MSK - Fractures

Question 1

How do you describe a fracture?

Answer 1

Site?
Open or closed?
Types of fracture
Describe the deformity (angulation, displacement, rotation)
Impaction?
Joint involvement?

Question 2

Types of fracture

Answer 2

• Hairline
• Greenstick
• Simple transverse
• Simple oblique
• Simple spiral
• Comminuted (multifragmantary)
• Crush

Question 3

How may fractures be managed?

Answer 3

• Initial management (analgesia, IV antibiotics, tetanus prophylaxis, )
• Reduction
• Immobilisation/ fixation (splints, plaster cast, Internal fixation, External fixation)

Question 4

(8) Cx of fractures

Answer 4

• Infection;
• haemorrhage (expected blood loss depends on which bone is injured);
• compartment syndrome;
• injuries to adjacent structures (nerves and vessels);
• avascular necrosis (if there is loss of blood supply to a bony fragment (e.g. head of femur);
• complications related to healing of fracture (non-union, delayed union, malunion);
• complex regional pain syndrome;
• epiphyseal fusion (may occur in growth plate injuries in children)

Question 5

Cx of management of fractures

Answer 5

− Infection of devices

− Complications of immobilisation
o DVT/ PE
o Respiratory tract: collapse; pneumonia
o Urinary tract infection

− Complications of surgery

Question 6

Can you see scaphoid fractures on initial imaging?

Answer 6

Not always

Question 7

Complication of osteoporosis in fractues

Answer 7

There may be bone loss with fractures in osteoporotic bones which leads to difficulty maintaining reduction

Question 8

What does a fat-fluid level in a joint or a fat pad sign indicate?

Answer 8

A fat-fluid level in a joint or a fat-pad sign may indicate the presence of a fracture not seen on initial bone views

Question 9

Posterior dislocation of the glenohumeral joint may be more likely missed on initial assessment because:

Answer 9

as it is associated with less obvious deformity on clinical examination and more subtle radiological abnormalities.

Anterior dislocation is more common

Question 10

Suspicions of serious underlying cause in joint/limb pain

Answer 10

If worse or particularly severe at night should

If pain at rest.

Question 11

What may mask signs of inflammation in infection?

Answer 11

Steroids

Question 12

If you find a sacral fracture, what else should you also look for?

Answer 12

associated disruption of the pelvic girdle