Fractures

Question 1

Most common shoulder dislocation

Answer 1

AnteriorInferiorPosterior

Question 2

Management of shoulder dislocation

Answer 2

Reduction (with Hippocratic method)ImmobilisationRehab

Question 3

What is a Colle’s fracture?

Answer 3

Caused by FOOSHDinner fork type deformityTypically: transverse fracture of radius 1-2 inch proximal to radio-carpal jointDorsal displacement + angulation

Question 4

What is a Smith’s fracture?

Answer 4

Ventral angulation of distal radius fragment (garden spade deformity)Caused by falling backwards onto an outstretched palm with wrist flexed

Question 5

What is a Barton’s fracture?

Answer 5

Distal radius fracture + associated radiocarpal dislocationResultant fragment tends to slip so fracture is unstable

Question 6

What is an isolated radial styloid fracture?

Answer 6

Caused by falls onto outstretched hand or kickback injuriesSometimes called Hutchinson fracture

Question 7

Grading of ankle sprains

Answer 7

1 = mild stretch of ligament without instability2 = partial rupture without instability3 = complete rupture with instability of joint

Question 8

S+S of sprain vs strain

Answer 8

Sprain: pain, tenderness, swelling, bruising, functional lossStrain: pain, spasm, weakness, cramping, haematomas

Question 9

What are the ottowa rules?

Answer 9

When to give ankle X rayPain in malleolar zone + 1 of the following:Inability to weight bearBone tenderness along distal portion of fibula or tip of lateral malleolusBone tenderness along distal edge of tibia or tip of medial malleolus

Question 10

Management of ankle strain

Answer 10

ProtectionRest Ice Compression ElevationAvoid HARMHeat Alcohol Running Massage

Question 11

Features of hip fracture

Answer 11

Common in elderly osteoporotic femalesPainShortened + internally rotated leg

Question 12

Location of hip fractures

Answer 12

Intracapsular: edge of femoral head to insertion of capsule into jointExtracapsular: trochanteric or sub trochanteric

Question 13

What is the Garden system?

Answer 13

Type 1: incomplete fracture - stable2: complete fracture but undisplaced3: complete + partially displaced4: complete + totally displaced

Question 14

Management of intracapsular fracture

Answer 14

Undisplaced: internal fixation/ hemiarthroplastyDisplaced: reduced + internal fixationIf older: hemiarthroplasty or hip replacement

Question 15

Management of extracapsular hip fracture

Answer 15

Dynamic hip screwIf reversible oblique, transverse or sub trochanteric: intramedullary device

Question 16

What to assess for in ?wrist fracture

Answer 16

Neurovascular compromiseExamine joints above + below

Question 17

Management of wrist fracture

Answer 17

Closed reductionTraction + manipulation under anaestheticRepeat Xray after 1 week to check for displacement - if displaced, surgical open reduction + internal fixation

Question 18

Complications of wrist fracture

Answer 18

MalunionMedian nerve compressionOsteoarthritis

Question 19

What are bony bankart lesions + Hill sachs defects?

Answer 19

Bankart = fractures of anterior inferior glenoid bone, seen with recurrent shoulder dislocationsHill-Sachs = impaction injuries to chondral surface of humeral head

Question 20

X rays for shoulder dislocation

Answer 20

Should get ‘trauma series’ = AP, Y scapular + axial viewsLightbulb signs = posterior dislocation

Question 21

What doesa Colles’ fracture indicate is underlying?

Answer 21

Osteoporosis

Question 22

Describe the features of a scaphoid fracture

Answer 22

Tenderness in anatomical snuff box
Pain on scaphoid tubercle
Pain on axial loading

Question 23

Management of scaphoid fracture

Answer 23

Postive x ray - thumb spica splint for 6-8 weeks, repeat x ray in 2 weeks
Negative x ray - thumb spica splint, repeat x ray in 1 week + CT scan

Question 24

What is a calcneal fracture associated with?

Answer 24

Fall from height

Axial loading

Question 25

When is a knee x ray required?

Answer 25

``` >55 y/o Tenderness at head of fibula Isolated tenderness of patella Inability to flex to 90 Inability to weight bear for 4 steps ```

Question 26

What are high risk factors for infection of a wound?

Answer 26

``` Puncture wounds Crush injuries Wounds >12 hrs old Hand or foot wounds Age >50 Prosthetic joints/ valves Immunocompromised ```

Question 27

What are bruises, abrasions + lacerations?

Answer 27

Non palpable bruise = ecchymosis Palpable bruise = haematoma Abrasion = partial to full thickness break in skin Lacerations = wound produced from tearing of skin

Question 28

Management of wounds

Answer 28

``` Disinfect skin Irrigate with saline Analgesia + anesthesia (7mg lidocaine w/ epinephrine or 5mg without) Evacuate hematomas Debride tissue Consider prophylactic abx Suture ```