Lecture 1 - general principles of fractures

Question 1

explain the foundational cause for bone fractures?

Answer 1

occurs when the force of impact exceeds the mechanical resistance of a bony structure

Question 2

what are the two general type of causes of bone fractures ?

Answer 2

Direct trauma - the force hits the bone directly at the point of trauma
and
indirect trauma - the force hits away from the point of trauma

Question 3

what are the 4 types of forces that causes indirect bone fractures ?

Answer 3

1. Torsion (twisting) - rotational force, spiral fracture
2. bending (flexion) - transver or wedge fractures
3. compression - bone are crushed by opposing forces
4. traction/avulsion - violent pulling of ligament or tendon

Question 4

what is the classifciation accoding to the skin involved in fractures ?

Answer 4

open
closed

Question 5

explain the 4 types of bone fractures, we can observe on X ray and the relation/positon of the bone fracture

Answer 5

1. Angulation
2. rotation
3. overlapping
   translation - side way shifting

Question 6

what are the classifcaitons of bone fractures according to the location of thee bone ?

Answer 6

1. diaphysis
2. metaphysis
3. epiphysis

Question 7

explain the simple classification of the actual fractures on the site of trauma ?

Answer 7

1. transverse
2. Oblique
3. spiral

Question 8

explain the complex classificsation of the acutal fractues on the site of trauma ?

Answer 8

1. 3rd fragment - wedge fragment
2. comminuted - more than 3 fractures
3. segmental
4. burst, irregular

Question 9

explain the mechanical force requried to break bones in bone pathology

Answer 9

In bone pathology the fractures requires minimal force, since the bone is weak compared to nonpathological bones

Question 10

what bone pathologies cause fragile bones?

Answer 10

ecrease in resistance in metabolic diseases (Paget)
Periosteal dysplasia Lobstein
Primary/secondary malignancies
Neuropathies - polio
Senile osteoporosis
Infections - osteitis

Question 11

what are the 3 types of cancers that can cause bone consolidation?

Answer 11

breast cancer
prostate cancer
Kahler disease (multiple myeloma)

Question 12

what are the treatment for fractures in bone pathologies ?

Answer 12

Osteosynthesis
Conventional palliative cement, mega prosthesis
Prevention = risk of fracture

Question 13

what type of cancers do not cause bone consolidations ?

Answer 13

Lung
Kidney
Digestive

Question 14

what parts of the bone MUST be included in image diagnostics ?

Answer 14

entire segment of interst + the joints inferior and posterior to the fracture
comparative image of the bilateral limb

Question 15

explain the typical clinical setting for bone fractures

Answer 15

pain
swelling
deformities
loss of function
crepitation
ecchymosis

Question 16

what are the position of the bone in radioligcal imageing ?

Answer 16

anteroposterior postion
lateral position

Question 17

what can CT tell us ?

Answer 17

details about smaller fractures

Question 18

waht are the indications of CT ?

Answer 18

spine
acetabulum
calcaneus
tibial plateau

Question 19

explain Doppler US and why is it used in the diagnosis of bone fractures ?

Answer 19

it is used to diagnose damage to blood vessels, in case of compressed vessel at the site of injury

Question 20

what are the 3 ways in which neurovascular injuries can occur ?

Answer 20

1. contusion
2. elongation
3. compression

Question 21

explain the immidate complications of fractures

Answer 21

neuro-vascular lesions
intimal lesions - thrombosis

Question 22

explain Seddons classifications of nerve damage

Answer 22

Neuropraxia - mild damage, recoverable (days or weeks)
Axontomesis - damgae to axons, recoverable (weeks, months)
neruotmesis - complete nerve severance including the sheath, requires surgical treatment

Question 23

what other local complications may occur ?

Answer 23

1. skin distruption
2. visicral diruption
3. infections

Question 24

sign of propability

Answer 24

• Local pain
• Swelling
• Inability to walk
• Deformities
• Late ecchimosis (Hennequin)
  Crepitation

Question 25

sign of certinity

Answer 25

* Loss of bone continuity * Abnormal mobility * Lack of motion transmission Crepitation

Question 26

what other general complications may occur ?

Answer 26

1. fat empolisim 2. hypovolmeic/traumatic shock

Question 27

what is the definiton of compartment syndrome ?

Answer 27

Compartment syndrome is a condition where increased pressure within a closed muscle compartment compromises circulation and tissue function within that space. Can lead to ischemia → necrosis → permanent dysfunction if not treated promptly.

Question 28

explain the pathophysiology of compartment syndrome

Answer 28

Normal compartment pressure: 0–10 mmHg Critical threshold: usually >30 mmHg, or ΔP < 30 mmHg (ΔP = diastolic BP – compartment pressure) Increased intracompartmental pressure → ↓ capillary perfusion → muscle and nerve ischemia.

Question 29

what are the etiologies causing compartment syndrome ?

Answer 29

Fractures (most common) — esp. tibial shaft fractures Crush injuries Burns Tight casts or dressings Reperfusion injury Prolonged limb compression (e.g. during surgery or unconscious state) Vigorous exercise (rare) — exertional compartment syndrome

Question 30

how is compartment syndrome diagnosed ?

Answer 30

Primarily clinical. Confirmatory: measure compartment pressure (Stryker device). ○ Absolute pressure >30 mmHg ΔP (diastolic – compartment) < 30 mmHg

Question 31

what is the investigative methods for compartment syndrome ?

Answer 31

Mainly used to rule out other causes. Labs: CK, myoglobin if suspect rhabdomyolysis. Imaging: rarely helpful, but can assess fractures or soft tissue injury. angiography doppler US

Question 32

treatment of compartment syndrome ?

Answer 32

Emergent fasciotomy — definitive treatment. Remove constrictive dressings immediately. Supportive care: fluids (prevent AKI if rhabdo present).

Question 33

complications of compartment syndrome ?

Answer 33

Muscle necrosis → contractures Nerve injury → permanent weakness or sensory loss Volkmann contracture (esp. forearm) Renal failure from rhabdomyolysis

Question 34

plaster complications ?

Answer 34

Nervous/vascular compression Pressure sores Joint stiffness

Question 35

risk factors that may cause compartment syndrome ?

Answer 35

Proximal 3rd tibial facture Important fracture displacement Muscles contusion Circular cast immobilization

Question 36

what are the treatmen methods of the conservative way ?

Answer 36

reduction immobilization rehabilitation

Question 37

how is conservative reduction performed ?

Answer 37

Following the opposite sense of the fracture displacement main manuver = axial traction device = skeletal traction

Question 38

what are the goals of skelete traction ?

Answer 38

Fights muscle contraction Fragments alignment Restore length

Question 39

how is immobilization performed ?

Answer 39

Casts/splints (plaster/reisins) Bandages Orthosis

Question 40

contraindications of plasters ?

Answer 40

Diabetes Arterial insufficiency Blisters Skin conditions

Question 41

surgical reduction has two pathways ?

Answer 41

open closed (orthopedic table traction)

Question 42

what are the advanges of surgical reduction ?

Answer 42

anatomical reduction osteoplasty

Question 43

what are the disadvanges of surgical reduction ?

Answer 43

higher chance of infection bleeding delayed/nonunion Soft Tissue Stripping ➔ Devascularisation

Question 44

what are the tools used in internal fixation ?

Answer 44

scews and plates tension band wiring K wires dynamic hip screws

Question 45

what are the complications of internal fixation ?

Answer 45

Infection (0.5 - 1.5 %) Second displacement Device failure Delayed/nonunion

Question 46

what are the internal fixation indications?

Answer 46

Open fractures - grade II-III G.A Comminuted fractures Pelvic fractures

Question 47

Gustilo Anderson classification

Answer 47

* Type 1 ○ Low energy ○ Wound - 1 cm ○ Minimal contamination * Type 2 ○ Medium energy ○ Wound larger than 2 cm ○ No devitalized tissues ○ Medium contamination * Type 2a ○ High energy ○ Extensive lacerations and soft tissue devitalization ○ Possible coverage of the fracture site ○ Important contamination * Type 3B ○ Fracture site exposrue ○ Periostal stripping ○ Gros contamination * Type 3C ○ Type 3B + arterial lesions Limb salvage procedures or amputation