how to manage orthopaedic conditions

Question 1

what is a fracture

Answer 1

a break in the structure of bone associated with a soft tissue injury

Question 2

what investigations are key for fractures

Answer 2

1) PLAIN RADIOGRAphs (x rays) from at least 2 views

2) special tests:
-CT
- MRI ( in stress fracture can see oedema and swelling )
- USS ( not as useful as the others)
- blood tests

Question 3

when is a fracture complex/ simple

Answer 3

complex : multifragmented vs simple: not multifragments

Question 4

when is a fracture stable vs unstable

Answer 4

unstable: when its at risk of further displacement with simple weightbearing so you need to intervene

stable: non need to intervene on the bone you can mobilise maybe cast and its fine

Question 5

what are the things you need to consider when describing bone fracture radiographs?

Answer 5

1) demographics of patient, age ect all the info at bottom of xray

2) ABC (general): adequacy (of imaging planes),

Bones young/ old can tell form osteoarthritis),

Cartilage- joint space asses if intact

specific:
3) which bone, and Location on specific bone: proximal, distal, mid shaft, intra articular, (physis diaphysis in younger people)

4) type of fracture:
A) simple vs complex/ comminuted (many pieces),
B) greenstick,
C) open/ closed

5) types of patterns:
transverse, oblique, spiral

6) type of displacement if any: shortened, rotated, translated

7) stable/ unstable

Question 6

what is the 3 main step process of treating fractures

Answer 6

reduce - external with manoeuvres (painful, unlpleasant to du and watch)
or internal with incision- anaesthesia ect

stabilise - internal or external (ext: casts vs int: nails, screws, plates )

rehabillitate - kids can do themselves but adults rl need deliberate

Question 7

what are some risks you need to be aware of and asses in a distal tibial fracture (Ankle)?

Answer 7

Tom Dick and Nervous Harry
T: Tibialis posterior tendon
D: Flexor digitorum longus tendon
N: Posterior tibial artery, nerve, and vein
H: hallucis longus muscle

Question 8

how to manage ankle injury (45y0 male with tibial and fibular fracture)

Answer 8

initial reduction and casting
then plan for surgery

Question 9

what is the classification system used to classify fibular fractures

Answer 9

weber classification: based on how close fracture is to the syndesmosis: fibrous joint linking tibia and fibula (A is on syndesmosis, B is higher up and C even higher up)

Question 10

why might you see some empty space in bone fracture x rays of older people

Answer 10

bc some bone may crash- smash to pieces and empty space forms

Question 11

what fracture can you get from fall on flexed wrist

Answer 11

Smith fracture

Question 12

what fracture can you get from falling on extended hand

Answer 12

colles fracture

Question 13

what is it called when you get an intra-articular fracture in the distal radius

Answer 13

Barton’s fracture- (can be from both extended or flexed fall - doesnt matter)

Question 14

what are the structures that need to be assesed when theres a wrist fracture? (colles and smith) + how will you test their integrity?

Answer 14

radial, ulnar and median nerves

make them do ok sign with their hand

Question 15

what are two tricks you can use on femur fracture xrays to help you tell if theres fracture

Answer 15

1) Shentons Line - line along femur to head and to ischeum - needs to be a nice intact curve

2) “lollipop” draw circle in acetabulum and line femoral neck angle- needs to be like a lollipop not displaced lollipop

Question 16

how would you manage a neck of femur fracture? why is age important in this injury?

Answer 16

age dependant management:
for younger people in general (No cutoff age but depends on whether they are in good condition aswell ect) you preserve their bone

for older you replace

however: contraindication for dementia: replacement not the best bc theres high risk of them displacing it

Question 17

classifications of hip fracture

Answer 17

intracapsular: (head and neck) - 1) subcapital - (akrivos kato apo kefali - head), 2) transcervical 3) basicervical

extracapsular:
1) intertrochanteric: cutting the greater trochanter in middle

2) subtrochanteric

Question 18

what is a dangerous complication you need to asses for in open leg fracture from road traffic collision

Answer 18

Compartment syndrome- sheath between bones- if bone breaks and this sheath fills with blood pressure builds up and starts pushing on bones – if a patient says they are in a lot of pain more thsan youd expect- they prob have this- you need to go into sheath

Question 18

where and by who would an open leg fracture from road traffic collision be managed?

Answer 18

major trauma centre

MDT: first by trauma team then plastic surgeon ect

Question 19

what is the classification system for severity/ degree of open fractures

Answer 19

Gustillo- Anderson classification

Question 20

how would you manage this open fracture trauma

Answer 20

procedures: you need to do washout, then youll do surgery with external fixation and intramedullary nail

guidelines: follow ATLS and BOAST guidelines

meds: antibiotics

Question 21

smth a bit confusing on young children xray

Answer 21

spaces between bones bc of growth plates- its not broken

Question 22

what to asses for in 5y Male fall onto right wrist

Answer 22

damage to physis or diaphysis - inhury to growth plate

Question 23

What is important to respect in this injury?
:5y Male fall onto right wrist

Answer 23

cant do a haematoma block you risk to further injure it. you need to manually sort of fix it

Question 24

classification for physeal injuries

Answer 24

slater harris: remember:

SALTeR
type 1: S: straight through
2: above
3: lower
4: through
5: cRush (along physis) - uncommon

Question 25

what may happen to the ulna of children if they break theur radius? what is this phenomenon called

Answer 25

ulna may bend - called plastic deformation

Question 26

what is a principle in trauma and what does this look like in elective surgery?

Answer 26

In trauma – we find that doing less is sometimes more effective!

In elective surgery – we try and improve the efficiency of implantation and the longevity of the implants

Question 27

importance of orhtopaedic research

Answer 27

Helps to keep our practice current, safe and reproducible!!