Fractures and dislocations

Question 1

What is the definition of a fracture?

Answer 1

Break in continuity of a bone, as a result of a force applied to that bone which exceeds tensile or compressive strength of the bone

Question 2

What is an open vs closed fracture?

Answer 2

open: penetrates the skin over the site
closed: doe not break the skin

Question 3

What is a comminuted vs non-comminuted fracture?

Answer 3

comminuted: > 3 fragments

non-comminuted: < 3 fragments

Question 4

What is a complete vs incomplete fracture?

Answer 4

complete: into 2 pieces
incomplete: not into 2 pieces,; remain attached (bent or buckled)

Question 5

What is an avulsion fracture?

Answer 5

• tearing away of bone from forceful muscular / ligament pulling
• corner / chip fracture

Question 6

What is an impacted fracture?

Answer 6

• impaction into another, giving shortening
• seldom visualized, white line
• depression fracture or compression fracture

Question 7

What is a depression fracture?

Answer 7

• type of impacted fracture
• inner bulging of outer bone surface
• tibial plateau
• frontal bone

Question 8

What is a compression fracture?

Answer 8

• type of impacted fracture in the spine only
• trabecular telescoping
• following forceful hyperflexion injury

Question 9

What is a compound fracture?

Answer 9

other name for open fracture

Question 10

What is a simple fracture?

Answer 10

other name for closed fracture

Question 11

What is a torus fracture?

Answer 11

• type of incomplete fracture
• long axis forces make buckling of the cortex
• in metaphysis
• very painful
• FOOSH

Question 12

What is a greenstick fracture?

Answer 12

• type of incomplete fracture
• perpendicular forces make bending
• disruption of cortex on one side
• paediatrics under age 10

Question 13

What is a stable fracture?

Answer 13

does not move during healing

Question 14

Where can an unstable fracture occur?

Answer 14

C1 broken in 3 parts

Question 15

What forces cause spiral fracture?

Answer 15

torsional + compression + angulation

Question 16

What is a stress fracture?

Answer 16

• repetitive stress causes gradual formation of micro fractures at greater rate than reparative process
• often starts as occult fracture

Question 17

What is an occult fracture?

Answer 17

• clinically evident but not radiologically until 10 days post
• ex. scaphoid, ribs

Question 18

What is an insufficient fracture?

Answer 18

stress fracture in diseased bone

Question 19

What is the definition of a pathological fracture?

Answer 19

normal force acting on a weekend bone and breaking it

Question 20

What is fracture alignment?

Answer 20

• position of distal fragment in relation to proximal fragment
• good alignment = no perceptible angulation

Question 21

What is fracture apposition?

Answer 21

• closeness of bony contact at the fracture site
• good = complete surface contact
• partial = partial contact
• separation = distraction

Question 22

What is fracture rotation?

Answer 22

• rotational deformity

* rotational malposition

Question 23

What are the 3 phases of fracture repair?

Answer 23

1) circulatory / inflammatory phase
2) reparative / metabolic phase
3) remodelling / mechanical phase

Question 24

List the events that occur during fracture repair

Answer 24

• bleeding from bone ends
• haematoma (day 1)
• necrosis of adjacent bone
• inflammatory reaction -debris removed by osteoclasts and macrophages
• granulation tissue invades fracture
• haematoma gets organized
• osteoblasts form provisional fracture callus (1-4 weeks)
• Formation of definitive fracture callus (4-12 weeks)
• remodelling of bone (3-12 months)

Question 25

What are the immediate complications of a fracture?

Answer 25

* Arterial injury * Neural injury * Compartment syndromes * Gas Gangrene * Fat embolism * Thromboembolism

Question 26

What are the intermediate complications of a fracture?

Answer 26

* osteomyelitis * failure of hardware * reflex sympathetic dystrophy syndrome * post-traumaticosteolysis * re-fracture * myositis ossificans * synostosis * delayed union

Question 27

What are the delayed complications of a fracture?

Answer 27

* osteonecrosis * DJD * lead arthropathy and toxicity * localized osteoporosis * non-union * mal-union

Question 28

What is Volkmann's contracture?

Answer 28

* immediate complication of fracture | * compartment syndrome in anterior forearm

Question 29

What is Sudeck's atrophy?

Answer 29

* immediate complication of fracture * reflex sympathetic dystrophy syndrome * severe and painful regional osteoporosis following relative trivial injury

Question 30

What is synostosis?

Answer 30

bony fusion of 2 bones or across interosseous membrane

Question 31

How do we diagnose fractures?

Answer 31

* how the injury occurred * history of trauma * pain * no previous symptomatology * guarding posture * distressed patient * swollen, red, guarded * discontinuity on palpation, haematoma, tenderness, heat, crepitus, spasm * note neuromuscular status

Question 32

What are the definitions of dislocation and subluxation?

Answer 32

Dislocation: loss of articulation between bony ends within the joint capsule with disruption of supporting ligaments Subluxation: partial loss with still partial contact

Question 33

What are the aetiologies of dislocations and subluxations?

Answer 33

* trauma * congenital * pathological

Question 34

What is the pathology of dislocations and subluxations?

Answer 34

results in muscular imbalance, joint instability, interference with ability of bones to be in right position

Question 35

What are the clinical features of dislocations and subluxations?

Answer 35

* pain * deformity * loss of function * swelling * maybe recurrent * if recurrent, pain becomes minimal

Question 36

What are the complications of dislocations?

Answer 36

* damages to nerves, blood vessels, capsule, ligaments | * ischaemia, muscle weakness, sensory changes

Question 37

Which direction does the shoulder and hip usually dislocate?

Answer 37

shoulder: anterior hip: rarely, but posteriorly