common fractures

Question 1

which 2 X-ray views are usually taken to ix a fracture

Answer 1

coronal and saggital

Question 2

what is a tomogram

Answer 2

a view of a slice through a part of the body

Question 3

what will an U/S show following a fracture

Answer 3

accumulation of fluid (especially blood)

Question 4

describe radioisotope scanning in ix of a fracture

Answer 4

• radioactive substance injected into bloodstream
• the substance ends up in bones because it attaches to phosphate molecules which are actively taken up by bone
• the more metabolically active the bone is the faster it will take it up
• therefore the areas of unusual metabolic activity (the fracture sites) can be seen

Question 5

when would radioisotope scanning be used?

what bone in particular is it commonly used to ix?

Answer 5

if there is clinical doubt about whether or not there is a fracture

scaphoid

Question 6

spiral fractures - a lot or little soft tissue damage?

Answer 6

usually little

Question 7

fractures are described in terms of the ? fragment in relation to the ? fragment

Answer 7

distal

proximal

Question 8

describing fractures

Answer 8

which bone
open or closed
where on the bone 
shape (spiral, oblique, transverse)
how many fragments (simple, comminuted)
position of distal fragment (displacement, angulation, rotation)

Question 9

describing fracture angulation

Answer 9

anterior, posterior, varus, valgus

Question 10

traction may be used early in tx to relieve what?

Answer 10

muscle spasm (which is a major component of post fracture pain)

Question 11

a femoral fracture will cause how much blood loss?

Answer 11

between 2 and 3 units

one unit is about 450ml

Question 12

major pelvic fractures are associated with what type of bleeding? how much blood could be lost?

Answer 12

major venous bleeding from pelvic plexuses

up to 6 units may be lost

Question 13

vast majority of wounds should be left open or closed?

Answer 13

left open (if any doubt about closure causing tension on the skin)

Question 14

describe a functional brace

Answer 14

accurate fit so needs to be fitted after swelling and pain have settled
hinges allow joint movement in one direction

Question 15

modern casting materials

Answer 15

glass fibre and polyurethane resin combinations

Question 16

when is external fixation advantageous

Answer 16

high energy fractures associated with soft tissue damage where access is needed for secondary surgery/skin grafting means internal fixation is not ideal (also because of risk of ischaemia)

Question 17

when is internal fixation used

Answer 17

where a high degree of accuracy is required or other methods fail

Question 18

types of internal fixation

Answer 18

apposition
inter fragmentary compression
inter fragmentary compression plus onlay device
inlay device

Question 19

what is used in apposition

Answer 19

k wires

Question 20

what is usually used in inter fragmentary compression

Answer 20

screws

Question 21

in which type of bone is inter fragmentary compression particularly valuable

Answer 21

cancellous bone around joints

Question 22

what do onlay devices usually consist of

Answer 22

a plate of metal

Question 23

what is worse for disruption of natural bone healing - inlay or onlay devices?

Answer 23

onlay

Question 24

are inlay devices useful around joints?

Answer 24

no because they are relatively inaccurate at restoring anatomical position

Question 25

how does traction work in holding a fracture in reduction

Answer 25

the pull of a weight stimulates muscles to contract which holds the bones in position

Question 26

in static traction what is the pull applied against? example?

Answer 26

another part of the body | e.g. Thomas splint - pull applied against a ring which presses against the pelvis

Question 27

when is balanced traction used?

Answer 27

when static traction is in danger of causing damage to a part of the body through pressure

Question 28

when is dynamic traction used

Answer 28

when joints are still permitted to move, but by means of pulleys, the pull is still maintained along the line of the broken bone

Question 29

for long term dynamic traction, what is preferred - strapping stuck onto the skin or a pin inserted through the bone?

Answer 29

pin

Question 30

stages of bone healing

Answer 30

first 2 weeks - swelling 2-6 weeks - callus forming 6-12 weeks - bone forming 1-2 years - remodelling has taken place and the bone returns to normal

Question 31

bone heals in the presence of what type of movement?

Answer 31

micro movement directed along the long axis of the bone at right angles to the break

Question 32

will bones heal as normal if there is no movement?

Answer 32

no, it will be slow and by a different process which does not involve natural external callus formation

Question 33

bones fixed rigidly will heal slowly. this is most marked in a) long bones b) cancellous bone

Answer 33

a) long bones

Question 34

what type of fixation is particularly valuable in high velocity injuries

Answer 34

external fixation

Question 35

is fixation indicated in pathological fractures?

Answer 35

yes

Question 36

Internal fixation leads to early/delayed mobility but fast/slow healing ? ?

Answer 36

internal fixation leads to EARLY mobility but SLOW healing

Question 37

commonest cause of bone infection in the western world

Answer 37

surgery!

Question 38

if a fracture is held stable but there is infection, will it unite?

Answer 38

yes

Question 39

if an unstable fracture becomes infected what will be required?

Answer 39

stabilisation by external fixation followed by surgical wound cleansing and later bone grafting

Question 40

when is fat embolism typically seen

Answer 40

following a long bone fracture in a man under 20

Question 41

symptoms of fat embolism

Answer 41

rapid and shallow breathing mild confusion may have rash on chest and neck

Question 42

other name for compartment syndrome

Answer 42

Volkmann's ischaemia

Question 43

can compartment syndrome occur without fracture

Answer 43

yes

Question 44

in compartment syndrome is the distal pulse usually normal?

Answer 44

yes

Question 45

what is found in abundance in the kidneys of people who die from renal failure following massive soft tissue injury

Answer 45

myoglobin

Question 46

why does early mobilisation following fracture prevent renal stone formation

Answer 46

thinning bone releases calcium which can cause renal stones

Question 47

if left to heal naturally how long will upper and lower limb fractures take to heal?

Answer 47

upper - 6 weeks | lower - 12 weeks

Question 48

once growth ceases is the rate of union age dependent?

Answer 48

no

Question 49

non union is most common in which bone

Answer 49

tibia

Question 50

timescale when we would generally class a fracture as non union in a) per limb b) lower limb

Answer 50

a) upper limb - 10 weeks | b) lower limb - 20 weeks

Question 51

what may be added to stimulate union

Answer 51

bone graft (autologous)

Question 52

children have a great capacity to remodel mal united fractures, but what type of deformity will they not be able to remodel

Answer 52

rotary

Question 53

what may arrest bone growth

Answer 53

fracture breaching the germinal layer of the epiphyseal growth plate

Question 54

when is dynamic traction particularly useful

Answer 54

treatment of fractures of the femur where splintage to involve the hip joint is impractical

Question 55

what is the main problem with traction

Answer 55

the injured person must remain in bed which prolongs hospital stay and makes nursing difficult

Question 56

describe fat embolism in detail - onset, symptoms, management ...

Answer 56

onset within 2-5 days from injury mild confusion, rapid shallow breathing, rash on chest/neck early dx important followed by high % oxygen, chest physio, maybe steroids

Question 57

name 6 early complications caused by fracture

Answer 57

``` blood loss compartment syndrome renal failure infection soft tissue injury fat embolism ```

Question 58

name 5 complications that may result from fracture treatment

Answer 58

``` plaster disease (skin sores, stiffness, muscle wasting) immobility infection compartment syndrome renal stones ```

Question 59

Why may arthritis develop following fracture

Answer 59

if the fracture goes through the joint then the surfaces will no longer be congruent a very angulated fracture will put uneven forces on the joint

Question 60

causes of delayed/non union

Answer 60

``` excess movement too little movement infection poor bloody supply soft tissue interposition excessive traction intact adjacent bone ```