Assessment of Fractures

Question 1

give some examples of types of fracture

Answer 1

complete
transverse
oblique
spiral
comminuted
incomplete
bowing
buckle
greenstick
growth plate injury

Question 2

possible sites of fracture in a bone?

Answer 2

diaphysis
metaphysis
epiphysis

Question 3

possible displacement of a fracture?

Answer 3

angulation
translation
rotation
distracted
impacted

Question 4

what is the likely pattern of injury based on?

Answer 4

age of the patient

mechanism of injury

Question 5

open vs closed fracture?

Answer 5

open has the potential for bacterial infection etc and contamination

Question 6

what is the risk with compartment syndrome?

Answer 6

loss of function

Question 7

what is fight bite and what can it cause?

Answer 7

cut at the MCP joint from hitting someone due to teeth
causes inoculation of bacteria from mouth into joint
can cause septic arthritis which can lead to loss of function of the joint

Question 8

what is compartment syndrome?

Answer 8

results from interstital pressure increase in closed osseofascial compartments
causes microvascular compromise

Question 9

risk factors for compartment syndrome?

Answer 9

tibial fracture
forearm fractures
IV drug users - lying comatose for prolonged time
anticoagulation and trivial trauma
may not involve a fracture (e.g can just be a blow to the anterior compartment etc)
burns

Question 10

what is the most commonly affected compartment in the leg?

Answer 10

anterior

therefore deep fibular nerve likely to be affected

Question 11

what can be a symptoms of damage to deep fibular nerve?

Answer 11

numbness in 1st and 2nd toe

Question 12

presentation of acute compartment syndrome?

Answer 12

disproportionate pain
pain on passive stretch of muscles in involved compartment (plantar flex for anterior comprtment, dorsiflex for posterior compartment etc)
paresthesiae

Question 13

how is compartment syndrome managed?

Answer 13

immediate release of all dressings/ casts
do not elevate, keep parallel to the heart
refer for surgery immediately

Question 14

compartment syndrome surgery?

Answer 14

emergency fasciotomy

Question 15

common features of ankle fracture/instability?

Answer 15

bruising and tender on both sides

Question 16

what is the order of injury to the ankle in a rotational injury?

Answer 16

syndesmotic ligament between tibia and fibula
then spiral fracture
deltoid tear
dislocation of the talus?/tibia?

Question 17

trifocal fracture?

Answer 17

3 places

- Weber C fracture of the ankle

Question 18

treatment for weber C fracture?

Answer 18

needs surgery

Question 19

classification of hip fractures?

Answer 19

intracapsular - can damage blood supply

extracapsular - no damage to blood supply

Question 20

comorbidities with hip fracture?

Answer 20

anticoagulation
recent medication changes
missed injury
cognitive impairment (dementia, delirium etc)

Question 21

when is an MRI needed for hip pain?

Answer 21

If extreme hip/groin pain with reluctance to weight bear and pain when pressing knees upwards but x rays are normal

Question 22

most commonly used prosthesis for hip for elderly?

Answer 22

Thompson hemiarthroplasty - titanium alloy

Question 23

commonly used hip prosthesis in younger patients?

Answer 23

hybrid

Question 24

treatment of intracapsular fracture in young people?

Answer 24

reduction with screws

Question 25

dangerous area for hip fracture?

Answer 25

subtrochanteric fracture as holds almost entire body weight

Question 26

where is fracture likely to occur if a prosthetic hip is present?

Answer 26

at the site where the solid prosthesis in the middle of the bone ends and the normal, softer bone starts

Question 27

options for tibial fracture?

Answer 27

reduce and plaster cast
add a plate (surgical)
add a frame - infection risk from outside pins
intramedullary nail (surgical)

Question 28

what are the risks with bisphosphonate treatment?

Answer 28

stress fractures

• slightly sclerotic
• very transverse

Question 29

how can the risk with bisphosphonates be managed?

Answer 29

take a 5 year break from treatment to assess bone density

Question 30

distal intra-articular radius fracture treatment?

Answer 30

volar locking plate (expensive)

can also use wires which is cheaper

Question 31

priorities with extreme open fracture?

Answer 31

ABCDE
stop the haemorrhage (comes first is extensive)
splint the extremity
document vascular and neural status

Question 32

how can you reduce a large haemorrhage?

Answer 32

tourniquet
apply wool and pressure
- don’t clamp the artery as it can cause problems with vessel reconstruction

Question 33

how do you document an injury?

Answer 33

location
size
incised, lacerated etc?
degloving?
capillary fill?
pulses
tendon action

Question 34

what is a flexion distraction injury?

Answer 34

AKA chance fracture
spine failing in tension
disruption of PLC - posterior ligamentous complex
usually occurs in young people due to hyperextension of the cervical spine over a seatbelt