Fractures

Question 0

Cancellous bone

Answer 0

Spongy bone

Question 1

The physical force required to break a bone always results in _____________.

Answer 1

Soft tissue injury

Question 2

Fractures can be classified according to:

Answer 2

Site 
Extent
Configuration 
Relationship of fragments to each other
Relationship to environment.

Question 3

Fractures classified according to site:

Answer 3

Epiphyseal 
Metaphysial
Diaphesial
Intra-articular
Fracture-dislocation

Question 4

Salter-Harris classification.

Answer 4

Used to describe fractures affecting epiphyseal or growth plate.

Type 1. Transverse
Type 2 (most common). Growth plate and metaphysis
Type 3. Growth plate and epiphysis
Type 4. Growth plate, metaphysis and epiphysis
Type 5. Compression fracture through growth plate.

Question 5

Complete fracture

Answer 5

Bone is broken into two or more pieces.

Question 6

Incomplete fracture

Answer 6

Bone is bent or cracked but periosteum remains intact.

Question 7

Compression fracture

Answer 7

Bone is crushed.

Occurs in cancellous (spongy) bone.

Question 8

Greenstick fracture

Answer 8

Bone is bent or partially broken. More common in children.

Question 9

Perforation fracture

Answer 9

Result of missile wound

Question 10

Stress fracture

Answer 10

Cracks in bone due to overuse or repetitive actions.

Common in tibia, metatarsals (March fracture), navicular, femur, pelvis.

Question 11

Fractures classification according to configuration.

Answer 11

Linear (north-south)
Transverse
Oblique
Spiral
Comminuted (two or more fragments)
Avulsion (ligaments pull bone apart)
Compacted/impacted (bones/fragments driven into each other)
Osteochondral (fragments of articular cartilage sheared from joint surface)

Question 12

Comminuted fracture

Answer 12

Two or more fragments

Question 13

Osteochondral fracture

Answer 13

Fragments of articular cartilage sheared from joint surface.

Question 14

Colles Fracture

Answer 14

Transverse fracture of radius proximal to wrist.
Fragment rotates and displaces dorsally.
Often FOOSH
“Dinner fork”
Complications include malunion.

Question 15

Reflex symptom dystrophy

Answer 15

Pain, swelling and vasomotor dysfunction of an extremity.

Can be a result of any trauma.

Question 16

Smith’s fracture

Answer 16

Reverse Colles
Transverse fracture of the radius proximal to wrist.
Fragment displaced ventrally.
“Spoon”

Question 17

Galeazzi fracture

Answer 17

Fracture of radial shaft and dislocation of distal radioulnar joint.
MOI: fall on hands with rotational component
Possible complications: ulnar nerve injury.

Question 18

Bartons Fracture

Answer 18

Intraventricular-articular fracture of the distal radius with dislocation of the radiocarpal joint

Dorsal and palmar types.

Caused by fall on extended and pronates wrist.

Question 19

Rolando Fracture

Answer 19

Comminuted intra-articular fracture through base of first MC bone

Three distinct fragments (T or Y).

Question 20

Boxers/Brawlers fracture

Answer 20

Fracture of 5th MC
MOI: punching with closed fist
Pain and tenderness around knuckle; snapping/popping sensation, discolouration, misalignment of finger.

Question 21

Monteggia Fracture

Answer 21

Fracture of proximal ulna with dislocation to head of radius.

MOI: FOOSH with hyperpronation; uncommonly blow to back of ulna.

Question 22

Potts Fracture

Answer 22

Ankle fracture affecting one or both malleoli

Distal fibular fracture close to lateral malleolus
Deltois ligament can rupture and avulse medial malleoli.

Question 23

Dupuytren’s fracture

Answer 23

Like Potts, but higher up fibula.

Medial malleolus avulses and talus pushed superior between tibia and fibula.

MOI: eversion with external rotation.

Question 24

Jones Fracture

Answer 24

AKA dancer's fracture Injury to proximal end of 5th Metatarsal. (Midfoot).

Question 25

Maisonneuve fracture

Answer 25

Spiral fracture of proximal third of fibula. Associated with tear of distal tibfib joint and io membrane Also medial malleolus fracture and possible of deltois ligament.

Question 26

How are the Maisonneuve and Galliazi fractures similar?

Answer 26

Both associated with important ligamentous disruption

Question 27

Toddlers fracture

Answer 27

AKA. Accidental childhood spiral tibial fracture. Distal part of tibia. 9 months to 3 years old.

Question 28

Trimalleolar fracture

Answer 28

Ankle fracture that involves lateral malleolus, medial malleolus, and distal portion of tibia.

Question 29

Bennett's fracture

Answer 29

Fracture-dislocation of 1st Carpometacarpal jt MOI: longitudinal force along axis of 1st MC when thumb is flexed. Swelling, pain, reluctance to use thumb

Question 30

Stages of fracture healing.

Answer 30

1. Cellular phase 2. Vascular phase 3. Primary callus phase 4. Reparative phase. 5. Remodelling phase

Question 31

Cellular stage of fracture healing

Answer 31

First stage Hematoma firms around fractured ends of bones. Inflammatory response initiated Mesh of fibrin forms around injury site Granulation tissue eventually invades and replaces hematoma.

Question 32

Vascular phase of fracture repair

Answer 32

Second stage Specialized circulatory network forms around fracture Proliferation of osteoblasts at periosteum Formation of fibrocartilage bridge between fragment ends

Question 33

Primary callus phase of fracture repair

Answer 33

Third stage Soft callus formed from mass of osteoblasts and exudate Osteoclasts clean up debris Fibrous, immature bone (woven bone) gradually calcified Movement decreases Union around 4 weeks

Question 34

Reparative phase of fracture repair

Answer 34

Fourth stage | Consolidation of immature bone into lamellar bone

Question 35

Remodelling phase of fracture repair

Answer 35

Fifth and final stage | Remodelling of irregular surfaces, reshaping of marrow spaces, realignment along lines of stress

Question 36

Osteonecrosis

Answer 36

Avascular necrosis of the bone | More common in bones that are poorly vascularized (scaphoid, neck of femur, talus, lunate).