Trauma fractures

Question 1

4 common sights for internal blood loss?

Answer 1

abdomen
chest
pelvis
long bones

Question 2

what is the biggest risk in open fractures

Answer 2

bone infection leading to osteomyelitis

Question 3

1st thing to do to an open fracture is?

Answer 3

photographed then irrigated

Question 4

what should an open fracture be dressed with?

Answer 4

saline soaked swabs

Question 5

what prophylaxis should be given to an open fracture?

Answer 5

Abx + tetanus

Question 6

what is performed in theatre on an open fracture wound?

Answer 6

aggressive debridement

Question 7

how is an open fracture stabilised?

Answer 7

external/internal fixation

Question 8

what is a fracture defined as?

Answer 8

loss of continuity of the cortex of the bone

Question 9

simple fracture is

Answer 9

bone fractured in 2 pieces

Question 10

segmental fracture is

Answer 10

a fracture at 2 levels in the same bone

Question 11

undisplaced fracture is

Answer 11

fractured bone with its anatomy entirely unchanged

Question 12

comminuted fracture is

Answer 12

bone in 3 or more pieces

Question 13

name 5 causes of pathological fractures

Answer 13

• multiple myeloma
• bone tumours
• metabolic bone diease
• infection
• RA

Question 14

when should you CT a fracture?

Answer 14

• complex fractures

- planning surgery

Question 15

what is compartment syndrome?

Answer 15

excessive pressure in a closed fascial muscle compartment

Question 16

what are the early clinical signs of compartment syndrome?

Answer 16

patient complains of excessive pain that is not responding to analgesia, and severe pain on passive stretch of the muscles involved

Question 17

what happens to the muscles in compartment syndrome?

Answer 17

necrosis

Question 18

how to manage compartment syndrome (3)?

Answer 18

• Release any dressings/casts which may be causing external compression
• position the limb level to the heart
• Contact a senior doctor for an emergency fasciotomy

Question 19

what is the post operative management following emergency fasciotomy to manage compartment syndrome?

Answer 19

physiotherapy + occupational therapist review

wound requires re dressing

monitoring in the community by the local district nursing team

Question 20

what are the late clinical signs of compartment syndrome?

Answer 20

paraesthesia

pulselessness

Question 21

name 2 complications of fractures?

Answer 21

• Delayed union

- Compartment syndrome

Question 22

what is delayed union defined by?

Answer 22

failure to reach bony union at 6 months post injury

Question 23

what is compartment syndrome?

Answer 23

when the pressure within the fascial compartment exceeds the perfusion pressure within the compartment causing ischaemia of the tissues within the compartment

Question 24

3 features of a fracture/injury that should make you consider compartment syndrome

Answer 24

• does not respond to analgesia
• associated with skin mottling
• severe pain on passive stretch

Question 25

late presentation of compartment syndrome (2)

Answer 25

• pulseless

- paraesthesia

Question 26

management of compartment syndrome

Answer 26

• emergency fasciotomy

Question 27

what is osteomyelitis

Answer 27

infection of bone

Question 28

what pathogen may cause osteomyelitis in Potts disease/

Answer 28

Mycobacterium tuberculosis

Question 29

causative organism of osteomyelitis seen in patients with sickle sell anaemia

Answer 29

salmonella spp

Question 30

how is osteomyelitis normally diagnosed

Answer 30

MRi imaging

Question 31

mainstay of management of osteomyelitis

Answer 31

antibiotics +/- surgical debridement