fractures

Question 1

compound fracture

Answer 1

skin is broken and broken bone exposed to air

Question 2

stable fracture

Answer 2

sections of bone remain in alignment at fracture

Question 3

pathological fracture

Answer 3

bone breaks due to abnormality within bone

Question 4

comminuted fractures

Answer 4

breaks into multiple fragments

Question 5

salter-harris fracture

Answer 5

growth plate fracture

Question 6

types of fracture more common in kids

Answer 6

greenstick

buckle

Question 7

colles fracture

Answer 7

transverse fracture of distal radius

causing distal portion to displace posteriorly (upwards)

Question 8

colle’s fracture deformity

Answer 8

dinner fork deformity

Question 9

colle’s fracture usual mechanism

Answer 9

FOOSH

Question 10

scaphoid fracture usual mechanism

Answer 10

FOOSH

Question 11

key sign of scaphoid fracture

Answer 11

tenderness in anatomical snuffbox

Question 12

scaphoid bone blood supply

Answer 12

retrograde - blood vessels supply blood from only one direction

fracture can result in loss of blood supply –> avascular necrosis and non-union

Question 13

which key bones have vulnerable blood supply

Answer 13

scaphoid
femoral head
humeral head
talus 
5th metatarsal

Question 14

what can happen if bones with vulnerable blood supply are fractures

Answer 14

avascular necrosis, impaired healing and non-union

Question 15

what do ankle fractures involve

Answer 15

lateral malleolus (distal fibula) or medial malleolus (distal tibia)

Question 16

ankle fractures: weber classification

Answer 16

describe fractures of lateral malleolus

described in relation to distal syndemosis (fibrous joint) between tibia and fibula

Question 17

The Weber classification defines fractures of the lateral malleolus as: Type A

Answer 17

below ankle joint

will leave syndemosis intact

Question 18

The Weber classification defines fractures of the lateral malleolus as: Type B

Answer 18

at level of ankle joint

syndemosis will be intact or patially torn

Question 19

The Weber classification defines fractures of the lateral malleolus as: type C

Answer 19

above ankle joint

syndemosis will be disrupted

Question 20

when is surgery more likely to be required for ankle fracture

Answer 20

if syndemosis is distrupted by fracture

need to regain good joint stability and function

Question 21

pelvic ring fractures

Answer 21

when one part of pelvic ring fractures another part will also fracture (think of breaking a polo mint)

Question 22

pelvic fractures often lead to…..

Answer 22

significant intra-abdo bleeding

can lead to shock and death to need emergency resus and trauma management

Question 23

why do pelvic # cause intra-abdo bleeding

Answer 23

either due to vascular injury or from cancellous bone of pelvis

Question 24

causes of pathological fractures

Answer 24

tumour
osteoporosis
Paget’s disease

Question 25

common sites of pathological #

Answer 25

femur | vertebral bodies

Question 26

main cancers that metastasise to bone

Answer 26

``` Prostate renal thyroid breast lung ```

Question 27

fragility fractures

Answer 27

occur due to weakness in bone, usually osteoporsos often occur w/o approp trauma needed to break bone

Question 28

how can patient's risk of fragility fracture be predicted

Answer 28

FRAX tool

Question 29

bone mineral density can be measured using a

Answer 29

DEXA scan

Question 30

1st line medical treatment for reducing risk of fragility fractures

Answer 30

calcium + vitamin D | bisphosphonattes

Question 31

how to bisphosphonates work

Answer 31

interfere with osteoclasts - reduce their activity and prevent reabsorption of bone

Question 32

bisphosphonate side effects

Answer 32

reflux + oesophageal erosions atypical fractures osteonecrosis jaw osteonecrosis external auditory canal

Question 33

what's an alternative to bisphosphonates

Answer 33

denosumab - monoclonal antibody which blocks osteoclast activity

Question 34

imaging

Answer 34

X-ray (2 views always required) CT

Question 35

principles of # management

Answer 35

1. mechanical aligment | 2. relative stability

Question 36

principles of # management: mechanical aligment

Answer 36

closed reduction - via manipulation of limb open reduction - via surgery

Question 37

principles of # management: relative stability

Answer 37

provide stability to give time for healing to occue fix bone in correct position whilst it heals

Question 38

various ways bones can be fixed

Answer 38

external cast IM wires, nails screws, plates

Question 39

possible early complications

Answer 39

``` damage to local structures haemorrhage compartment syndrome far embolism VTE ```

Question 40

possible long-term complications

Answer 40

``` delayed union malunion non-union avascular necrosis infection (osteomyeltitis) joint instability joint stiffness contractures arthritis chronic pain complex regional plain syndrome ```

Question 41

fat embolism

Answer 41

can occur following fracture of long bone fat globules are released into circulation following # and can become lodges in blood vessels

Question 42

fat embolism syndrome

Answer 42

fat embolisaion can cause systemic inflammatory response

Question 43

when does fat embolism typically present

Answer 43

~24-72hrs after fracture

Question 44

Fat embolism: Gurd's major criteria

Answer 44

resp distress petechial rash cerebral involvement

Question 45

Fat embolism: Gurd's minor criteria

Answer 45

jaundice thrombocytopenia fever tachycardia