specific fracture management

Question 1

assessing a fracture- 5 signs to look out for

Answer 1

-pain
-swelling
-crepitus
-deformity
-collateral damage- nerve/vessel

Question 2

order to describe fracture radiograph

Answer 2

demographic
Adequacy
Bone-young/old
Cartilage-joint space

which bone and location

type of fracture
-Pattern: transverse/oblique/spiral
-Displacement: undisplaced/Translated/angulated?
-X/Y/Z plane

Question 3

orthopaedic management/trauma - 4Rs

Answer 3

ortho-
look
feel
move
x-ray

trauma
resuscitate
reduce
restrict
rehabilitate

Question 4

4 types of displacement

Answer 4

translation (medial/lateral)
angulation (valgus/varus)
rotation (internal/external)
impaction

Question 5

3 points of direct fracture healing

Answer 5

anatomical reduction
absolute stability
no callus

Question 6

3 points of indirect fracture healing

Answer 6

-sufficient reduction
-micromovement
-callus

Question 7

what is Wolff’s Law:

Answer 7

bone grows and remodels in response to force placed on it

Question 8

process of indirect fracture healing

Answer 8

[Inflammation, repair, remodel ]

inflammation-form haematoma +release cytokines

repair-soft callus formation (t2 collagen-cartilage) convert to hard callus (t1 collagen-bone)

remodelling-callus respond to external forces

Question 9

fracture complications general vs specific

Answer 9

general - FID
fat embolus
infection
DVT

Specific
neurovascular injury
muscle/tendon injury

Question 10

what affects fracture healing in the biological environemnt - 4 points

Answer 10

BIIN

-blood supply
-immune function
-infection
-nutrition

Question 11

risk of intracapsular fracture in NoF

Answer 11

blood supply more likely to be compromised- AVN/Non-union

Question 12

management of extracapsular NoF fracture

Answer 12

fix-
internal fixation-plates/screws/nails

Question 13

management of NoF fracture- intracapsular displaced less than 55y/o

Answer 13

reduce and fixation with screws

Question 14

management of NoF fracture -intracapsular, displaced, 65 y.o+

Answer 14

replace-
fit and mobile=THR
less fit=hemiarthroplasty

Question 15

management of NoF fracture, intracapsular undisplaced

Answer 15

fixation with screws

Question 16

shoulder dislocation management
2 different methods and relaxation med name

Answer 16

traction-counter traction +/- gentle internal rotation

stimson method if alone

relaxation med- benzodiazepine

Question 17

what is hill-sachs defect and bankart leison

Answer 17

hill-sachs defect=humorous head breaks a piece of bone

bankart leison=separated piece of glenoid

Question 18

what risks recurrent shoulder disocation

Answer 18

Hill-sachs defect and bankart leison

Question 19

distal radius fracture management- 3 types

Answer 19

cast/splint
MUA + k-wire
ORIF

Question 20

when are these used and what they are
cast/splint
MUA + k-wire
ORIF

Answer 20

cast/splint
-temporary or
-minimally displaced extra-articular fracture

MUA + k-wire
-unstable extra-articular fracture
-esp children

ORIF
-displaced unstable fracture unsuitable for K-wires
-intra-articular involvement

Question 21

tibial plateau fracture causes

Answer 21

-extreme varus/valgus force
-extreme axial loading of knee

Question 22

tibial plateau fracture management: when to use non-operative

Answer 22

undisplaced fractures with congruent joint line on CT/MRI

Question 23

tibial plateau fracture management: operative

Answer 23

-restore articular surface with plate+screws
-bone graft to prevent further depression

Question 24

ankle fracture management- operative vs non-operative. Treatment and which weber class for each

Answer 24

non-operative
-weber A/ stable weber B
-non-weighbearing below knee cast for 6-8 weeks. Transfer into walking boot then physio

operative
-unstable weber B/weber C
-soft tissue dependent- strict elevation due to swelling
-ORIF +/- Syndesmosis repair with screw

Question 25

weber classification

Answer 25

a- below syndesmosis fracture (lateral malleolus)- stable

b-fibula fracture at level of syndesmosis. variable stability

c- fibular fracture above syndesmosis level- unstable

Question 26

what is Barton’s fracture

Answer 26

intra-articular fracture (wrist)