specific fractures

Question 1

5 main hip # classification based on treatment

Answer 1

-intracapsular undisplaced= cannulated hip screw
-intracapsular displaced young=cannulated hip screw
-intracapsular displaced old>80=hemiarthroplasty
-intracapsular displaced old<80=THR depending
-extracapsular intertrochanteric=dynamic hip screw
=subtrochanteric=intra-medullary nailing

Question 2

arteries of the femoral head

Answer 2

• medial circumflex
• lateral circumflex
• ascending transverse arc
• retinacular arteries
• artery of ligamentum teres

Question 3

fractures most associated to osteoporosis and elderly

Answer 3

femoral head
humeral head
vertebrae
colles wrist

Question 4

what are neck of femur fractures at risk of and why

Answer 4

-AVN

due to blood supply all comes from below except small amount ligamentum teres

Question 5

cause of subtrochanteric fractures

Answer 5

pathological or high energy trauma

Question 6

assessment of nof fracture

Answer 6

• inability to weight bear
• shortened and externally rotated leg
• co-morbidities
• pain

Question 7

x-rays for hip fracture

Answer 7

AP pelvis and lateral

Question 8

femoral shaft fracture cause, management and risk

Answer 8

• high energy trauma
• IM nailing or
• risk of fat embolism and ARDS

Question 9

splint used for femoral fractures

Answer 9

thomas splint

Question 10

wrist fractures classification based on treatment

Answer 10

• posterior dorsal angualted=MUA and cast

- anterior volar angulated will slip in cast so use ORIF

Question 11

what is a colles fracture

Answer 11

FOOSH
dorsal angulated
displaced
distal radius
-shortened and bayonetting can be
low energy in elderly

Question 12

complications of wrist fractures

Answer 12

• median nerve compression
• mal union
• carpal tunnel syndrome
• can get impingement of ulna

Question 13

management dru # in children

Answer 13

closed reduction in plaster or internal fixation with percutaneous k wires

Question 14

surgery for wrist fracture

Answer 14

-plates and screws
distal radius locking plates
can be done under brachial plexus block

Question 15

what is a smith fracture and treatment

Answer 15

volar displaced ankle fracture

volar buttress plate

Question 16

weber classification

Answer 16

-A distal to syndesmosis
B=at level of syndesmosis
C=proximal to syndesmosis
fracture of fibula

Question 17

which weber has greater risk of talar shift and instability and needs orif

Answer 17

weber c

sometimes B

Question 18

what other factor in ankle fracture determines treatment

Answer 18

bi or uni-malleolus
uni can do conservative probably
-bi usually weber c so orif and risk of talar shift

Question 19

what is a proximal humerus # associated too

Answer 19

• ostop

- elderly women FOOSH

Question 20

management of proximal humerus #

Answer 20

-non-op in elderly
use a sling
-orif sometimes in young depending if comminuted

Question 21

complications of proximal humerus #

Answer 21

• NV
• stiffness
• non union
• 2ndary arthritis
• AVN

Question 22

humeral # shaft mangement

Answer 22

• heals well due to blood supply

- immobilise in U slab or functional brace 8-12 weeks

Question 23

nerve commonly trapped at elbow

Answer 23

ulna

Question 24

distal humerus # 4 types

Answer 24

unicondylar
bicondylar
supracondylar
intercondylar

Question 25

most common distal humerus #

Answer 25

intercondylar as fall drives coronoid into trochlea so split condyles apart

Question 26

complications of distal humerus #

Answer 26

ulna nerve - heterotopic ossification - arthritis - stiffness

Question 27

most common distal humerus # in children

Answer 27

supracondylar due to FOOSH as force transmits up forearm to metaphysis

Question 28

forearm fractures are common in

Answer 28

children

Question 29

treatment for forearm fracture

Answer 29

plate or cast in children

Question 30

complication of forearm fracture

Answer 30

- mal union - damage to all 3 nerves - cross union between forearm bones - compartment syndrome

Question 31

what is a galeazzi #

Answer 31

radius shaft # with dislocation of DRUJ

Question 32

what is a monteggia #

Answer 32

displaced ulna # assoc. to radial head dislocation

Question 33

what is the most commonly # carpal bone

Answer 33

scaphoid bone

Question 34

what causes a scaphoid # and who most commonly

Answer 34

violent hyperextension of the wrist-fall | seen most commonly in young males

Question 35

why is the scaphoid at risk of AVN

Answer 35

blood arises from distal end so gets disrupted

Question 36

most common part of the scaphoid to fracture

Answer 36

80% in mid part

Question 37

symptoms of a scaphoid fracture

Answer 37

- pain in anatomical snuff box - weakness of pinch grip - pain axial compression of the thumb

Question 38

x-ray views of the scaphoid

Answer 38

AP lateral and oblique x2 as easy to miss

Question 39

management of a scaphoid#

Answer 39

- cast if absent clinical signs and inx and repeat view in 2 weeks - cast for 6-8 weeks if minimmaly displaced or undis - for displacement >1mm then ORIF

Question 40

pelvic ring fracture complications

Answer 40

retroperitoneal and abdo haemorrhage risk

Question 41

management of pelvic ring #

Answer 41

-ATLS resuscitation AP for radiograph pelvic cast

Question 42

what is the most common cause for compartment syndrome

Answer 42

tibia shaft #

Question 43

what are tibia plateau # associated too

Answer 43

meniscal tears collateral/ cruciate rupture NV and compartment syndrome

Question 44

management of tibia shaft #

Answer 44

- cast if closed | - if open need debridement and IM nailing or ex fix

Question 45

name for distal tibia # from a heigh

Answer 45

pilon #

Question 46

3 areas on a 5th metatarsal # | prox to distal

Answer 46

- avulsion # - Jones #either stress or acute break - proximal diaphyseal #

Question 47

management of Jones #

Answer 47

risk of watershed injury due to blood supply so may need ORIF

Question 48

OTTAWA rules for deciding whether to x-ray an ankle

Answer 48

 If ankle pain is present and there is tenderness over the posterior lateral malleolus 6cm  If midfoot pain is present and there is tenderness over the navicular or the base of the 5th metatarsal then x-ray foot  If there is ankle or midfoot pain and the patient is unable to take 4 steps