Trauma & Orthopaedics

Question 1

What is a pathological fracture?

What are the risk factors for their development? Where do they most frequently develop?

Answer 1

• Spontaneous fracture following minor physical exertion or trauma
• Due to underlying weakness in the bone, e.g:
  
  • Osteoporosis
  • Paget disease of the bone
  • Osteomalacia
  • Osteogenesis imperfecta
  • Bone tumours (malignant or benign [e.g. cysts])
• Most frequently affect the spine (vertebral compression fractures), hip and wrist.

Question 2

What is an avulsion fracture?

Answer 2

• A fracture that occurs bonne shearing at the site of insertion of a ligament or tendon

Question 3

Common types of forearm fracture?

Answer 3

• Colles fracture
  
  • Distal radius ± distal ulna
  • Fall onto an extended wrist
• Smith fracture
  
  • Distal radius
  • Fall onto a flexed wrist
• Monteggia fracture
  
  • Proximal third of the ulna and dislocation of the radial head
• Galeazzi fracture
  
  • Distal radial shaft and dislocation of the distal radioulnar joint

Answer 4

Question 5

What is a system of classification commonly used for femoral neck fractures?

Answer 5

• The Garden classification system
• Type I - IV

Question 6

What is a fracture classification system commonly used for ankle fractures?

What is the clinical relevance?

Answer 6

• The Weber classification system
• Type A, B, C
  
  • A = usually stable
  • B = may be unstable, may require open reduction and internal fixation (ORIF)
  • C = unstable, usually require ORIF

Question 7

What structures are damaged in an ankle sprain injury?

Answer 7

• Supination injury (overinversion) → sprain of lateral ligament complex (anterior talofibular ligament [ATFL] most commonly affected)
• Pronation injury → sprain of medial ligament complex (deltoid ligament)

Question 8

How do you decide whether to x-ray after an ankle injury or to advise conservative care only?

Answer 8

• Ottawa ankle rules
  
  • Pain in the malleolar zone:
    
    • Palpate posterior edge/tip of both malleoli
  • Pain worst in the midfoot
    
    • Palpate navicular tarsal and base of 5th metatarsal
  • If palpation doesn’t precipitate pain and the patient can weight bear → no x-ray needed
• Has near 100% sensitivity

Question 9

Conservative management of ligament/tendon injury?

Answer 9

• Initial: POLICE
  
  • ​Protection e.g. cast
  • Optimal Loading i.e. graduated physiotherapy
  • Ice
  • Compression
  • Elevation
• If severe pain and/or instability may require cast boot or short leg cast for a few days

Question 10

What are “shin splints”?

Answer 10

• AKA media ltibial stress syndrome
• Epidemiology:
  
  • Commmon in runners and military personnel
• Cause:
  
  • Overuse injury causing periostitis causing increased bone resorption and degradation
• Presentation:
  
  • Diffuse pain over the middle and distal tibia and surrounding muscles