Principles of Fractures

Question 1

How do you describe a fracture on an x-ray?

Answer 1

1. Type - complete (more specific) or incomplete
2. Where - diaphysis, metaphysis, epiphysis
3. Displacement - translation, angulation, shortening, comment on AP and lateral views
4. Joint/other bones involved

Question 2

How long does it take for a hard callus to be seen on x-ray after an injury?

Answer 2

8-12 weeks

Question 3

Which is the simplest fracture and how long does it take to heal?

Answer 3

1. Closed, paediatric, metaphyseal, upper limb
2. 3 weeks
3. Anything complicating this doubles the healing time (adult 6, diaphyseal 12 etc)

Question 4

What are the risk factors for poor bone healing?

Answer 4

Older age, diabetes mellitus, recent trauma, smoker, osteoporosis, steroids, NSAIDs

Question 5

What is an open fracture?

Answer 5

Fracture with direct communication to external environment - commonly tibia and phalanx

Question 6

What is the general management for a fracture?

Answer 6

1. Take a picture
2. IV antibiotics - co-amoxiclav 1.2g
3. Assess neurovascular status
4. Analgesia
5. Tetanus status - booster/IV Ig
6. Irrigate open fracture
7. Cover in saline soaked dressing
8. Splint and stabilise limb
9. Surgical fixation +/- soft tissue reconstruction within 72hrs

Question 7

What are the immediate complications of fractures?

Answer 7

1. Bleeding
2. Organ injury
3. Nerve/skin injury
4. Vessel injury/ischaemia

Question 8

What are the later local complications of fractures?

Answer 8

1. Pressure sores
2. Infection
3. Delayed union
4. Non-union

Question 9

What are the later systemic complications of fractures?

Answer 9

1. VTE/fat embolus
2. PE
3. Pneumonia
4. Arthritis

Question 10

What is this a presentation of?
Pelvic/femoral fracture, day 2-3, altered mental state, fever, SOB, hypoxia, raised HR, petechial rash, retinal haemorrhages.

Answer 10

Fat embolus

Question 11

What is the treatment for a fat embolus?

Answer 11

ITU and supportive for respiratory failure

Question 12

Which injuries are neurovascular injury most common in?

Answer 12

1. Knee dislocations

2. Supracondylar humeral fracture (radial nerve)

Question 13

Which infections can commonly happen with a fracture?

Answer 13

1. Cellulitis
2. Osteomyelitis
3. Sepsis

Question 14

What are the risk factors for a delayed union?

Answer 14

1. Poor blood supply
2. Infected fracture
3. Systemic disease

Question 15

What is the VTE prophylaxis for fracture surgery?

Answer 15

LMWH (enoxaparin 40mg) 12-24 hours post-op and for further 7-10 days afterwards.

Question 16

What is this a presentation of?
Pain in limb unresponsive to analgesia on passive muscle stretching, oliguria, hyperkalaemia, swollen, red, mottled limb, paraesthesia.

Answer 16

Compartment syndrome (with renal failure due to rhabdomyolysis)

Question 17

What are the most common causes of compartment syndrome?

Answer 17

Tibial shaft or supracondylar fractures

Question 18

How is compartment syndrome investigated and managed?

Answer 18

1. Clinical diagnosis (can measure intracompartmental pressures)
2. Prompt fasciotomy