Fractures

Question 1

Define fractures.

Answer 1

Disruption in the integrity and continuity of bone associated with soft tissue injury.

Question 2

Explain the aetiology of fractures.

Answer 2

Trauma: Force applied to bone exceeds its strength. Direct force (penetrative, crushing) or indirect (tension, compression or rotation injuries).

Greenstick: Incomplete fracture with angulation on the opposite side due to stronger fibrous periosteum in children.

Pathological: Minor force causes fracture secondary to underlying bone weakness (malignancy, congenital).

Question 3

What are the risk factors for fractures?

Answer 3

Contact sports

Trampoline use

RTA

Osteogenesis imperfecta

Non-accidental injury

Question 4

What is the Salter-Harris classification for fractures?

Answer 4

Epiphyseal injuries: involve growth plate, types I–V depending on involvement of the physis, metaphysis and epiphysis.

Question 5

What is Salter-Harris Type 1?

Answer 5

Through the growth plate

(Straight through)

Question 6

What is Salter-Harris Type 2?

Answer 6

Through growth plate and metaphysis,

(Above)

Question 7

What is Salter-Harris Type 3?

Answer 7

Through growth plate and epiphysis.

(Lower)

Question 8

What is Salter-Harris Type 4?

Answer 8

Through all three elements (metaphysis, growth plate, epiphysis)

(Through Everything)

Question 9

What is Salter-Harris Type 5?

Answer 9

Crush injury of growth plate.

(cRush)

Question 10

Summarise the epidemiology of fractures.

Answer 10

Very common. Males more than females.

Question 11

What are the symptoms for fractures?

Answer 11

Usually a history of trauma.

Need to assess if there is a history of non-accidental injury:
Time elapsed, force, possibility of glass contamination, associated head injury, medications and previous fractures.

Question 12

What are the signs for closed fractures?

Answer 12

Pallor and swelling over fracture site, obvious deformity.

Question 13

What are the signs for open fractures?

Answer 13

Bleeding and bruising over fracture, associated soft tissue injury.

Question 14

What are some tests for fractures?

Answer 14

Neurovascular status: Assess for distal numbness, tingling, paralysis or loss of pulse.

Musculoskeletal examination: Examine joint above and below for crepitus, effusion and pain.

Tuning fork test: Exacerbates pain over small stress fractures.

Question 15

What are some approriate investigations for fractures?

Answer 15

X-ray (usually in two views frontal and lateral)

Repeat x-ray.

MRI and Bone scan

Genetics for bleeding disorders and osteogenesis imperfecta.

Question 16

What is the management for fractures?

Answer 16

Initial: Resuscitation, analgesia, stabilisation with splints.

Closed reduction: Manipulation under anaesthetic (MUA).

Open reduction and internal fixation: Adequate exposure before fracture is reduced using wires, plates, screws or nails.

External fixation: Avoids soft tissues that are adjacent to the fracture.

Immobilisation: With plaster casts, braces or splints attached from joint above to joint below to allow healing. Traction by application of tension aligns ends of fracture.

Physiotherapy: Prevents contractures and loss of function.

Question 17

What are some complications associated with fractures?

Answer 17

Neurovascular damage

Malunion, non-union or delayed union of fracture.

Avascular necrosis

Psychological impact of disabling condition.

Compartment.

Fractures that involve the growth plate – interrupts growth.

Question 18

What is the prognosis for fractures?

Answer 18

Typically, upper limb fractures require 3–4 weeks and lower limb 6–8 weeks to heal.