Fractures & management

Question 1

How does a fractured hip usually present?

Answer 1

Pain in the hip, groin & knee Unable to weight bear Shortened and externally rotated leg

Question 2

What will an X-Ray of a hip fracgure show?

Answer 2

A break in shentons line

Question 3

what is the difference between an intra-capsular and extra-capsular fracture?

Answer 3

intracapsular = neck of femur and within the joint capsulre

extracapsular = fractures outside the joint capsule

Question 4

What are the 2 types of extra-capsular hip fractures? How are they managed?

Answer 4

trochanteric and subtrochanteric

Dynamic hip screw and IM nail

Question 5

Management of an intra-capsular hip fracture?

Answer 5

THR or hemiarthroplasty if patient was already immobile bc increased risk of dislocation in THR

Question 6

What is the usual mechanism of injury in femoral shaft fractures?

Answer 6

High energy trauma e.g. RTA

Question 7

What are 2 potential complications of femoral shaft fracture?

Answer 7

Substantial blood loss

Fat embolus

Question 8

Management of femoral shaft fracture?

Answer 8

Thomas splint initially to stabilise

Closed reduction and IM nail

Question 9

What is a tibial plataeu fracture and what can it present with/lead to?

Answer 9

Proximal tibial fracture involving the articular surface of the knee joint

Associations:

• lots of swelling
• compartment syndrome
• common fibular nerve injury

Question 10

What is the slowest healing fracture in the body?

Answer 10

Tibial shaft

Question 11

What is the mechanism of injury in tibial shaft fractures?

Answer 11

Rotational forces +/- compression from sudden deceleration

Question 12

Management of tibial plataeu and tibial shaft fractures?

Answer 12

Internal fixation

Question 13

What is a pilon fracture and what is their mechanism of injury?

Answer 13

Distal tibial fracture involving articular surface of ankle

High impact fracture - fall from height

Question 14

Management of pilon fractures?

Answer 14

External fixation ASAP

Question 15

What is an avulsion fracture?

Answer 15

When a bit of bone is pulled away from the main bone by the muscles that attach to it

Question 16

What is at risk in a supracondylar fracture?

Answer 16

Brachial artery

Question 17

What is Volkmann’s contracture?

Answer 17

complication of elbow fractures (usually in children) - contraction of the forearm muscles due to ischeamia following trauma

Question 18

What movements are affected in radial head fracture?

Answer 18

Loss of pronation and supination

Question 19

What is the difference between a Gellazi fracture and a Monteggia fracture?

Answer 19

Gellazi = radial fracture with ulnar dislocation

Monteggia = Ulnar fracture with radial dislocation

Question 20

What is a Colles fracture and what is a classic presentation?

Answer 20

fracture of the distal radius (not involving the wrist joint) due to FOOSH with wrist extended

Dinner fork deformity

Question 21

What structure is at risk in a Colles fracture?

Answer 21

Median nerve compression

Question 22

Management of a Colles fracture?

Answer 22

Reduction and cast

Question 23

What is a Smiths fracture?

Answer 23

Distal radial fracture (not involving wrist joint) - FOOSH with wrist flexed (opposite of a Colles fracture)

Question 24

Management of a Smiths fracture?

Answer 24

open reduction and internal fixation - v unstable fracture

Question 25

What is a bartons fracture?

Answer 25

Intra-articular fracture of the wrist

Question 26

What is compartment syndrome?

Answer 26

When bleeding from a fracture/swelling of muscles due to trauma increase the pressure in the limb compartment affected - will compress vasculature and nerves

Question 27

Symptoms of compartment syndrome?

Answer 27

More severe pain expected from injury alone Swollen limb Altered sensation Extreme pain on passive stretching of the muscles in the affected compartment

Question 28

Management of compartment syndrome?

Answer 28

Immediate removal of cast/dressings urgent fasciotomy

Question 29

Fractures of the distal radius that heal in malunion can result in reduced grip strength, is this due to loss of flexion or extension at the wrist?

Answer 29

Extension (try to make a fist without extending wrist - not as strong)

Question 30

What nerve is at risk in a humeral shaft fracture?

Answer 30

Radial nerve

Question 31

What nerve is at risk in anterior dislocation of the shoulder?

Answer 31

Axillary nerve

Question 32

What nerve is at risk in colles fractures?

Answer 32

Median nerve

Question 33

What nerve is at risk in supracondylar fracture of the humerus?

Answer 33

Median nerve

Question 34

Give 4 risk factors for a proximal femoral fracture?

Answer 34

Osteoporosis (3x more common in females) Smoking Malnutrition Excess alcohol

Question 35

What is the management of fractured femoral shafts in children under 3 and why is it different to adult management?

Answer 35

Traction - stops the muscles going into spasm and pulling the bone segments away