Principles of fractures

Question 1

When assessing a patient with a fracture, what’s the most important aspect to consider?

Answer 1

If there is soft tissue injury

Question 2

how do you describe the location of a fracture in a long bone? what terminology ?

Answer 2

in 1/3rds, ie proximal, middle or distal third

Question 3

There are many fracture configurations, name 4

Answer 3

Transverse
Oblique
Comminuted
Spiral
Segmental
Avulsion
Compression
Torus
Greenstick

Question 4

Describe the fracture configuration in this picture.

what is the cause of these injuries?

Answer 4

transverse

due to a direct blow (most commonly an injury to the ulnar from protecting yourself in a fight from a baton)

Question 5

Describe the fracture configuration in this picture.

what is the cause of these injuries?

Answer 5

oblique fracture

due to a bending force

Question 6

Describe the fracture configuration in this picture.

what is the cause of these injuries?

Answer 6

spiral fracture

due to a rotational force

Question 7

Describe the fracture configuration in this picture.

what is the cause of these injuries?

Answer 7

comminuted fracture

high energy injury

Question 8

Describe the fracture configuration in this picture.

what is the cause of these injuries?

Answer 8

segmental

due to a high energy injury

Question 9

Describe the fracture configuration in this picture.

what is the cause of these injuries?

Answer 9

Avulsion fracture

musculo-tendinous pull off

Question 10

Describe the fracture configuration in this picture.

what is the cause of these injuries?

Answer 10

torus fracture

low energy - usually in children

Question 11

Describe the fracture configuration in this picture.

what is the cause of these injuries?

Answer 11

greenstick fracture

Question 12

when considering fracture displacement, what are the different types of displacement?

Answer 12

• undisplaced
• angulated (distal portion angled in relation to proximal e.g. dorsally or volar)
• translated (medio-lateral or anterior-posterior shift)
• shortened
• rotated (usually seen clinically e.g. femoral neck fracture causes external rotation)

Question 13

what are the risks associated with open fractures?

Answer 13

infection, non-union, malunion

Question 14

what is the immediate treatment for open fractures?

Answer 14

urgent debridement, reduction and immobilisation

Question 15

list 3 risks of intra-articular fractures if joint congruity is not restored

Answer 15

• joint pain
• stiffness
• post-traumatic osteoarthritis

Question 16

what is the treatment for intra-articular fractures?

Answer 16

reduction and rigid fixation

Question 17

what are the 3 basic Rs of fracture management

Answer 17

Reduce (to realign the fragments)
Retain (immobilise)
Rehabilitate

Question 18

what are the methods of conservative and surgical immobilisation of a fracture?

Answer 18

conservative: splint, sling, cast

surgical:

• smooth wires (k-wires)
• intramedullary nail
• plate and screw
• external fixator (cage thing)

Question 19

list 4 complications of fractures

Answer 19

• compartment syndrome
• non-union
• malunion
• infection

Question 20

what are the 2 main types of non-union and what might the reasons for these be

Answer 20

atrophic:

• smoking
• malnutrition
• immunocompromised

hypertrophic: failure of immobilisation