Fractures and Dislocations

Question 1

What is the definition of an open fracture?

Answer 1

There is a direct communication between the external environment and the fracture.

Question 2

What are the three classifications of fractures in the Gustilo grading?

Answer 2

Type I - low energy, wound <1cm, clean, often bone piercing skin from inside

Type II - moderate soft tissue damage, wound <10cm, no soft tissue flap or avulsion
Type III -
high energy, extensive soft tissuedamage,
severe fracture (comminution,displacement),
wound >10cm;
any gunshot, farm accident, segmental fracture, bone loss, severe crush injury, marine

IIIA - soft tissue damage +++ but not grossly contaminated
IIIB - periosteal stripping, extensive muscle damage, heavy contamination
IIIC - assoc. neurovascular complication

Question 3

What is the management of open fractures?

Answer 3

Full ATLS assessment and treatment
Tetanus and antibiotic prophylaxis
Cefuroxime / Augmentin / Clindamycin- Gent at time of fixation
Repeated examination n/v status
Wounds only handled to remove gross contamination,
photograph, cover (saline swabs) and stabilise limb
No provisional irrigation / exploration
Radiographs- orthogonal views including joint above and below

Question 4

What are the criteria of an open fracture that require immediate emergency surgery?

Answer 4

Polytraumatised patient
Marine or Farmyard environment
Gross contamination
Neurovascular compromise
Compartment syndrome

Question 5

What four aspects are considered in an open fracture that may require amputation?

Answer 5

Limb ischaemia-pulse. temperature, cap refill and numbness
Patient’s age
Shock-blood pressure below 90 systolic
Injury Mechanism-measure of energy

Question 6

What is the difference between dislocation and subluxation?

Answer 6

Dislocation = complete joint disruption
Subluxation = partial dislocation – not fully out of joint

Question 7

What position does the hip go into when there is a posterior dislocation?

Answer 7

Shortened leg
Adducted
Flexed
Internal Rotation

Question 8

What is the appearance of a posterior shoulder dislocation on X ray?

Answer 8

“Lightbulb” appearance of humerus

Question 9

What kind of injury mechanisms cause posterior shoulder dislocations?

Answer 9

Needs a high energy injury
Epileptic fits and falls
Electric shocks