trauma: fractures

Question 1

what factors contribute to the golden hour in early deaths

Answer 1

airways, head injury, fractures, blood loss

Question 2

describe the advanced trauma life support (ATLS) guidelines initial and primary survery

Answer 2

primary: vital signs, ABCDE
secondary: head -> toe inspection, spine

Question 3

when does primary bone healing occur, what happens and how do you manage it

Answer 3

mimimal fracture gap (<1mm) AKA hairline fractures, bone bridges gap from osteoblasts, fixed with screws and plates

Question 4

what is secondary bone healing

Answer 4

gap in fracture site which needs to be filled and scaffold for new bone, inflam response and stem cells

Question 5

describe the process of secondary bone healing (8)

Answer 5

1) fracture 2) haematoma and inflam 3) macrophages/ osteoclasts remove debris and damaged bone 4) granulation tissue and new blood vessels (fibroblasts) 5) chondroblasts form soft callus 6) osteoblasts lay bone matrix (enchondral ossification) 7) calcium mineralisation makes hard callus 8) remodelling

Question 6

how is soft callus produced and how long does it take to form

Answer 6

chondroblasts form cartilage - 2-3 weeks

Question 7

how is hard callus produced

Answer 7

calcium mineralisation to hard callus - 6-12 weeks

Question 8

why is excessive movement in fractures bad

Answer 8

can’t bridge gap

Question 9

what types of fracture are there (5)

Answer 9

transverse, oblique, spiral, comminuted, segmental

Question 10

describe a transverse fracture

Answer 10

bending force, flat fracture, one side fails on compression the other on bending

Question 11

describe an oblique fracture

Answer 11

shearing force from fall/ deceleration, can shorten and angulate

Question 12

describe a spiral fracture

Answer 12

torsional (rotational), can angulate

Question 13

describe a comminuted fracture

Answer 13

3 or more fragments, high energy, very unstable, need surgery

Question 14

describe a segmental fracture

Answer 14

2 separate fractures –> 3 pieces, very unstable

Question 15

how is an oblique fracture managed

Answer 15

screws

Question 16

how is a spiral fracture managed

Answer 16

interfragmentary screws

Question 17

how is a segmental fracture managed

Answer 17

rods and plates

Question 18

what is translation

Answer 18

movement of fragment anteriorly posteriorly medially or laterally

Question 19

how is translation measured

Answer 19

% out of place - 100% = off-ended

Question 20

what is angulation

Answer 20

distal fragment points inwards/ outwards ie varus and valgus

Question 21

what is rotation

Answer 21

malalignes and pivots around, unstable and poorly tolerated

Question 22

what are signs and symptoms of fractures

Answer 22

localised bony tenderness, swelling, deformity, crepitus, pain on movement

Question 23

what is usually first line in fracture assessment

Answer 23

x rays

Question 24

when would a tomogram be used

Answer 24

moving x-ray - usually mandibular fractures

Question 25

when would a CT be used

Answer 25

complex bones eg vertebrae and pelvis - surgical planning

Question 26

when would bone scans be used

Answer 26

stress fractures > (cant see stress fracture on X ray)

Question 27

what is the initial management of long bone fractures

Answer 27

assessment, analgesia (IV morphine), splintage/ immobilisation, investigations (x ray etc)

Question 28

what is the definitive management of long bone fractures

Answer 28

which bone, where, pattern, stability, neurovascular, soft tissue, age and morbidities

Question 29

how would you treat undisplaced fractures (or minimally angulated/ displaced)

Answer 29

stable, splintage and rehab

Question 30

how would you treat displaced or angulated fractures

Answer 30

reduction under anaesthetic, cast may be needed - unstable may need surgical stabilisation

Question 31

how would you treat unstable extra-articular diaphysial fractures

Answer 31

ORIF (plates and screws)

Question 32

how do you treat displaced intra-articular fractures

Answer 32

reduction and rigid ORIF (wires, screws and plates), may need joint replacement

Question 33

what are open fractures and what do they increase risk of

Answer 33

spike from bone/ laceration of skin, need to prevent from infection

Question 34

what is gustilo classification

Answer 34

higher energy = higher risk of contamination

Question 35

what broad spectrum AB’s would you use in open fractures

Answer 35

fluclox, gentimicin, metro

Question 36

if skin is too contaminated after debridement of open fractures what is usually done

Answer 36

skin graft nd flap coverage

Question 37

if skin is contaminate after open fracture how do you manage it

Answer 37

debride and leabe open 48 hours for infection to drain then close

Question 38

how do you manage dislocations and instability

Answer 38

reduce ASAP, closed manipulation under sedation

Question 39

who often presents with delayed presentation dislocations and how do you treat it

Answer 39

alcoholics, open manipulation

Question 40

what associated injuries can be with dislocations

Answer 40

tendon tears, nerve injury, vascular injury, compartment syndrome, fractures

Question 41

how are soft tissue (tendons/ ligament) injuries graded

Answer 41

grade 1 = sprain, grade 2 = partial tear, grade 3 = rupture

Question 42

how do you treat soft tissue injuries

Answer 42

RICE (rest, ice, compression,elevation) movement after to prevent stiffness

Question 43

which tendon tears need surgery

Answer 43

quadriceps and patellar tendon