Week 5 - D - General Trauma (2) - Describing a fracture and the clinical signs

Question 1

What are the five basic fracture patterns?

Answer 1

* Transverse

* Oblique,

* Spiral,

* Comminuted

* Segemental

Question 2

When do transverse fractures occur?

Answer 2

They occur during a bending force when the cortex on one side fails in compression and the the cortex on the other side in tension

Question 3

When do oblique fractures occur?

Answer 3

They occur due to shearing forces eg falling from height or deceleration

Question 4

How are oblique fractures fixed?

Answer 4

They have the benefit of being fixed with an interfragmentary screw

Question 5

Which between oblique and transverse fractures tend to shorten(overall bone length and angulate)

Answer 5

Oblique fractures tend to shorten and may also angulate.

Transverse fractures can angluate but usually not shorten

Question 6

When can transverse fractures shorten?

Answer 6

Transverse fractures can shorten if they are completely displaced

Question 7

Which fractures are most unstable due to rotational (torsional) forces?

Answer 7

Spiral fractures

Question 8

What can potentially be used to fix both spiral fractures and oblique fractures?

Answer 8

Interfragmentary screws

Spiral fractures occur due to torsional forces

Question 9

How many fragments must a comminuted fracture have?

Answer 9

Comminuted fractures are fractures with 3 or more fragments.

Question 10

What are the two main causes of comminuted fractures?

Answer 10

They are a reflection of higher energy injury or poor bone quality

Question 11

There may be substantial soft tissue swelling and periosteal damage with reduced blood supply to the fracture site which may impair healing in comminuted fractures Comminuted fractures are very unstable and how do they tend to be stabilised?

Answer 11

Tend to be surgically stabilised

Question 12

A segmental fracture occurs when the bone is fractured in two separate places How are they treated?

Answer 12

Segmental fractures tend to require stabilisation with long rods or plates

Question 13

Questions for which fracture

* Occurs due to a shearing force? (describe a shearing force)

* Occurs due to torsional force?

* Occurs due to a bending force?

* Fractured in two places?

* Fracture is 3 segements?

Answer 13

• Shearing force - this is an oblique fracture due to eg fall from a height or decelerating
• Torsional force - spiral fracture
• Bending force - would be transverse
• Fractured in two places - segemental fracture
• Fracture is in 3 segements - comminuted fracture

Question 14

How are spiral and oblique fractures treated?

Answer 14

Uusally with interfagmentary screws

Question 15

A decision regarding the optimum management of a fracture depends on the site of the fracture, whether its position is satisfactory or not and its stability (likelihood of displacing) which is related to the fracture pattern and the degree of initial displacement. What are the three separate parts of the bone? - can use to desribe the type of bone involved in the fracture

Answer 15

Have the epiphysis, metaphysis and diaphysis

Question 16

What type of bone is in the diaphysis and epiphysis?

Answer 16

Diaphysis - compact cortical bone

Epiphysis - trabecular/cancellous bone

Question 17

Which of the five types of fractures are very unstable?

Answer 17

Spiral, comminuted and segemental fractures

Question 18

A fracture of a long bone can be described according to the site of the bone involved How would this be described?

Answer 18

Proximal, middle or distal 1/3rd of the bone

Question 19

A fracture at the end of a long bone (metaphyseal / epiphyseal) can be intra‐articular (extending into the joint) or extra‐articular. Which have a greater risk of stiffness, pain and post‐traumatic osteoarthritis?

Answer 19

This would be intra-articular bone fractures

Question 20

The position of a fracture depends on the degree of displacement and angulation What does the displacement of a fracture mean?

Answer 20

This refers to the direction of translation of the fracture and is described using anatomic terms eg anterior, posterior, medial and lateral

Question 21

In the forearm and hand, anterior and posterior displacement are typically substituted by volar (or palmar) and dorsal How are medial and lateral displacement changed?

Answer 21

They are described by ulnar or radial displacement

Question 22

So what is dispalcement and how is it described in the forearm/hand?

Answer 22

Displacement is the direction of translation of the distal fragment of bone and can be described using the terms, anterior, posterior, medial and lateral

In the forearm and hand,

anterior = volar (or palmar),

posterior = dorsal,

medial = ulnar, l

ateral = radial translation

Question 23

Displacement can be estimated with reference to the width of the bone (eg 25%, 50%, 75% displacement) What is 100% displacement often referred to as?

Answer 23

Off ended fracture - a long bone fracture that is displaced by more than the width of the bone.

Question 24

Angulation desribes the direction in which the distal fragment points towards and the degree of this deformity. Event though it is typically described as anterior, posterior, medial and lateral How is it described usually in the lower and upper limb?

Answer 24

Upper limb - described as volar, dorsal, ulnar and radial

Lower limb - varus (distal fragment pointing towards the midline) , valgus (distal fragment pointing away from midline)

Question 25

Angulation can be measured in degrees from the longitudinal axis of the diaphysis of a long bone. Describe this fracture? (in terms of angulation)

Answer 25

The distal portion of the bone has varus angulation (towards the mdiline)

Question 26

Define displacement and angulation of the bone?

Answer 26

Displacement - the direction of translation of the distal fragment of the bone

Angulation - direction in which the distal fragment points towards and the degree of this deformity.

Question 27

Describe these fractures

Answer 27

• 1. Distal fragment of femur is medially displaced
• 2. Distal fragment of femur is laterally displaced
• 3. Valgus angulation of fracture of the femeur (distal fragment is away from the midline)
• 4. Varus angulation of fracture of femur (distal fragment is towards the midline)

Question 28

Describe the tibia fracture - location, displacement and angulation

Answer 28

Oblique mid-diphyseal tibial fracture - 30% lateral displacement - minimal angulation

Question 29

The displacement and angulation of a fracture gives information of the direction of forces involved in the injury and gives information about the reversed direction of forces required to reduce a fracture. What are clinical signs of a fracture?

Answer 29

Localised bony (marked ) tenderness

Swelling

Deformity

Creptius due to bone ends grafting with an unstable fracture

Question 30

If a patient presents and cannot weight bear on injured lower limb, what investigation is carried out?

Answer 30

Carry out an Xray