Management of Fractures

Question 1

What four factors can help predict most orthopaedic injuries?

Answer 1

Chief complaint, age of the patient, mechanism of injury, and energy of trauma.

Question 2

What should you do if a fracture is suspected clinically but X-rays are negative?

Answer 2

Treat it as a fracture and reassess clinically and radiographically in 7–10 days.

Question 3

When should radiographic studies be performed in fracture care?

Answer 3

Before attempting most reductions, unless delay would be harmful.

Question 4

What neurovascular checks are essential in fracture management?

Answer 4

Neurovascular status must be checked and documented before and after reductions and immobilisation.

Question 5

What’s the difference between a closed and open fracture?

Answer 5

Closed: Skin is intact; Open: Bone is exposed to the outside environment.

Question 6

How should fracture location be described?

Answer 6

Using the name of the bone, side (left/right), and specific reference points (e.g., distal third of the right radius).

Question 7

What terms describe the direction of fracture lines?

Answer 7

Transverse, oblique, spiral.

Question 8

What is a comminuted fracture?

Answer 8

A fracture with more than two bone fragments.

Question 9

How is displacement described in fractures?

Answer 9

Based on the position of the distal fragment relative to the proximal.

Question 10

What does angulation refer to in fractures?

Answer 10

Deviation in the longitudinal axis, described by the apex direction.

Question 11

What is an avulsion fracture?

Answer 11

A fragment pulled away by tendon or ligament force.

Question 12

What is an impaction fracture?

Answer 12

One bone fragment is forcefully driven into another.

Question 13

What is a pathologic fracture?

Answer 13

Fracture through weakened bone due to disease (e.g., malignancy, osteomalacia).

Question 14

What is a stress fracture?

Answer 14

A fracture from repetitive low-intensity forces (aka fatigue or March fracture).

Question 15

What is a greenstick fracture?

Answer 15

Incomplete fracture causing angulation, common in children.

Question 16

What is a torus fracture?

Answer 16

Incomplete fracture with buckling of the cortex.

Question 17

What is the Salter-Harris classification used for?

Answer 17

Describing epiphyseal (growth plate) fractures.

Question 18

Describe Salter-Harris Type I injury.

Answer 18

A slip of the growth plate only.

Question 19

What is a Type V Salter-Harris fracture?

Answer 19

Crushing injury to the growth plate.

Question 20

What is the primary imaging modality for fractures?

Answer 20

Plain X-ray.

Question 21

How many views are mandatory in long bone X-rays?

Answer 21

At least two perpendicular views (AP and lateral).

Question 22

What imaging is helpful for detecting stress fractures early?

Answer 22

MRI or bone scans.

Question 23

When should CT be used in fracture diagnosis?

Answer 23

To assess alignment, displacement, or confirm complex fractures.

Question 24

What is the sequence of fracture healing?

Answer 24

Haematoma → Inflammation → Callus formation → Ossification → Remodelling.

Question 25

How long does a femur fracture typically take to heal in a healthy adult?

Answer 25

Around 4 months.

Question 26

What type of fractures heal faster: oblique or transverse?

Answer 26

Oblique fractures.

Question 27

What factors can delay healing?

Answer 27

Corticosteroids, hyperthyroidism, chronic hypoxia, and poor alignment.

Question 28

What is delayed union?

Answer 28

Healing that takes longer than expected.

Question 29

What is malunion?

Answer 29

Fracture heals with deformity.

Question 30

What is nonunion?

Answer 30

A fracture fails to unite.

Question 31

What is pseudarthrosis?

Answer 31

A false joint formed due to nonunion.

Question 32

What are the 5 Ps of vascular injury?

Answer 32

Pain, pallor, pulselessness, paraesthesia, paralysis.

Question 33

What is the hallmark sign of compartment syndrome?

Answer 33

Pain out of proportion to the injury.

Question 34

What is the treatment for compartment syndrome?

Answer 34

Complete fasciotomy.

Question 35

What bones are prone to avascular necrosis?

Answer 35

Femoral head, talus, scaphoid, lunate, capitate.

Question 36

What is fat embolism syndrome associated with?

Answer 36

Long bone or pelvic fractures, especially in young adults.

Question 37

What are early signs of fat embolism syndrome?

Answer 37

Respiratory distress and hypoxaemia.

Question 38

What is a sprain?

Answer 38

Injury to ligament fibres due to abnormal joint motion.

Question 39

What is tendinitis?

Answer 39

Inflammation at a tendon’s insertion, often from overuse.

Question 40

What is bursitis?

Answer 40

Inflammation of a bursa, commonly at joints like elbow, knee, and shoulder.

Question 41

What is a subluxation?

Answer 41

Partial loss of joint surface contact.

Question 42

What is a dislocation?

Answer 42

Complete loss of joint congruity.

Question 43

What is a fracture dislocation?

Answer 43

A fracture occurring along with a joint dislocation.

Question 44

What are the first priorities in managing trauma with orthopaedic injury?

Answer 44

Life- and limb-threatening injuries (ABCDE of trauma).

Question 45

What are the mainstays of orthopaedic treatment?

Answer 45

Pain control, reduction, immobilisation, surgery, and rehabilitation.

Question 46

What are common methods of immobilisation?

Answer 46

Splints, braces, casts, bandages.

Question 47

How are long bone fractures classified by location?

Answer 47

Diaphyseal (shaft), metaphyseal, and epiphyseal (end of bone).

Question 48

What is the difference between simple and complex (comminuted) fractures?

Answer 48

Simple: two bone fragments; Comminuted: more than two fragments.

Question 49

What is an intra-articular fracture?

Answer 49

A fracture that extends into the joint space.

Question 50

What is an extra-articular fracture?

Answer 50

A fracture that does not involve the joint space.

Question 51

What injury type is typically caused by a twisting mechanism?

Answer 51

Spiral fracture.

Question 52

What injury is common in elderly women after low-energy trauma (like a fall)?

Answer 52

Colles' fracture (distal radius).

Question 53

What kind of trauma often causes pelvic fractures?

Answer 53

High-energy trauma (e.g., MVCs, falls from height).

Question 54

What fracture type is associated with repetitive loading (like in runners)?

Answer 54

Stress fracture (fatigue fracture).

Question 55

What is Volkmann’s ischemic contracture?

Answer 55

Contracture of the forearm muscles due to untreated compartment syndrome.

Question 56

What is myositis ossificans?

Answer 56

Bone formation within muscle tissue after trauma.

Question 57

What is reflex sympathetic dystrophy (RSD) aka complex regional pain syndrome?

Answer 57

Pain, swelling, and skin changes following an injury without nerve damage.

Question 58

What is the most common nerve injury in a midshaft humeral fracture?

Answer 58

Radial nerve injury.

Question 59

What nerve is commonly injured in a posterior hip dislocation?

Answer 59

Sciatic nerve.

Question 60

Name systemic factors that impair fracture healing.

Answer 60

Smoking, diabetes, corticosteroid use, malnutrition, hypothyroidism.

Question 61

What vitamins are essential for fracture healing?

Answer 61

Vitamin D and Vitamin C.

Question 62

How does smoking affect bone healing?

Answer 62

Reduces blood flow and oxygenation, delaying healing.

Question 63

What fracture might be missed on X-ray and seen only on MRI or bone scan?

Answer 63

Stress fracture.

Question 64

What imaging is most sensitive for detecting occult hip fractures?

Answer 64

MRI.

Question 65

What is the radiologic hallmark of a nonunion?

Answer 65

Persistent fracture line with no signs of bridging callus.

Question 66

What are the radiographic signs of healing?

Answer 66

Bridging callus, obliteration of fracture line, and cortex continuity.

Question 67

What is the goal of reduction in fracture care?

Answer 67

To restore anatomic alignment and joint function.

Question 68

When should open reduction be considered?

Answer 68

When closed reduction fails, or in cases of intra-articular or unstable fractures.

Question 69

What is internal fixation?

Answer 69

Stabilisation using plates, screws, or rods inside the body.

Question 70

What is external fixation?

Answer 70

Use of external frames with pins or wires to stabilise fractures.

Question 71

What is traction used for in fracture treatment?

Answer 71

To realign bones, reduce muscle spasm, and maintain length.

Question 72

What is a pathological fracture?

Answer 72

A fracture through bone weakened by disease (e.g., cancer, osteoporosis).

Question 73

What is the most common site of pathological fractures?

Answer 73

Vertebrae (spine) and proximal femur.

Question 74

What test is used to detect fat embolism?

Answer 74

Chest imaging and ABG (hypoxemia is often present), clinical triad is key: petechiae, hypoxia, altered mental status.