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Question 1

What are the common causes of pelvic fractures?

Answer 1

High energy injuries in the young (e.g., RTA or fall from height) and frailty fractures of older osteoporotic bone.

Question 2

What typically happens in bony ring disruption in pelvic fractures?

Answer 2

Bony ring disruption usually affects more than one site, often multiple bones or symphysis/SI joints, more likely in high-energy injuries.

Question 3

What classification system is used for pelvic ring fractures?

Answer 3

The Young-Burgess classification is used to classify pelvic ring fractures.

Question 4

What are the primary clinical features of pelvic fractures?

Answer 4

The primary clinical features include pain and the inability to bear weight.

Question 5

How are pelvic fractures investigated in high-energy injuries?

Answer 5

If the pelvis is the only site of injury, an x-ray is conducted first. In polytraumatic patients, a CT scan is the primary investigation. CT can also provide details of fractures shown by x-ray.

Question 6

What investigation methods are used for low-energy pelvic fractures?

Answer 6

Low-energy fractures are often undisplaced and might not show on x-rays. CT is more sensitive than x-ray, especially as fractures start to heal. MRI is the most sensitive and the test of choice.

Question 7

What is the initial management for high-energy mechanisms in pelvic fractures?

Answer 7

The initial management involves using a pelvic binder, which helps control circulatory loss.

Question 8

What are the conservative management options for pelvic fractures?

Answer 8

Conservative management includes analgesia and weight-bearing as tolerated.

Question 9

What are the operative methods for managing pelvic fractures?

Answer 9

Operative approaches include ORIF (Open Reduction and Internal Fixation), external fixators, and internal fixators.

Question 10

What are the typical mechanisms of injury for pelvic fractures based on age groups?

Answer 10

In the elderly, pelvic fractures typically result from a low-impact fall, while in young adults, they are caused by high-energy trauma.

Question 11

What are some associated factors with pelvic fractures in the elderly population?

Answer 11

Osteoporosis is a significant factor, with 73% of affected patients being female. Additionally, low-impact falls are the common cause, and 92% of patients are over 60 years old.

Question 12

What are the risk factors associated with pelvic fractures?

Answer 12

Risk factors include osteoporosis, smoking, alcohol use, malnutrition, neurological impairment, impaired vision, and low BMI.

Question 13

How are intracapsular fractures classified and what complications are associated with them?

Answer 13

Intracapsular fractures occur proximal to the intertrochanteric line, involve the femoral head and neck, and can be subcategorized as subcapital and transcervical fractures. These fractures may lead to femoral head AVN (avascular necrosis) and non-union. The Garden classification is used to predict union and the risk of AVN, influencing treatment decisions.

Question 14

What characterizes extracapsular fractures and their associated risks?

Answer 14

Extracapsular fractures occur distal to the intertrochanteric line and are subcategorized into basicervical, intertrochanteric, reverse oblique, and subtrochanteric fractures. They generally maintain blood supply to the head of the femur, making AVN and non-union rare.

Question 15

What clinical symptoms are associated with pelvic fractures?

Answer 15

Symptoms include hip/groin pain, possible swelling, and the inability to bear weight.

Question 16

What signs might indicate a pelvic fracture upon examination?

Answer 16

Signs include a shortened and externally rotated lower limb on the affected side, neurological and vascular status assessment of the lower limb, assessment for cognitive impairment, scrutiny for missed injuries, and evaluation for dehydration in cases where patients may have been immobile for an extended period.

Question 17

What is the mortality rate at one year for pelvic fractures?

Answer 17

The mortality rate at one year is reported to be around 30%.

Question 18

What imaging methods are commonly used for diagnosing pelvic fractures?

Answer 18

X-ray and MRI are frequently employed. X-rays can detect most fractures, particularly in the pelvis and lateral hip. Loss of contour of Shenton’s line in a pelvic x-ray can indicate a hip fracture, but fractures to the femoral neck may not always cause this loss. MRI is used when fractures are subtle or not visible on x-ray, especially in cases where clinical suspicion persists.

Question 19

How is the management typically approached for pelvic fractures?

Answer 19

Usually, management involves an operation followed by early mobilization to prevent complications from prolonged bed rest. Additionally, local nerve blocks are preferred over strong opiates for analgesia.

Question 20

What role does surgical management play in treating pelvic fractures?

Answer 20

Surgical management is often involved, aiming to stabilize the fractures and enable early mobilization.

Question 21

Besides X-ray and MRI, what other investigations might be considered for pelvic fractures?

Answer 21

Other investigations such as ECG and blood tests are sometimes conducted in the management of pelvic fractures.

Question 22

What is the approximate 30-day mortality rate for hip fractures?

Answer 22

The 30-day mortality rate for hip fractures typically ranges from 5-10%.

Question 23

What are the major risk factors associated with hip fractures?

Answer 23

Increasing age and osteoporosis are major risk factors for hip fractures. Additionally, females are more frequently affected than males.

Question 24

What is the usual timeframe for performing surgery for hip fractures?

Answer 24

Surgery for hip fractures is generally aimed to be performed within 48 hours to decrease associated morbidity and mortality.

Question 25

What specialty focuses on optimizing the medical complications of inpatients, particularly the elderly with hip fractures?

Answer 25

Orthogeriatrics is the specialty that focuses on identifying and optimizing the medical co-morbidities and complications of inpatients on orthopaedic wards, particularly in elderly patients with hip fractures.

Question 26

How are hip fractures categorized?

Answer 26

Hip fractures are categorized into intra-capsular fractures and extra-capsular fractures.

Question 27

What structures constitute the top of the femur?

Answer 27

The top of the femur consists of the head, neck, greater trochanter (lateral), lesser trochanter (medial), intertrochanteric line, and shaft (body).

Question 28

What structures does the hip joint capsule attach to?

Answer 28

The hip joint capsule attaches to the rim of the acetabulum on the pelvis and the intertrochanteric line on the femur, surrounding the neck and head of the femur.

Question 29

What is the significance of the blood supply to the femoral head in intra-capsular fractures?

Answer 29

In intra-capsular fractures, disruption of the blood supply to the femoral head can lead to avascular necrosis. Depending on the displacement of the fracture, different surgical interventions such as internal fixation for non-displaced fractures or hemiarthroplasty/total hip replacement for displaced fractures are considered to preserve or replace the femoral head.

Question 30

What does the Garden classification indicate in intra-capsular neck of femur fractures?

Answer 30

The Garden classification differentiates intra-capsular fractures based on their severity: Grade I (incomplete and non-displaced), Grade II (complete and non-displaced), Grade III (partially displaced), and Grade IV (fully displaced).

Question 31

What are the differences between hemiarthroplasty and total hip replacement for treating displaced intra-capsular fractures?

Answer 31

Hemiarthroplasty involves replacing the head of the femur while leaving the acetabulum intact, often for patients with limited mobility or significant co-morbidities. Total hip replacement replaces both the head of the femur and the socket and is generally offered to patients who can walk independently and are fit for surgery.

Question 32

How are extra-capsular fractures distinguished in terms of the femoral head's blood supply and their treatment approach?

Answer 32

Extra-capsular fractures do not disrupt the blood supply to the femoral head. As a result, the femoral head does not require replacement. Intertrochanteric fractures between the greater and lesser trochanter can be treated with a dynamic hip screw. Subtrochanteric fractures, occurring distal to the lesser trochanter, are managed using an intramedullary nail.

Question 33

What are the typical symptoms and presentation of a patient with a hip fracture?

Answer 33

The typical presentation includes an older patient (usually over 60) who has fallen, presenting with pain in the groin or hip, which may radiate to the knee. They are unable to bear weight, and their leg might appear **shortened, abducted, and externally rotated**.

Question 34

Why is it crucial to assess acute illnesses in a patient with a new hip fracture?

Answer 34

Assessing acute illnesses is vital as there is often an underlying reason for the hip fracture, such as anaemia, electrolyte imbalances, arrhythmias, heart failure, myocardial infarction, stroke, or infections (urinary or chest). Identifying these conditions early is essential to optimize the patient for surgery and minimize delays.

Question 35

What is the significance of exploring the circumstances surrounding a "mechanical fall" in a patient with a hip fracture?

Answer 35

Exploring the details of a "mechanical fall" is crucial because while it might suggest a simple cause for the fall, such as tripping over an object or being knocked over, a more comprehensive investigation may reveal an underlying and correctable medical cause such as anaemia, arrhythmias, or social contributors like dehydration, incorrect eyewear, poor footwear, or obstacles at home. Addressing these factors can significantly impact the patient's well-being and impress orthogeriatric colleagues.

Question 36

What imaging methods are typically used for diagnosing hip fractures?

Answer 36

X-rays, particularly anterior-to-posterior (AP) and lateral views, are the initial choice for diagnosis. What is Shenton's line, and why is it important in hip X-rays?

Question 37

When might MRI or CT scans be used in diagnosing hip fractures?

Answer 37

MRI or CT scans may be utilized when x-rays do not show a fracture but one is still suspected.

Question 38

What initial management steps are typically taken upon admission for a patient with a hip fracture?

Answer 38

Upon admission, patients with a hip fracture are typically provided with appropriate analgesia, undergo diagnostic investigations such as x-rays, are assessed for venous thromboembolism risk, receive prophylaxis (e.g., low molecular weight heparin), have pre-operative assessments including blood tests and an ECG to ensure fitness for surgery, and receive input from orthogeriatrics.

Question 39

According to NICE guidelines, when should surgery be performed for a patient admitted with a hip fracture?

Answer 39

As per NICE guidelines (updated 2017), surgery for a hip fracture should be performed either the same day or the day following admission, within a 48-hour timeframe.

Question 40

Why is it important for patients to weight bear immediately after the operation for a hip fracture?

Answer 40

Allowing immediate weight bearing after the operation facilitates early mobilization and rehabilitation by physiotherapists, aiding in a quicker post-operative recovery. Additionally, post-operative analgesia is crucial to encourage early mobilization.

Question 41

What type of injuries are typically associated with femoral shaft fractures?

Answer 41

Typically, femoral shaft fractures result from high-energy injuries and are common in major trauma patients, often accompanied by other injuries.

Question 42

What imaging method is primarily used for diagnosing femoral shaft fractures?

Answer 42

X-rays are the primary imaging method used for diagnosing femoral shaft fractures.

Question 43

What is the initial stabilization method used for femoral shaft fractures?

Answer 43

A Thomas splint is employed for temporary stabilization in the initial management of femoral shaft fractures.

Question 44

Is conservative management commonly utilized for femoral shaft fractures?

Answer 44

Conservative management is not typically used for femoral shaft fractures.

Question 45

What are the operative methods for managing femoral shaft fractures?

Answer 45

Operative methods for femoral shaft fractures include intramedullary (IM) nail fixation or plate fixation such as ORIF (Open Reduction Internal Fixation) or MIPPO (Minimally Invasive Plate Osteosynthesis).

Question 46

What complications can arise from femoral shaft fractures?

Answer 46

Femoral shaft fractures can lead to significant blood loss and present a risk of fat embolism.

Question 47

What are the typical causes of a patellar fracture?

Answer 47

Patellar fractures often occur due to traumatic injury, involving direct trauma or rapid contraction of the quadriceps muscle with a flexed knee.

Question 48

What symptoms are associated with a patellar fracture?

Answer 48

Symptoms include severe pain in or around the kneecap.

Question 49

What signs might indicate a patellar fracture upon examination?

Answer 49

Signs of a patellar fracture might include a palpable defect in the patella, significant haemarthrosis (bleeding into the joint), and the inability to perform a straight leg raise.

Question 50

What imaging methods are commonly used to diagnose a patellar fracture?

Answer 50

X-rays, particularly anterior-posterior (AP) and lateral views, are typically used for diagnosing a patellar fracture.

Question 51

What are the conservative management approaches for patellar fractures?

Answer 51

Conservative management includes immobilizing the knee in extension and allowing full weight-bearing.

Question 52

What are the surgical options for managing patellar fractures?

Answer 52

Surgical interventions for patellar fractures include Open Reduction Internal Fixation (ORIF) as well as partial or total patellectomy.

Question 53

What are the common causes of tibial plateau fractures in different age groups?

Answer 53

Tibial plateau fractures result from higher energy injuries in the young and low-energy injuries in older individuals with osteoporotic bone. Around 80% of these fractures affect the lateral condyle, often following a valgus force with the foot planted (referred to as a 'bumper injury').

Question 54

What is the Schatzker classification used for in tibial plateau fractures?

Answer 54

The Schatzker classification system is used to categorize tibial plateau fractures, providing a way to classify and understand the various types and severity of these fractures.

Question 55

What imaging methods are commonly used in diagnosing tibial plateau fractures?

Answer 55

Imaging methods such as X-rays (including AP and horizontal beam lateral views) are commonly employed. X-rays may present with varying appearances, from an obvious fracture line to subtle subchondral sclerosis. A horizontal beam lateral X-ray can reveal lipohaemarthrosis, which is fat floating on blood in the suprapatellar recess and is a specific sign of an intra-articular fracture. CT scans are also utilized to show the extent of condylar involvement or the depth of depression, aiding in treatment decisions.

Question 56

What are the conservative and operative management options for tibial plateau fractures?

Answer 56

Conservative management involves the use of an above-knee cast. Operative approaches encompass Open Reduction Internal Fixation (ORIF), external fixators, and, in some cases, delayed Total Knee Replacement (TKR).

Question 57

What complications are associated with tibial plateau fractures?

Answer 57

Tibial plateau fractures carry several potential complications, including damage to the common fibular nerve due to a blow to the lateral aspect of the knee ('bumper injury'), risk of neurovascular injury to popliteal structures, a higher risk of compartment syndrome, and associated soft tissue injuries to knee joint structures.

Question 58

What are loose bodies in the knee joint, and what causes them?

Answer 58

Loose bodies in the knee joint are small fragments of cartilage or bone that can freely move around in the joint fluid or synovium. They can result from trauma, osteochondritis dissecans, or joint degeneration, causing fragments of cartilage or bone to detach and create a loose body in the joint.

Question 59

How do loose bodies grow and what clinical features might they present?

Answer 59

Over time, loose bodies can grow, receiving nutrition from synovial fluid, and might cause painful locking or catching sensations. Clinically, patients may present with a history of a mobile lump or sharp, occasional pain, often with symptoms of locking or catching, suggesting the presence of a loose body. However, they typically do not cause constant, generalized, or severe pain.

Question 60

How are loose bodies commonly misdiagnosed on an X-ray, and what other diagnostic tools can confirm their presence?

Answer 60

Loose bodies are often overdiagnosed due to opacifications identified on X-rays. A fabella, which is an accessory ossicle in the lateral head of the gastrocnemius, is commonly misdiagnosed as a loose body. To confirm the presence of a loose body, MRI or serial X-rays can be utilized.

Question 61

What is the recommended management for troublesome symptoms caused by loose bodies in the knee joint?

Answer 61

Arthroscopic removal is a recommended intervention to address troublesome symptoms caused by loose bodies. However, it's important to note that while this procedure can alleviate specific symptoms related to loose bodies, it won't help with degenerative joint pain.

Question 62

What are the causes of tibial shaft fractures based on the energy involved in the injury?

Answer 62

Tibial shaft fractures can occur due to low-energy injuries, often resulting from indirect torsional forces, or high-energy injuries caused by direct force.

Question 63

What are the potential fracture configurations and associated risks in tibial shaft fractures?

Answer 63

Tibial shaft fractures can manifest in multiple configurations such as spiral, transverse, oblique, or comminuted. Open fractures are more common in these injuries, and there is a higher risk of developing compartment syndrome.

Question 64

What are the common clinical features associated with tibial shaft fractures?

Answer 64

Clinical features typically include pain, inability to bear weight, and the presence of a deformity.

Question 65

What imaging methods are commonly used to diagnose tibial shaft fractures?

Answer 65

X-rays, particularly anterior-posterior (AP) and lateral views, are commonly utilized for diagnosing tibial shaft fractures.

Question 66

What are the conservative and operative management approaches for tibial shaft fractures?

Answer 66

Conservative management may involve the use of an above-knee cast. In some cases, a closed reduction in the theatre may be necessary before fitting the cast. Operative approaches include intramedullary (IM) nailing or Open Reduction Internal Fixation (ORIF).

Question 67

What is the typical cause of ankle fractures?

Answer 67

Ankle fractures commonly result from an inversion injury, involving a rotational force applied to the foot.

Question 68

What structures are commonly affected in ankle fractures, and what distinguishes solitary malleolar fractures from trimalleolar fractures?

Answer 68

Ankle fractures frequently involve multiple areas, affecting the lateral malleolus, medial malleolus, and posterior malleolus (posteroinferior tibia). Solitary malleolar fractures are often small avulsion fractures or undisplaced, while trimalleolar fractures have a particular tendency to instability.

Question 69

What assessment tools and classifications are used in evaluating ankle fractures?

Answer 69

The Weber Classification (A, B, C) is commonly used to classify ankle fractures. Evaluation involves assessing the stability of the fracture and looking for talar shift.

Question 70

What imaging methods are employed in diagnosing ankle fractures, and what are the key indicators to observe in X-rays and CT scans?

Answer 70

X-rays, particularly anterior-posterior (AP) and lateral views, are commonly utilized for ankle fracture diagnosis. In X-rays, it's important to check for soft tissue swelling, bony alignment, and non-uniform ankle joint space indicating instability. CT scans can help clarify fracture anatomy, especially in complex ankle fractures like Pilon fractures, which occur at the bottom of the tibia, involving the ankle joint. Pilon fractures often lead to significant soft tissue problems and may necessitate USS and MRI for defining soft tissue injury.

Question 71

What are the conservative and operative management strategies for ankle fractures?

Answer 71

Conservative management may involve the use of a cast or moonboot, while operative approaches may entail Open Reduction Internal Fixation (ORIF), with the specific strategy determined by the Weber classification.

Question 72

What are the common causes of calcaneus fractures?

Answer 72

Calcaneus fractures typically occur due to axial compression, such as falling from a height and landing onto the heel. These injuries often result in intra-articular fractures.

Question 73

What are the typical clinical features associated with calcaneus fractures?

Answer 73

Clinical manifestations of calcaneus fractures include pain, an inability to bear weight, and significant swelling. Additionally, it's essential to assess for other injuries, particularly spinal injuries.

Question 74

What imaging techniques are used to diagnose calcaneus fractures, and what specific indicators are observed in X-rays and CT scans?

Answer 74

X-rays are employed to assess calcaneal compression, indicated by the loss of the central peak seen in a normal calcaneus (measured by Bohler's angle), along with increased bone density. CT scans are often used to clarify the anatomy, particularly in comminuted fractures.

Question 75

What are the typical approaches to managing calcaneus fractures?

Answer 75

Treatment for calcaneus fractures often involves cast immobilization with non-weightbearing for 6-12 weeks. Surgical intervention is controversial due to the high risk of infection or wound breakdown, with uncertain proven benefits.

Question 76

What complications are associated with calcaneus fractures?

Answer 76

There is a risk of developing compartment syndrome following calcaneus fractures, which necessitates close monitoring and early intervention if detected.

Question 77

What defines a Lisfranc injury in terms of the affected anatomical structures?

Answer 77

A Lisfranc injury involves a traumatic disruption between the articulation of the medial cuneiform and the base of the second metatarsal.

Question 78

What is the primary cause or aetiology commonly associated with Lisfranc injuries?

Answer 78

High-energy trauma is often the primary cause, frequently accompanied by other injuries.

Question 79

What are the typical clinical features associated with Lisfranc injury?

Answer 79

The common clinical features include severe midfoot pain and the inability to bear weight.

Question 80

What specific features are examined in X-rays for diagnosing Lisfranc injuries?

Answer 80

X-rays, particularly the AP and oblique views, are used for diagnosing Lisfranc injuries.

Question 81

Why is alignment assessment critical in X-rays when diagnosing Lisfranc fractures?

Answer 81

Alignment assessment is crucial in X-rays to evaluate the congruity of the affected TMT (tarsometatarsal) joints.

Question 82

Which imaging technique is considered optimal for visualizing multiple ligamentous avulsion fractures in Lisfranc injuries?

Answer 82

CT scans are preferred for visualizing Lisfranc fractures, showing multiple ligamentous avulsion fractures.

Question 83

What is the standard management approach for Lisfranc injuries?

Answer 83

Lisfranc injuries typically necessitate fixation through Open Reduction Internal Fixation (ORIF).

Question 84

What potential complications are linked to Lisfranc injuries?

Answer 84

Lisfranc injuries can lead to potential long-term complications, such as causing disability and osteoarthritis (OA).

Question 85

What defines a stress fracture in terms of bone injury?

Answer 85

A stress fracture is a bone break caused by repetitive stress or injury.

Question 86

Who are the most susceptible groups prone to metatarsal stress fractures?

Answer 86

Runners, soldiers on prolonged marches, dancers, and individuals unaccustomed to extended walks are most susceptible to metatarsal stress fractures.

Question 87

Which metatarsal bone is frequently affected by stress fractures?

Answer 87

The 2nd metatarsal is the most commonly affected bone, followed by the 3rd metatarsal.

Question 88

What are the common clinical features linked to metatarsal stress fractures?

Answer 88

Typical clinical features of metatarsal stress fractures include pain and the inability to bear weight.

Question 89

Why might X-rays be inconclusive initially in diagnosing metatarsal stress fractures, and what alternative diagnostic method is suggested?

Answer 89

X-rays may not immediately depict the fracture, as it might take around three weeks until signs appear due to resorption or callus formation. A bone scan can be useful to confirm the diagnosis.

Question 90

How is the standard management approach for metatarsal stress fractures typically carried out?

Answer 90

The standard management for metatarsal stress fractures involves prolonged rest, typically 6-12 weeks, utilizing a rigid soled boot to allow healing and alleviate symptoms.

Question 91

What are the common mechanisms leading to a talus fracture?

Answer 91

Talus fractures typically result from forced dorsiflexion or rapid deceleration.

Question 92

Why is avascular necrosis (AVN) a concern in talus fractures?

Answer 92

The talus bone has a reversed blood supply, making it particularly susceptible to avascular necrosis (AVN) following injury.

Question 93

What is a potential long-term risk associated with talus fractures?

Answer 93

Talus fractures have an increased risk of developing osteoarthritis (OA) over time.

Question 94

How does the talus injury typically relate to the fibia and fibula?

Answer 94

The fibia and fibula form an elongated ring with the talus, and bony ring injuries often involve disruption at more than one site.

Question 95

What leads to a talar dome margin fracture?

Answer 95

Talar dome margin fractures are commonly caused by excessive inversion or eversion movements.

Question 96

What typically causes a 5th metatarsal fracture?

Answer 96

An inversion injury commonly leads to a 5th metatarsal fracture.

Question 97

What are the different types of fractures related to the 5th metatarsal, and how do they differ in healing and potential complications?

Answer 97

Avulsion by peroneus brevis tendon generally heals predictably with a moon boot, whereas a Jones fracture, due to a poor blood supply, has a 25% risk of non-union. Proximal shaft fractures are a common site for stress fractures.

Question 98

What clinical signs indicate a 5th metatarsal fracture?

Answer 98

Pain over the lateral border of the forefoot, particularly evident during weight-bearing.

Question 99

How can an X-ray assist in diagnosing a 5th metatarsal fracture?

Answer 99

Clinically resembling a lateral malleolar fracture, it's crucial to check the lateral x-ray to identify 5th metatarsal base fractures, which appear transverse and should not be confused with the normal longitudinal adolescent ossification center.

Question 100

How is the management approach determined for a 5th metatarsal fracture?

Answer 100

Treatment options may involve protected weight bearing, immobilization, or surgery, depending on the fracture's location, degree of displacement, and the patient's athletic level.