. Osteomyelitis.
6. Joint Instability.
7. Joint Stiffness.
8. Contractures - Tightening of Soft Tissues.
9. Arthritis.
10. Chronic Pain / Complex Regional Pain Syndrome.