A3: Grafting, fractures, ESF

Question 1

Why are open fractures more common on distal limbs?

Answer 1

Little soft tissue coverage

Question 2

What is a grade 1 open fracture?

Answer 2

A small wound created by a fragment from the inside, no bone protruding

Question 3

What is a grade 2 open fracture

Answer 3

Outside to inside, soft tissue damage and contusion, but reversible muscle damage and minimal tissue loss

Question 4

What is a grade 3 open fracture?

Answer 4

More severe wound with lots of skin, soft tissue and bone damage

Question 5

How can you further categorise grade 4 fractures?

Answer 5

By soft tissue, periosteal and vascular injury

Question 6

What is the initial first aid for an open fracture?

Answer 6

Stop bleeding, cover with sterile dressing, support the fracture, take radiographs

Question 7

What do you NOT do to an open fracture?

Answer 7

Leave the wound open or manipulate the fracture

Question 8

In how many fractures is bacterial isolation successful?

Answer 8

Below 50%

Question 9

Where do you take the bacterial culture from?

Answer 9

Deep tissue after lavage

Question 10

Which bacteria cause post-traumatic osteomyelitis?

Answer 10

staphs

Question 11

What do you use to lavage?

Answer 11

Large volumes of sterile isotonic fluid

Question 12

What do you use to debride?

Answer 12

Scalpel blade

Question 13

What’s the advantage of wet to dry dressings?

Answer 13

Provide debridement and encourage granulation tissue

Question 14

What are the advantages of a stable environment for the bone?

Answer 14

Better healing, reduced SSI risk

Question 15

What are the indications for internal fixation?

Answer 15

Grade 1, articular fracture, multiple orthopaedic injuries, ESF not possible, poor healing potential

Question 16

What are the advantages of external fixation?

Answer 16

Preserves the soft tissue and haematoma which have important growth factors

Question 17

Why do you use hanging leg preparation in orthopaedic surgery?

Answer 17

Can help align the fractures

Question 18

How do you perform countertraction to reduce a fracture?

Answer 18

Slow force, muscles stretch and fracture reduces

Question 19

How can you reduce a fracture that is overriding?

Answer 19

Use toggling (V shaped contact) for reduction

Question 20

What’s the disadvantage of toggling?

Answer 20

Can cause fissures

Question 21

How do you do Levering of a fracture?

Answer 21

Use a Hohman retractor to lever it and reduction forceps

Question 22

What’s one final way to reduce a fracture?

Answer 22

A pusher pin with a plate on top

Question 23

Where must the pins in an ESF engage?

Answer 23

Must engage two cortices

Question 24

What are the three types of ESF frames?

Answer 24

Linear, circular or hybrid

Question 25

How thin must transfixation pins be?

Answer 25

Below 33% bone diameter

Question 26

What types of transfixation pins are there?

Answer 26

Smooth, threaded, negative profile (Ellis), positive profile (end threaded or centre threaded)

Question 27

Where is the weak point of a negative pin?

Answer 27

Where the thread starts - must be inside the bone

Question 28

What are two types of connecting clamps?

Answer 28

Kirschner-Ehmer or SK

Question 29

What is a type Ia frame?

Answer 29

Unilateral and uniplanar

Question 30

What is a tied-in IM pin?

Answer 30

Unilatera, uniplanar, with an IM pin tie-in

Question 31

What is a type Ib frame?

Answer 31

Unilateral, but biplanar

Question 32

What kind of pins do unilateral frames have?

Answer 32

Half pin as unilateral

Question 33

What is a type 2b ESF?

Answer 33

Bilateral, uniplanar

Question 34

What kind of pins do bilateral frames have?

Answer 34

Full pin as bilateral

Question 35

What is a type 3 ESF?

Answer 35

Bilateral, biplanar

Question 36

When do you use a circular frame (Ilizarov ring)?

Answer 36

Angular limb deformities

Question 37

What are the three types of bone graft you can use?

Answer 37

Synthetic, autograft, allograft

Question 38

What are the indications for a bone graft?

Answer 38

Complex fractures, poor healing potential, filling of bone defect, arthrodesis, intervertebral fusion, delayed or non-union

Question 39

What are the advantages of doing a cancellous bone graft?

Answer 39

Provides matrix, releases growth factors, recruits stem cells

Question 40

Where do you take bone grafts from?

Answer 40

Pelvis, distal femur, proximal tibia etc

Question 41

When do you take the bone graft?

Answer 41

At the point in surgery you need it

Question 42

What are the two types of autografts?

Answer 42

Vascularised (with the artery and vein) or non-vascularised

Question 43

What are the three types of union?

Answer 43

Bone, clinical or radiographic

Question 44

What is apposition?

Answer 44

The fracture fragments

Question 45

What is alignment?

Answer 45

Bone and joints

Question 46

What is apparatus?

Answer 46

The implants used

Question 47

What is activity?

Answer 47

Evidence of healing

Question 48

What is a clinical union?

Answer 48

No pain and can use normally

Question 49

What is a radiographic union?

Answer 49

Evidence of mineralisation