Fracture extra

Question 1

How long do the features of lower limb take to heal?

A. in adults

B. in children

Answer 1

A. Adults → 12 weeks

B. Children → 6 weeks

Question 2

How long do fractures of upper limb take to heal?

A. In adults

B. In children

Answer 2

A. Adults → 6 weeks

B. Children → 3 weeks

Question 3

What’s MRI is used for in terms of fracture?

Answer 3

MRI → to assess spinal injury; soft tissues; muscles

Question 4

What’s CT used to assess in terms of fracture?

Answer 4

• visceral injury in pelvic fracture
• visceral injury in lower rib fracture

Question 5

What air in the tissue on the imaging may indicate?

Answer 5

• open wound
• fracture
• visceral injury
• infection

Question 6

How would you fix articular and comminuted long-bone fracture under ORIF e.g. ankle fracture?

Answer 6

Plate and screws

Question 7

The method used to fix long bone (femur, tibia, humerus) fractures?

Answer 7

Intramedullary nail

* it allows early mobilisation

Question 8

The method used to fix foot, wrist and hand fractures?

Answer 8

Kirschner (K) wires

* wires are inserted percutaneously and can be placed under tension

Question 9

Phases of fracture healing (3) just name

Answer 9

1. Inflammatory phase
2. Reparative phase
3. Remodelling phase

Question 10

What happens in the inflammatory phase of fracture healing?

Answer 10

1. Inflammatory 2. Reparative 3. Remodelling

Inflammatory phase:

• first 24-72 hrs
• fracture → bleeding → swelling
• cytokines are released
• this all stimulate repair mechanism

Question 11

What happens in the reparative phase of fracture healing? (2)

Answer 11

1. Inflammatory 2. Reparative 3. Remodelling

Reparative phase → depends on stability of the fracture:

• healing by callus in unstable fractures: occurs between 4-8 weeks; necrotic bone is reabsorbed and weak woven bone is laid down (it’s a precursor for highly organised and strong bone)
• healing by primary bone healing in stable fractures: contact healing can occur when two ends are in direct contact

Question 12

What happens in the remodelling phase of fracture healing?

Answer 12

1. Inflammatory 2. Reparative 3. Remodelling

Remodelling phase:

• starts 8-12 weeks after the fracture
• ends of the repair phase
• continues for years
• strong lamellar bone replaces woven bone

Question 13

Management of clavicular fracture (2)

Answer 13

Conservative → for uncomplicated fracture:

• broad arm sling for 3 weeks
• analgesia

*bump forms in the healed bone

Reduction with ORIF → needed if the fracture is open or if there s neurovascular compromise

Question 14

Fracture of which part of the neck of the humerus is more dangerous?

Answer 14

The anatomical neck of humerus → risk of avascular necrosis

Question 15

What’s the difference between dislocation and subluxation?

Answer 15

• Dislocation → complete loss of contact between the articular surfaces of a joint
• • Subluxation → partial loss of contact

Question 16

What’s the main complication of an anterior shoulder dislocation?

Answer 16

Axillary nerve injury (Regimental badge area)

It supplies: Teres minor, teres major and deltoid

Question 17

Name (3) methods to reduce dislocated shoulder

Answer 17

A. Kocker’s method

B. Hippocratic method

C. traction/countertraction

Question 18

Treatment of acromioclavicular joint subluxation/dislocation

Answer 18

• often occur in rugby players

Treatment:

• sling with strapping over joint
• ORIF - occasionally to repair the ligament

Question 19

Classification of a fracture around the elbow and management (4)

Answer 19

• radial head → undisplaced fractures (support bandage) + immobilisation; displaced (ORIF)
• supracondylar → Mx depends on a fracture pattern
• olecranon → ORIF and K-wires
• Condylar:
• medial epicondylar → ORIF + K-wires
• lateral epicondylar → ORIF (if significant discplacement)

Question 20

Possible complications of condylar fractures (4)

Answer 20

• growth arrest (in children)
• mal-union
• stiffness
• ulnar nerve palsy

Question 21

Types of humeral mid-shaft fractures (2)

Answer 21

Both are fracture-dislocation

• Galeazzi
• Monteggia

Question 22

Management of Galeazzi and Monteggia fractures-dislocations

Answer 22

ORIF with plates and/or intramedullary nail

Question 23

(4) Types of distal radius fractures (just name)

Answer 23

• Colle’s fracture
• Smith’s fracture
• Chauffeur’s fracture
• Barton’s fracture

Question 24

Colle’s

• what is this
• management
• complications

Answer 24

Colle’s

• fracture that occurs 2.5 cm from a distal end of the radius + dorsal angulation
• classic dinner fork deformity

Management: reduction of fracture under regional anaesthesia + plaster backslab for 6 weeks + X ray

Complications: Carpal tunnel syndrome, mal-union, stiffness, rupture of extensor pollicis longus

Question 25

**Smith's** ## Footnote - what is this - management

Answer 25

***Smith's*** ## Footnote \*reverse of Colle's * anterior angulation of radius + tilt **Management:** manipulation under anaesthesia and plaster casts for 6 weeks

Question 26

**Barton's** fracture ## Footnote - what is this - management

Answer 26

***Barton's fracture*** * intra-articular fracture of a wrist → hand and distal radius displace proximally Management: Usually ORIF

Question 27

What's Chauffeur's fracture?

Answer 27

Fracture of the radial styloid

Question 28

What's needed to assess a suspected **scaphoid fracture** (imaging wise) - management

Answer 28

4 radiographic views → but the fracture may still not be visible \*therefore fracture is assumed if there is a tenderness in the anatomical snuffbox area **Management:** * scaphoid plaster (from elbow to knuckles) * repeat X ray in 2 weeks (bone scan may be needed if still cannot identify fracture) * if it shows the fracture → plaster on for 8 further weeks * if fracture not united at 12 weeks → internal fixation needed

Question 29

What's **Bennet's fracture**? - cause - management

Answer 29

***Bennet's*** ## Footnote Fracture of first metacarpal extending into carpometacarpal joint **Cause:** blow ti the point of the thumb **Management**: unstable → should be reduced if it fails → percutaneous pin inserted

Question 30

Management of metacarpal and pharyngeal injuries (2)

Answer 30

examples: punching, fighting * most managed by closed reduction (if necessary) + immobilisation with splinting to the neighbouring finger * unstable fractures or multiple metacarpal involvement → percutaneous K - wire