Specific fracture management

Question 1

whats the difference between trauma and orthopaedics (not important)

Answer 1

trauma - advanced trauma life support, reduce hold rehabilitate
orthopaedics - history, examination ,look feel move and investigations

Question 2

presentation of a fracture

Answer 2

pain
swelling
crepitus
deformity
adjacent structural injury - nerves, vessels, ligaments, tendons

Question 3

investigations for a fracture?

Answer 3

gold standard X ray/radiograph
CT scan
bone scan
MRI scan

Question 4

how to describe a fracture X ray

Answer 4

location - bone and part of bone
pieces - simple/comminuted
pattern - transverse/oblique/spiral
displaced/undisplaced
translated/angulated
XYZ plane - varus valgus

Question 5

what is fracture translation?

Answer 5

lateral movement of bones
proximal/distal
anterior/posterior
medial/lateral

Question 6

types of angulation of fractures?

Answer 6

internal/external rotation
dorsal/volar (Z plane)
varus/valgus (X plane)

Question 7

when is a fracture classified as varus or valgus?

Answer 7

varus - distal part of bone more medial

valgus - distal part of bone more lateral

Question 8

what is the broad process of healing?

Answer 8

bleeding
inflammation
new tissue formation
remodelling

Question 9

what happens in the inflammatory stage of healing?

Answer 9

haematoma formation
release of cytokines
granulation tissue and blood vessel formation

Question 10

what happens in the repair stage of healing?

Answer 10

1 - soft callus formation (type ii collagen - cartilage)

2 - hard callus transformation (type i collagen - bone)

Question 11

what is wolffs law?

Answer 11

bone grows/remodels according to stresses put on it

Question 12

what is intramembranous ossification for fracture healing? aka primary bone healing

Answer 12

mesenchymal cell - osteoblast produces woven bone straight away
results in stable fractures
when bone ends are still together

Question 13

what is endochondral ossification in fracture healing? aka secondary bone healing

Answer 13

chondral precursor then bone cells migrate to location and produce woven bone
therefore means more callus and less stability than intramembranous

Question 14

when is healing visible on an x ray?

Answer 14

7-10 days

Question 15

what are the concepts of general fracture management?

Answer 15

reduce
hold/fixate
rehabilitate

Question 16

choices for fracture reduction?

Answer 16

closed - manipulation or traction (skin/skeletal traction)

open - full exposure or mini incision

Question 17

choices for fracture holding?

Answer 17

closed - plaster, traction (skin/skeletal)

fixation

Question 18

choices for fracture fixation?

Answer 18

internal - intramedullary (pins nails) or extramedullary (plates pins)
external - monoplanar or multiplanar (all way round)

Question 19

what are the concepts of fracture rehabilitation?

Answer 19

use
move
strengthen
weight bear

Question 20

general complications of fractures

Answer 20

fat embolus
deep vein thrombosis
infection
prolonged immobility (UTI, chest infections, sores)

Question 21

fracture - specific complications

Answer 21

neurovascular injury
muscle/tendon injury
non union/malunion
local infection
degenerative change
reflex sympathetic dystrophy

Question 22

biological factors affecting fracture healing

Answer 22

blood supply
immune function
infection
nutrition

Question 23

mechanical factors affecting healing

Answer 23

stresse

environment

Question 24

causes of neck of femur fracture NOF#

Answer 24

osteoporosis
trauma
combination

Question 25

location of NOF# classification

Answer 25

``` subcapital(intracapsular) transcervical (extracapsular) intertrochanteric (extracapsular) subtrochanteric 3 part intertrochanteric ```

Question 26

what type of neck of femur fracture is more likely to cause avascular necrosis?

Answer 26

displaced intracapsular fracture

Question 27

management of an extracapsular neck of femur fracture

Answer 27

fix with plate and screws (dynamic hip screw)

Question 28

Management of intra-capsular NOF undisplaced

Answer 28

Fix with screws

Question 29

Management of intra capsular NOF displaced

Answer 29

30% risk of AVN. replace in older patients, fix if young (under 55)

Question 30

Replacement of undisplaced NOF fracture in over-65 year olds

Answer 30

fit and mobile - totla hip replacement | less fit - Hemi-arthroplasty

Question 31

Presentation of shoulder dislocation

Answer 31

Variable HX - often direct trauma pain restricted movement loss of normal shoulder contour

Question 32

clinical examination for shoulder dislocation

Answer 32

assess neurovascular status of auxiliary nerve

Question 33

Investigation for shoulder dislocation

Answer 33

X-ray prior to manipulation: scapular Y-view in addition to AP

Question 34

Reducing shoulder dislocation

Answer 34

Avoid vigorous manipulation or twisting. Safest methdo is traction / counter-traction and gentle internal rotation Ensure adequate patient relaxation. Could use Stimson method

Question 35

Complication of shoulder dislocation

Answer 35

Hill-Sachs - ball of humerus chipped off (bankart lesion) may lead to re-dislocation

Question 36

Management of distal radius fracture for minimally displaced extra-articular

Answer 36

reduction of fracture and placement into cast until definite fixation

Question 37

Distal radius fracture management - extra-arcticular and unstable

Answer 37

MUA in theatre with K-wire fixation. | Wires removed clinic post-op

Question 38

Distal radius fracture management displaced + unstable

Answer 38

not suitable for K-wires | Open reduction / internal fixation with plate and screws

Question 39

What is a lipohaemarthrosis

Answer 39

Fat moves when sat down, creating a straight line above tibia tells you that there is a fracture in the joint

Question 40

non-operative management of tibial plateau fracture indications

Answer 40

undisplaced fractures with good joint line congruency assessed on CT (rare)

Question 41

Operative management of tibial plateau fracture

Answer 41

Restoration of articular surface using plates and screws maybe bone graft or cement to prevent further depression

Question 42

Mechanism of injury for tibial-plateau fracture

Answer 42

Key weight-bearing surface Any extreme valgus/varus force or axial loading across the knee Impaction of femoral condyles causing comparatively soft bone of tibial plateau or depress or split Additional ligumentus or miniscal injury possible

Question 43

Non operative management of ankle fracture (Weber A and B stable)

Answer 43

Non-weight bearing below-knee cast 6-8 weeks then walking boot then physiotherapy

Question 44

What is Weber A ankle fracture

Answer 44

simple fracture to bottom part of fibular

Question 45

What is Weber B ankle fracture

Answer 45

Fracture to fibular- unstable fractures with Tellar shift / medial or posterior malleoli

Question 46

What is Weber C ankle fracture?

Answer 46

Fibular fracture above level of syndersmosis therefore unstable

Question 47

Operative management of ankle fracture (Weber B unstable or Weber C)

Answer 47

Open reduction with internal fixation +/- syndersmosis repair using screw or tightrope technique

Question 48

What is operative ankle fracture management dependent upon?

Answer 48

Pateint's soft tissues | patients need strict elevation as injury swells significantly

Question 49

Broad mechanisms of fracture

Answer 49

trauma stress pathalogical / insufficiency

Question 50

Causes behind pathological fractures

Answer 50

``` Osteoporosis Malignancy - primary / bone mets Vitamin D deficiency osteamyelitis Osteogenesis imperfecta Pagets ```

Question 51

Urgent complications of fractures

Answer 51

``` Local visceral injury vascular injury nerve injury compartment syndrome Haemarthrosis Infection Gas gangrene ```