Fractures

Question 1

See picture 2. Name types of fractures.

Answer 1

Memo in album.

Question 2

How is fracture displacement described?

Answer 2

LARA
Length
Angulation
Rotation
Apposition/translation

Question 3

Name 5 basic steps of how fractures heal.

Answer 3

1. Haematoma
2. Inflammation
3. Callus formation
4. Consolidation
5. Remodelling

Question 4

What is an acetabular #

Answer 4

Femoral head driven into pelvis

Question 5

4 types of acetabular fractures

Answer 5

1. Anterior column #
2. Posterior column
3. Transverse
4. Combination

Question 6

What is an anterior column acetabular fracture (3)

Answer 6

Runs through ant acetabulum- separates a segment between ASIS and obturator foramen.
Uncommon, good prognosis
Doesn’t involve weight bearing of acetabulum.

Question 7

Where is posterior column acetabular #

Answer 7

Run upwards from obturator foramen to sciatic notch.

Question 8

What injury is usually associated with or causes a posterior column acetabular #?

Answer 8

Posterior hip dislocation

Question 9

Possible complication of posterior column acetabular #

Answer 9

Injury sciatic nerve

Question 10

Rx post column acetabular #

Answer 10

ORIF

Question 11

What is transverse acetabular #

Answer 11

Uncomminuted # running transversely through acetabulum. Separates ilium above from ischium and pubis below

Question 12

transverse acetabular # rx

Answer 12

Easy to reduce. ORIF.

Question 13

What is combined or complex acetabular #

Answer 13

Combination of ant and post column and transverse acetabular #
Usually in value roof of acetabulum
Poor prognosis. V difficult to reduce.

Question 14

How treat acetabular fractures in general? (4)

Answer 14

Resus ATLS
Reduce dislocation if present
Maintain reduction with traction, (10kg/10% body weight)
Definitive rx delayed until pt fit for sx. DON’T DELAY MORE THAN 7 DAYS!

Question 15

Contra-indications for surgery to acetabular # (4)

Answer 15

1. Severly comminuted complex #
2. Lack sx expertise
3. Lack of blood transfusion service
4. Associated abdominal injuries requiring a laparotomy/bladder repair.

Question 16

Are acetabular # usually treated surgical or non-surgical?

Answer 16

Non-surgical
ORIF preferred mostly, but due to many contraindications due to associated injuries and high R complications, it’s not done commonly in practice.

Question 17

5 complications of acetabular #

Answer 17

1. Sciatic nerve injury
2. Sepsis
3. AVN femoral head
4. Osteoarthritis
5. Shock

Question 18

Which structure is at risk in posterior column acetabulum fracture?

Answer 18

Superior gluteal NV bundle

Question 19

Usual treatment supracondylar fracture?

Answer 19

Closed reduction and percutaneous pinning (crpp) except type 1 Gartland(immobilise 3 weeks )
Adults orif

Question 20

Mechanism of injury supracondylar fracture?

Answer 20

Fall on outstretched hand mostly

<4% flexion injury

Question 21

Usual demographic of supracondylar fracture?

Answer 21

One of most common fractures in paeds, age 5-7

Question 22

!!! Which 3 nerves and artery are of concern in supracondylar fracture?

Answer 22

• Anterior interosseous nerve neuropraxia (branch of median n !) - most common (can’t flex IPJ of thumb and DPJ of index - can’t do ok sign)
• radial nerve palsy - close second (inability to extend wrist, MCPJ, thumb IPJ)
• ulnar nerve palsy seen with flexion type injury patterns, but far less common

Radial artery

Question 23

How is displacement of fracture described?

Answer 23

In terms of distal fragment

Question 24

Name 10 early local complications of fractures

Answer 24

Skin
• skin necrosis
• fracture blisters
Open wound

Muscle
• compartment syndrome
• tendon injury

Nerve
• neuropraxia
• axonotmesis
• neuronotmesis

Vessels:
• arterial injury

• infection

Question 25

Name 10 early systemic complications of fractures

Answer 25

* Haemorrhagic shock * fat embolism syndrome * ARDS * sirs * multiple organ failure syndrome * DvT * pe * pressure sores * tetanus * sepsis

Question 26

Name 10 late complications of fractures

Answer 26

* Delayed Union * non union * mal union * avascular necrosis * growth disturbance * osteoarthritis * joint stiffness * complex regional pain syndrome * heterotopic ossification * osteomyelitis

Question 27

Name 10 complications of #nonunion

Answer 27

``` • Conversion to open # • neuro vascular compression • limb length discrepancy . Deformity . Unstable limb • weak, pain, loss of function • bone atrophy • osteoarthritis • bone hypertrophy • malignancy ```

Question 28

How long do # of lower and upper limb take to heal in children?

Answer 28

• Upper limb: 3 weeks | . Lower limb: 6 weeks

Question 29

How long do # of lower and upper limb take to heal in adults?

Answer 29

Upper: 6 weeks Lower: 12 weeks

Question 30

What is a Colles # (7)

Answer 30

``` ColleD • distal radius # • dorsal displacement • dorsal angulation • dinner fork deformity on arm . From fall on outstretcheD hand - dorsal flexion • common in elDerly (osteoporosis) •Rx closeD reDuction and cast ```