Fractures generally & ankle

Question 1

what is a transverse fracture

Answer 1

a straight break through a bone at a right angle, caused by a force applied directly to the site of the fracture

Question 2

what is a spiral fracture

Answer 2

a corkscrew type fracture due to a rotational injury

Question 3

what is an oblique fracture

Answer 3

a rare fractrue; straight break through the bone but at an angle

Question 4

what is subluxation

Answer 4

malalignment of the joint surface

Question 5

what is a greenstick fracture

Answer 5

fracture that occurs in children due to the soft bone making it flexible; bone bends without fracturing across the cortex

Question 6

name the nerve affected in the following fractures

• midshaft humerus
• supracondylar fracture
• shoulder dislocation
• hip dislocation
• fibula neck fracture

Answer 6

• radial nerve
• median nerve
• axillary nerve
• sciatic nerve
• common peroneal

Question 7

name 5 causes of pathological fractures

Answer 7

• osteoporosis
• osteopaenia
• tumours
• infection
• metabolic bone disease

Question 8

when should stabilisation be achieved by in a traumatic fracture in a and e

Answer 8

within 24 hours on a daytime trauma list

Question 9

which opioid out of; morphine, fentanyl and pethidine is preferred in known renal failure, and why?

Answer 9

fentanyl

because it is shorter acting so therefore prevents accumulation of active metabolites

Question 10

what is the clinical presentation of a hip fracture?

Answer 10

hip shortened and externally rotated

Question 11

what are the 3 steps in managing a fracture?

Answer 11

1. Reduce
2. Stabilise
3. Rehabilitation

Question 12

what is reduction of a fracture?

Answer 12

surgical procedure to correct the alignment of the bone so that the fracture can heal with minimal deformity

Question 13

what are the 2 types of reduction?

Answer 13

open and closed

Question 14

what is open reduction of a fracture?

Answer 14

fracture segments are exposed surgically by dissecting the tissue

Question 15

what is closed reduction of a fracture?

Answer 15

manipulation of the bone fragments without surgical exposure of the fragments

Question 16

how is a reduced fracture maintained?

Answer 16

either internal or external fixation

Question 17

what is external fixation?

Answer 17

stabilising frames, metal pins or screws placed into the bone through small incisions into the skin and muscle

Question 18

what is internal fixation?

Answer 18

plates, screws, nails, rods, wires, pins

Question 19

what is ORIF?

Answer 19

open reduction internal fixation

open surgery, fixation with screws/plates/intramedullary bone nails

Question 20

what is closed reduction infernal fixation

Answer 20

reduction without surgery

Question 21

what do you do if manipulation and external mobilisation devices are unsuccessful in managing a trauma fracture

Answer 21

surgical reduction of internal fixation

Question 22

what prophylaxis should be given for open wounds?

Answer 22

tetanus

Question 23

when should open fractures be debrided and lavaged by?

Answer 23

by 6 hours of the injury

Question 24

what is delayed union defined as?

Answer 24

failure to reach bony union @ 6 months post injury

Question 25

what is compartment syndrome?

Answer 25

when the pressure within the fascial compartment exceeds the perfusion pressure within the compartment resulting in ischaemia of the tissues within that compartment

Question 26

what are the early signs of compartment syndrome? (3)

Answer 26

- does not respond to analgesia - associated with skin mottling - severe pain on passive stretch

Question 27

late signs of compartment syndrome?

Answer 27

- pulselessness | - paraesthesia

Question 28

what are the indications for an ankle x-ray?

Answer 28

Pain in the malleolar zone & one of following - bony tenderness at lateral malleolar zone - bony tenderness at medial malleolar zone - inability to walk 4 weight bearing steps immediately after the injury & in ED

Question 29

name of classification of ankle fractures

Answer 29

weber

Question 30

What is weber classification A & typical mechanism of injury

Answer 30

fracture of fibula below the level of syndemosis typically from an inversion injury

Question 31

What is weber classification B & typical mechanism of injury

Answer 31

fracture at level of syndesmosis & extends proximally in oblique fashion typically eversion injury

Question 32

What is weber classification C & typical mechanism of injury

Answer 32

fracture above the syndesmosis may be associated wtih an avulsion fracture or rupture of deltoid ligament always unstable - requiring fixation

Question 33

what type of bacteria is staph aureus

Answer 33

gram positive cocci

Question 34

1st and 2nd most common isolated organisms of most series

Answer 34

- strep pyrogens | - group B strep

Question 35

name 2 gram negative rods

Answer 35

- E.coli | - Klebsiella

Question 36

which organism is most commonly seen in septic arthritis in IVDU?

Answer 36

Pseudonomas aeruginosa

Question 37

abx course duration in septic arthritis

Answer 37

6 weeks

Question 38

abx of choice for gonococcal arthritis

Answer 38

ceftriaxone

Question 39

what causes tibial plateau fractures?

Answer 39

- high energy trauma in young | - low energy falls in elderly