T&O

Question 1

What are the stages of bone healing?

Answer 1

Haematoma formation
Soft (fibrocartilaginous) callus formation
Hard (bony) callus formation
Bone remodelling

Question 2

What are some risk factors for fractures?

Answer 2

Older age 
Post menopausal 
Smoking 
Prolonged steroid use 
Vit D deficiency

Question 3

What are some early complications of fractures?

Answer 3

Damage to surrounding structures
Compartment syndrome
Fat embolism

Question 4

What are some late complications of fractures?

Answer 4

Non-union, malunion
Contractures
Osteomyelitis 
Avascular necrosis 
Arthritis

Question 5

How does a scaphoid fracture occur?

Answer 5

FOOSH

Question 6

How are scaphoid fractures managed?

Answer 6

Undisplaced fracture of distal pole/waist => immobilisation with a cast
Proximal pole fractures may require surgery

Question 7

What are some complications of a scaphoid fracture?

Answer 7

Avascular necrosis
Non-union
Osteoarthritis

Question 8

How can avascular necrosis occur in a scaphoid fracture?

Answer 8

Blood supply to scaphoid is retrograde

Proximal pole fractures can disrupt the blood supply => avascular necrosis

Question 9

What is a Colles’ fracture?

Answer 9

Extra-articular fractures the radius, with dorsal displacement of the distal segment
Can include a fracture of the ulnar styloid process

Question 10

How should a Colles’ fracture be managed?

Answer 10

Closed reduction, back slab and repeat x-ray
May require surgery (ORIF, external fixation)
Should be immobilised for 6 wks

Question 11

What are some complications of Colles’ fractures?

Answer 11

Median/ulnar nerve damage - can cause acute carpal tunnel syndrome
Malunion => reduced range of motion of wrist

Question 12

How does someone with a fractured NOF present?

Answer 12

Pain in outer, upper thigh/groin, can radiate to knee
Inability to weight bear
Affected leg can be shortened and externally rotated

Question 13

What investigations should be done for a NOF fracture?

Answer 13

AP and lateral hip x-ray 
FBC - anaemia 
Cross match - will probs require surgery 
Renal function - AKI, rhabdomyolysis 
ECG, CXR, urine dip

Question 14

How is a displaced intracapsular NOF fracture managed?

Answer 14

Hemiarthroplasty

THR if previously mobile, not cognitively impaired, medically fit for anaesthesia

Question 15

How is a non-displaced intracapsular NOF fracture managed?

Answer 15

Cannulated hip screws

Question 16

How is an extracapsular NOF fracture managed?

Answer 16

Intratrochanteric - dynamic hip screw

Subtrochanteric - intramedullary femoral nail

Question 17

What are some complications of NOF fractures?

Answer 17

Avascular necrosis
High mortality rate
Neurovascular damage
infection

Question 18

How can a NOF fracture result in avascular necrosis?

Answer 18

Blood supply to femoral head is retrograde from the medial circumflex artery
In an intracapsular fracture this can become disrupted

Question 19

What is the Weber classification of ankle fractures?

Answer 19

Medial malleolus fractures
A - below level of syndesmosis
B - at the level of the syndesmosis
C - above the syndesmosis

More proximal => more unstable therefore will probs need surgery

Question 20

How can an ankle fracture present?

Answer 20

Ankle pain after direct blow/twisting injury
Dislocation
Neurovascular compromise

Question 21

How is an ankle fracture investigated?

Answer 21

AP and lateral x-ray views

Look for talar shift - deltoid ligament damage

Question 22

What is the initial management of an ankle fracture?

Answer 22

Analgesia
Reduce under sedation, back slab
Repeat neuromuscular exam
Repeat x-ray

Question 23

When is conservative management required in an ankle fracture?

Answer 23

Non-displaced medial malleolar fracture

Weber A/B with no talar shift

Question 24

When is surgery required for ankle fractures?

Answer 24

Displaced bimalleolar/trimalleolar fracture
Weber C
Weber B with talar shift
Open fractures

Question 25

What is an open fracture?

Answer 25

Direct communication between a fracture site and external environment
Can result from bone penetrating skin, or something else penetrating the skin from above

Question 26

What are common sites for open fractures?

Answer 26

Tibial, phalangeal, forearm, ankle, metacarpal

Question 27

How can open fractures be classified?

Answer 27

Gustilo-Anderson classification
1 - <1cm, clean
2 - 1-10 cm, clean
3 - >10cm, adequate soft tissue coverage
4 - >10cm, inadequate soft tissue coverage
5 - vascular injury

Question 28

What is the initial management of an open fracture?

Answer 28

Realignment and splinting of the fracture
Reassess neurovascualr supply
Broad spectrum antibiotic, tetanus vaccination
Dress with saline soaked gauze

Question 29

What is the definitive management of an open fracture?

Answer 29

Urgent debridement - immediately if contamination from sewage, marine or agricultural debris
Ensure there is adequate soft tissue coverage
Reconstruction and external fixation

Question 30

What are some complications of open fractures?

Answer 30

Damage to overlying skin
Damaged soft tissue
Neurovascular injury
Infection - reduced vascularity, systemic compromise, need to metalwork for stabilisation

Question 31

What are some red flag signs for caudal equina?

Answer 31

Saddle paraesthesia 
Painless retention of urine
Recent onset faecal incontinence 
Loss of anal tone 
Bilateral sciatica

Question 32

What are the stages of disc herniation?

Answer 32

Degeneration
Prolapse
Extrusion
Sequestration

Question 33

What are common levels of disc herniation?

Answer 33

L4/5 - affects L5, lateral leg and sole of foot, big toe extension
L5/S1 - affects S1, lateral foot, plantarflexion