fractures

Question 1

what is primary bone healing?

Answer 1

-when there is a minimal fracture gap (less than 1m) and the bone simply bridges the gap with new bone from osteoblasts.

Question 2

describe secondary bone healing

Answer 2

• fracture occurs
• haematoma occurs with inflammation from damaged tissues
• macrophages and osteoclasts remove debris and resorb bone ends
• granulation tissue forms from fibroblasts and new blood vessels
• chondroblasts form cartilage (SOFT CALLUS)
• osteoblasts lay down bone matrix (collagen type 1) ENCHONDRIAL OSSIFICATION
• calcium mineralization produces immature woven bone (HARD CALLUS)
• remodelling occurs with organization along lines of stress into lamellar bone

Question 3

what are 5 common fracture patterns?

Answer 3

• transverse
• oblique
• spiral
• comminuted
• segmental

Question 4

what may cause an oblique fracture ?

Answer 4

• shearing force

e. g. fall from height or deceleration

Question 5

how may an oblique fracture present?

Answer 5

• may shorten or angulate the bone

- oblique fracture (parallel)

Question 6

what is the treatment for an oblique fracture?

Answer 6

inter fragmentary screw

Question 7

what causes a transverse fracture?

Answer 7

-occur with pure bending force where the cortex on one side fails in compression and the cortex on the other side in tension

Question 8

what causes a spiral fracture?

Answer 8

-torsional forces

Question 9

what causes a comminuted fracture?

Answer 9

• high energy injury or poor bone quality
• may be substantial soft tissue swelling and periosteal damage with reduced blood supply to the fracture site which may impair healing

Question 10

what does a comminuted fracture look like?

Answer 10

-fractures with 3 or more fragments

Question 11

what is the treatment for a comminuted fracture?

Answer 11

-stabilized in surgery

Question 12

what is the treatment for a segmental fracture?

Answer 12

-stabilization with long rods or plates

Question 13

what is a segmental fracture?

Answer 13

-bone fractured in two separate places

Question 14

what is management for undisplaced, minimally displaced and minimally angulated fractures which are considered stable?

Answer 14

• treated non operatively

- period of splintage and immobilization

Question 15

how are displaced and angulated fractures treated?

Answer 15

closed reduction and cast applications with serial Xrays

Question 16

what is the treatment for unstable injuries?

Answer 16

may need surgical stabilisation

Question 17

what is the treatment for unstable extra articular diaphyseal fractures?

Answer 17

ORIF (open reduction and internal fixation)

Question 18

what patients are more likely to be treated non operatively?

Answer 18

elderly with co morbidities, osteopersosis and dementia

-as they are at higher risk of complications during surgery, failure of fixation and failure to rehabilitate satisfactorily

Question 19

what is the main late systemic complication of fractures?

Answer 19

pulmonary embolism (tends to occur several days to weeks after injury)

Question 20

what are some early local complications of fractures?

Answer 20

• compartment syndrome
• vascular injury with ischaemia
• nerve compression injury
• skin necrosis

Question 21

what are some early systemic complications of fractures?

Answer 21

• hypovolaemia
• fat embolism
• shock
• ARDS
• acute renal failure
• systemic inflammatory response syndrome
• multi organ dysfunction syndrome
• death!

Question 22

what are some late local complications?

Answer 22

• stiffness
• loss of function
• chronic regional pain syndrome
• infection
• non union
• mal union
• Volkmann’s ischaemic contracture
• post traumatic OA
• DVT

Question 23

what is neuraprexia?

Answer 23

• mildest form of nerve injury
• when the nerve has a temporary conduction defect from compression or stretch and resolves over time with full recovery (28 days)

Question 24

what is axonotmesis?

Answer 24

• more severe than neuropraxia
• nerve injury sustained from compression or stretch in higher degree of force
• recovery is variable and full power sensation may not be achieved

Question 25

what is neurotmesis?

Answer 25

• most severe type of nerve injury
• complete transaction of nerve
• no recovery will occur unless there is surgical repair

Question 26

what is Colles fracture?

Answer 26

-distal radius fracture

Question 27

what nerve injury may a Colles fracture lead to?

Answer 27

-acute median nerve compression/ carpal tunnel syndrome

COLLES FRACTURE= fracture of distal radius

Question 28

what nerve may anterior dislocation of the shoulder cause?

Answer 28

-axillary nerve palsy

Question 29

what nerve may be injured in a humeral shaft fracture?

Answer 29

radial nerve

Question 30

what nerve may be injured in a supracondylar fracture of the elbow (fracture to humorous at its narrowest point just above elbow)?

Answer 30

-median nerve (usually anterior interosseous branch)

Question 31

what nerve may be injured in a posterior dislocation of the hip?

Answer 31

-sciatic nerve

Question 32

what artery risks getting injured in an elbow injury?

Answer 32

brachial

Question 33

what is the management for dislocations?

Answer 33

-closed reductions

however the longer you leave it the more likely you will need to do an open reduction

Question 34

how are ligament ruptures graded?

Answer 34

Grade 1 (sprain)
Grade 2 (partial tear)
Grade 3 (complete tear)

Question 35

what is the treatment for elderly patients with osteoporosis osteopereotic ‘wedge’ insufficiency fractures?

Answer 35

-usually do not require anything other than symptomatic treatment

Question 36

what do all high energy thoracolumbar fractures require?

Answer 36

-neurological assessment and full trauma evaluation

Question 37

what is the treatment for unstable thoracolumbar spinal fractures?

Answer 37

-operative stabilisation

Question 38

what is the treatment for stable thoracic spinal injuries?

Answer 38

stable= without substantial displacement or collapse

treatment- brace to limit flexion and prevent kyphosis

Question 39

what are indications for surgery in thoracolumbar spinal fractures?

Answer 39

• the presence of neurological deficit especially if progressive or very unstable injury
• unstable injury pattern with substantial loss of vertebral height, displacement or involvement of the posterior ligamentous structures

Question 40

what is spinal shock?

Answer 40

A physiologic response to injury with complete loss of:

• sensation
• motor function
• loss of reflexes below the level of injury

usually resolves in 24 hours with the return of reflexes and the severity of spinal cord injury may not be determined until after spinal shock has resolved

BULBOCAVERNOUS REFLEX ABSENT (contraction of anal sphincter with either squeeze of glans penis, tapping the mons pubis or pulling on a urethral catheter)

Question 41

what can cause neurogenic shock?

Answer 41

• it occurs secondary to temporary shutdown of sympathetic outflow from the cord from T1 to L2 due to injury in the cervical or upper thoracic cord
• results from loss of sympathetic tone to heart and vasculature

occurs exclusively in patients with spinal cord injuries!!

Question 42

True or False

Priapism may present with neurogenic shock

Answer 42

True

-as sympathetic outflow not working to unopposed to parasympathetic flow to the penis

Question 43

what is used to treat neurogenic shock?

Answer 43

IV fluid therapy

Question 44

how may spinal cord injuries be classed?

Answer 44

-complete or incomplete spinal cord injury

Question 45

what is central cord syndrome?

Answer 45

• incomplete spinal injury
• most common injury pattern
• usually occurs due hyperextension injury in cervical spine with osteoarthritis
• often there is no associated fracture or dislocstion

-paralysis of the arms more than legs occurs!!

Question 46

what is anterior cord syndrome?

Answer 46

• an incomplete cord injury

- loss of movement, pain and temperature