General Fractures

Question 1

When would a femoral shaft fracture occur?

Answer 1

due to falling on a flexed knee or rotational bending

bear in mind malignancy

Question 2

How are femoral shaft fractures in children treated?

Answer 2

<2 yrs - suspect NAI - treat with Gallows traction and hip sica cast
2-6 yrs - thomas splint or hip sica cast
6-12 yrs - flexible intramedullary nails
>12 yrs - adult intramedullary nail is used

Question 3

What is the most common tibial fracture in toddlers? How is it treated?

Answer 3

spiral fracture

short time in cast

Question 4

What is a humeral neck fracture often due to?

Answer 4

FOOSH

often in osteoporotic bone

Question 5

What can a humeral neck fracture result in?

Answer 5

avascular necrosis

Question 6

What are the management options for a humeral neck fracture depending on the severity?

Answer 6

minimally displaced: sling
persistantly displaced: internal fixation - screws, nails, plates
comminuted: shoulder replacement

Question 7

What does an anterior shoulder dislocation often result in?

Answer 7

Blankart lesions

stretch of the axillary nerve

Question 8

What is a Blankart lesion?

Answer 8

detachment of the anterior gelnoid labrum

Question 9

How are anterior shoulder dislocations managed?

Answer 9

closed reduction under sedation

Question 10

What are posterior shoulder dislocations caused by?

Answer 10

force on the adducted and laterally rotated arm

Question 11

What is the sign on an AP xray commonly seen in posterior shoulder dislocations?

Answer 11

lightbulb sign

Question 12

How are posterior shoulder dislocations managed?

Answer 12

closed reduction

Question 13

How can a sprain, subluxation or dislocation of the acromioclavicular joint be managed?

Answer 13

reconstruction of the coracoclavicular ligament

Question 14

How do humeral shaft fractures occur?

Answer 14

direct trauma

fall

Question 15

What nerve is susceptible to injury in humeral shaft fractures? What sign does this cause?

Answer 15

radial nerve

wrist drop

Question 16

What is the management of humeral shaft fractures?

Answer 16

brace or interneral fixation

Question 17

When would an olecranon fracture occur?

Answer 17

due to a fall onto a point inthe elbow with contraction of the triceps muscle

Question 18

How is an olecranon fracture managed?

Answer 18

open reduction and internal fixation - ORIF

Question 19

Where do Nightstick fractures occur? Due to what?

Answer 19

Ulnar shaft

Direct blow

Question 20

How are radial and ulnar fractures managed?

Answer 20

ORIF

Question 21

What is a Monteggia fracture?

Answer 21

fracture of the ulnar and dislocation of the radial head at the elbow
therefore: XRAY the ELBOW TOO

Question 22

What is a Galeazzi fracture?

Answer 22

fracture of the radius with dislocation of the ulnar at the radio-ulnar joint
therefore: XRAY the WRIST TOO

Question 23

How are both Monteggia and Galeazzi fractures managed?

Answer 23

ORIF

Question 24

What is a Colles fracture?

Answer 24

extra articular fracture of the distal radius due to FOOSH

Question 25

What is a Smiths fracture?

Answer 25

volarly displaced fracture of the distal radius occuring after falling onto the back of flexed wrist

Question 26

What is a Barntons fracture?

Answer 26

intra-articular fracture of the distal radius with dislocation of the radiocarpal joint can be volar or dorsal

Question 27

How are Colles, Smiths and Barnton fractures all managed?

Answer 27

depending on severity, some need ORIF

Question 28

What does a Scaphoid fracture present with?

Answer 28

tenderness in the anatomical snuff box after FOOSH

Question 29

How are Scaphoid fractures managed?

Answer 29

6 weeks plaster cast

Question 30

What are the 3 ways that the pelvis can fracture?

Answer 30

1. lateral compression fracture due to side impact 2. verticle shear force due to axial force on hemipelvis 3. anteroposterior compression injury - pelvis opens up and fills with blood

Question 31

What are the risks of intracapsular hip fractures?

Answer 31

avascular necrosis - poor healing

Question 32

How are intracapsular hip fractures managed?

Answer 32

young - fix old and fit - total hip replacement old and frail - hip hemiarthroplasty (just replace femoral head)

Question 33

How are extracapsular hip fractures managed?

Answer 33

internal fixations using dynamic compression or a hip screw | higher union rate than intracapsular

Question 34

Why is a knee dislocation a surgical emergency?

Answer 34

increased incidence of vascular injury, nerve injury and compartment syndrome

Question 35

How are knee dislocations managed?

Answer 35

first - investigate neurlogical damage | then: reduction, external fixation and multilligament reconstruction

Question 36

How are patella dislocations managed?

Answer 36

temporary splintage and physiotherapy

Question 37

When do tibial plateau fractures occur?

Answer 37

``` Young = high energy Old = osteoporsis ```

Question 38

What are the ways that a tibial plateau fracture could occur?

Answer 38

intra articular fracture with either: a split in the bone a depression of the articular surface or both

Question 39

When would a tibial shaft fracture occur?

Answer 39

due to indirect force and either bending or rotating | open fractures are common and can often lead to compartment syndrome

Question 40

What is the management of tibial shaft fractures?

Answer 40

above the knee cast | internal fixation

Question 41

How is a stable ankle fracture managed?

Answer 41

walking splint - 6 weeks

Question 42

How is an unstable ankle fracture managed?

Answer 42

ORIF

Question 43

What is a Lisfranc fracture?

Answer 43

Midfoot fracture - at the base of the 2nd metatarsal alongside a dislocation of the base of the 2nd metatarsal

Question 44

How are Lisfranc fractures diagnosed?

Answer 44

CT scan | missed on Xrays

Question 45

How do Lisfranc fractures present?

Answer 45

swollen foot | cannot weight bear

Question 46

How are Lisfranc fractures treated?

Answer 46

open or closed reduction | fixation with screws