Fractures

Question 1

Dislocation

Answer 1

Complete loss of contact between the articular surfaces of a joint

Question 2

Subluxation

Answer 2

Incomplete dislocation resulting in a non concentric joint surface

Question 3

Reduction

Answer 3

To return a fraction or dislocation to anatomic alignment

Question 4

Nonunion

Answer 4

Failure of bony edges to unite

Question 5

Malunion

Answer 5

Healing of the bony fragments in a faulty position (get imperfect alignment, deformity, or rotation)

Question 6

Stages of fracture healing

Answer 6

1. Inflammation (days) - Hematoma, inflammatory cell proliferation
2. Repair (weeks) - Soft callus, hard callus
3. Remodelling (years) - Lamellar bone continues to remodel by Wolff’s law

Question 7

Fracture complications - Early local

Answer 7

1. Infection
2. Compartment syndrome
3. Neurologic injury
4. Vascular injury
5. Implant failure
6. Fracture blisters

Question 8

Fracture complications - Late local

Answer 8

1. Malunion
2. Nonunion
3. Avascular necrosis
4. Osteomyelitis
5. Post-traumatic arthritis
6. Heterotropic ossification

Question 9

Fracture complications - Systemic

Answer 9

1. Sepsis
2. DVT/PE
3. Fat embolism
4. ARDS

Question 10

Traumatic fractures

Answer 10

Normal bone + Abnormal force

Question 11

Stress fracture

Answer 11

Normal bone + Repetitive force

Question 12

Pathologic fracture

Answer 12

Abnormal bone + Normal force

Question 13

Describing fractures

Answer 13

1. Location
2. Fracture pattern
3. Open vs closed
4. Intra or extraarticular
5. Displacement - apposition, angulation, rotation

Question 14

Describing fractures - 6 A’s

Answer 14

1. Anatomy - Bone? Where on the bone? Morphology?
2. Articular - Intra vs extra
3. Apposition - %
4. Alignment - Varus, values
5. Angulation, rotation
6. Apex

Question 15

Heterotropic ossification

Answer 15

Formation of bone in abnormal locations (e.g. muscle) secondary to pathology

Question 16

Avascular necrosis

Answer 16

Ischemia to bone due to disrupted blood supply - common in bones covered by cartilage or with distal to proximal blood supply

Question 17

Fracture blister

Answer 17

Formation of vesicles or bullae that occur on edematous skin overlying a fractured bone

Question 18

X-rays, rule of 2’s

Answer 18

2 views - AP and lateral
2 joints - above and below
2 times - before and after reduction
(2 sides)

Question 19

Principles of fracture treatment

Answer 19

1. Obtain reduction - closed, open
2. Maintain reduction - external, internal stabilization
3. Early mobilization
4. Pain management

Question 20

External stabilization

Answer 20

• Splint
• Cast
• Traction
• External fixator

Question 21

Internal stabilization

Answer 21

• Percutaneous pinning
• Extramedullary fixation (screws, plates, wires)
• Intramedullary fixation (rods)

Question 22

Complications of casting

Answer 22

1. Compartment syndrome
2. Skin/soft tissue injury
3. Pressure sores
4. Chafing, pruritus
5. Swelling
6. Muscle atrophy