Common fractures

Question 1

Colles vs Smiths fracture

Answer 1

Both distal radial fractures caused by FOOSH
Colles - distal fragment dorsal angulation resulting in dinner fork deformity
Smiths - distal fragment volar angulation

Question 2

Management of Colles fracture

Answer 2

If good alignment, backslab for 1 week and then full cast for ~5 further weeks
If poor alignment, closed reduction (under anaesthetic) and K wires followed by cast
Plate and screws alternative to K wires

Question 3

Management of proximal humerus fractures

Answer 3

Collar and cuff sling so gravity pulls distal fragment down
Mobilise shoulder at 2 weeks to prevent frozen shoulder
Check rotator cuff tears in elderly, can have shoulder replacement if deltoid intact and poor function following conservative management

Question 4

What is frozen shoulder

Answer 4

Adhesive capsulitis (scarring in capsule)
Shoulder painful and stiff
Reduced ROM (can be reduced to no movement)

Question 5

Mechanism of olecranon fracture

Answer 5

Avulsion fracture of olecranon due to rapid elbow extension

Direct blow to elbow

Question 6

Management of olecranon fracture

Answer 6

Elbow cast for no longer than 3 weeks as elbow will become very stiff

Question 7

Surgical management for intraarticular fractures

Answer 7

Tension band wiring
A tension band (plate or wire loops) placed across convex side of fracture and converts tension to compression so brings articular surfaces together

Question 8

Interpreting pelvic X-rays

Answer 8

Sacroiliac widening - lateral compression
Pubic symphysis widening - AP compression

Look at whole ring, never breaks in 1 place

Question 9

Management of pubic rami fractures

Answer 9

Medical management
Analgesia
Initial bed rest then mobilisation with walking aids (not fully weight bearing for several months)

Question 10

What fractures risk damage to sciatic nerve

Answer 10

Hip

Pelvic

Question 11

Test for sciatic nerve damage

Answer 11

Positive sciatic nerve damage if unable to dorsiflex foot

Question 12

Fracture complications

Answer 12

Neurovascular damage
Fat embolism
Infection 
Malunion, nonunion
Avascular necrosis
Contracture
DVT, PE
Compartment syndrome
Complex regional pain syndrome

Question 13

Describe complex regional pain syndrome

Answer 13

type 1 - nerve damage
type 2 - no nerve damage

Imbalance between sympathetic and parasympathetic NS

Question 14

Describe compartment syndrome

Answer 14

Pain out of proportion on passive movement
Analgesia makes no difference
Pain has crescendo pattern

Question 15

Management of compartment syndrome

Answer 15

Emergency fasciotomy with large excision
Excise necrotic muscle
Slowly close wound over weeks
Keep in broad arm sling with wet bandages