Fractures

Question 1

Different kinds of fractures

Answer 1

• Compound fracture
  
  • Skin broken and bone exposed to air
• Stable fracture
  
  • Bone remain in alignment with fracture
• Pathological fracture
  
  • Bone breaks due to abnormality within bone

Question 2

Words to describe different ways bones break

Answer 2

• Transverse
• Oblique
• Spiral
• Segmental
• Comminuted (breaking into multiple fragments)
• Compression (affecting vertebrae in spine)
• Greenstick
• Buckle (torus)
• Salter-Harris (growth plate fractures)

Question 3

INVESTIGATIONS

First choice

Answer 3

• X-rays
  
  • Two views required
• CT
  
  • More detailed view

Question 4

MANAGEMENT

General principles

Answer 4

• Two principles
  
  • Achieve mechanical alignment
  • Provide stability
• Pain management
• Simple may be fixed in A&E, complex and those requiring surgery need on-call trauma and ortho team - admitted and made nil by mouth

Question 5

MANAGEMENT

How can mechanical alignment be achieved

Answer 5

• Closed reduction via manipulation of limb
• Open reduction via surgery

Question 6

MANAGEMENT

How is stability achieved

Answer 6

• Fix bone in position
  
  • External casts (eg plaster)
  • K wires
  • Intramedullary wires
  • Intramedullary nails
  • Screws
  • Plates and screws

Question 7

COMPLICATIONS

Early complications

Answer 7

• Damage to local structures (eg nerves, tendons, arteries, skin, lungs)
• Haemorrhage leading to shock and death
• Compartment syndrome
• Fat embolism
• Venous thromboembolism

Question 8

COMPLICATIONS

Longer term complications

Answer 8

• Delayed union
• Malunion
• Non-union
• Avascular necrosis
• Infection (osteomyelitis)
• Joint instability
• Joint stiffness
• Contractures (tightening of soft tissue)
• Arthritis
• Chronic pain
• Complex regional pain syndrome

Question 9

COMPLICATIONS

How can fat embolism occur

Answer 9

• Following fracture of long bones like femur
  
  • Fat globules released into circulation and can cause embolism

Question 10

What can fat embolism cause

Answer 10

• Systemic inflammatory response resulting in fat embolism syndrome
  
  • 24-72 hours after fracture
  • Gurds criteria for diagnosis

Question 11

Describe Gurd’s major critiera

Answer 11

• Respiratory distress
• Petechial rash
• Cerebral involvement

Question 12

Describe Gurds minor critiera

Answer 12

• Long list including
  
  • Jaundice
  • Thrombocytopenia
  • Fever
  • Tachycardia