General orthopaedics

Question 1

List two types of fractures that typically occur in children

Answer 1

greenstick
buckle
salter-Harris

Question 2

Which fracture only ever arises in children

Answer 2

salter-harris = growth plate fracture

Question 3

What is another name for dinner form deformity

Answer 3

colle’s fractrue

Question 4

what is colle’s fracture?

Answer 4

transverse fracture of distal radius

Question 5

What is the cause of colle’s fracture

Answer 5

FOOSH- fall onto outstretched hand

Question 6

What is the blood supply of the scaphoid?

Answer 6

retrograde blood supply

Question 7

List two complications of scaphoid fracture

Answer 7

AVN and non-union

Question 8

List four bones at risk of AVN

Answer 8

scaphoid
femoral head
humeral head
talus
navicular
fifth metatarsal foot

Question 9

What is the classification for ankle fractures

Answer 9

Weber classification

Question 10

What are pathological fractures?

Answer 10

underlying disease

Question 11

State two causes of pathological fracture

Answer 11

tumour
osteoporosis
paget’s disease

Question 12

List three cancers that metastasize to bone

Answer 12

PoRTaBLe
Po – Prostate
R – Renal
Ta – Thyroid
B – Breast
Le – Lung

Question 13

T score > -1?

Answer 13

normal

Question 14

T score

Answer 14

-1 to -2.5

Question 15

T score <-2.5?

Answer 15

osteoporosis

Question 16

What is FRAX>

Answer 16

Patient fragility score- predicts risk of fracture over the next 10 years

Question 17

What is the medical treatment to reduce risk of fall

Answer 17

calcium
vit D
biphosphonates

Question 18

What is the MOA of biphosphonates

Answer 18

reduce oscteoclastic activity, prevent reabsorption of bone

Question 19

What is the advice on admin of oral biphosphonates?

Answer 19

take on empty stomach, sittingupright for 30 mins before moving or eating

Question 20

What are the side effects of biphosphonates

Answer 20

reflux
oesophageal erosions
osteonecrosis of jaw
osteonecrosis of external auditory canal

Question 21

What is closed reduction?

Answer 21

manipulation of limb to correct mechanical alignment

Question 22

List two principles of fracture management

Answer 22

mechanical alignment
stability- fixing bone

Question 23

List three early complications of fractures

Answer 23

Damage to local structures (e.g., tendons, muscles, arteries, nerves, skin and lung)
Haemorrhage leading to shock and potentially death
Compartment syndrome
Fat embolism (see below)
Venous thromboembolism (DVTs and PEs) due to immobility

Question 24

List three long term complications of fractures

Answer 24

Delayed union (slow healing)
Malunion (misaligned healing)
Non-union (failure to heal)
Avascular necrosis (death of the bone)
Infection (osteomyelitis)
Joint instability
Joint stiffness
Contractures (tightening of the soft tissues)
Arthritis
Chronic pain
Complex regional pain syndrome

Question 25

Why does fat embolisation arise following fracture of long bone?

Answer 25

fat globules released into circulation, possibly from bone marrow. Fat become lodged in blood vessels

Question 26

What is Gurd' criteria?

Answer 26

the result of fat embolism resulting in systemic inflammatory response

Question 27

What are the components of Gurd's criteria?

Answer 27

Major: respiratory distress petechial rash cerebral involvement Minor: Jaundice Thrombocytopenia Fever Tachycardia

Question 28

Which classification is used for open fractures?

Answer 28

Gustilo grade

Question 29

Describe the gustilo grade classification

Answer 29

Grade 1- wound ≤1 cm, minimal contamination or muscle damage Grade 2- wound 1-10 cm, moderate soft tissue injury Grade 3a- bad 3b- extra bad 3c- horror show- vascular involvement/repair

Question 30

Which investigation is best for assessing intra-articular fractures?

Answer 30

CT scan