Fractures

Question 1

What are the 2 fracture extents?

Answer 1

• complete (360 of bone circumference)
• incomplete (seen mostly in children)
  - Greenstick fracture
  - buckle fracture

Question 2

What type of fracture does tension lead to?

Answer 2

transverse

Question 3

what type of fracture does compression lead to?

Answer 3

oblique

Question 4

What type of fracture does torsion lead to?

Answer 4

spiral

Question 5

What type of fracture does bending lead to?

Answer 5

triangular BUTTERFLY fracture (wedge)

Question 6

What is a comminuted fracture?

Answer 6

fracture with 3 or more segments

Question 7

What is a segmental fracture?

Answer 7

2 fractures that separate a bone segment

Question 8

What are the mechanisms of fractures?

Answer 8

• high energy vs low energy
• multiple injuries vs isolated injury
• pathological fracture weakened bone (tumor, osteoporosis, infection)
• stress fracture: normal bone subjected to repeated load

Question 9

What is considered an open fracture?

Answer 9

any skin breach in proximity of a fracture is an open fracture until proven otherwise

Question 10

Why should we splint fractures?

Answer 10

1- to alleviate pain
2- to ensure union takes place in a good position
3- permit early movement of the limb and a return of function

Question 11

What are the 4 stages of indirect bone healing (endochondrial ossification) occuring in untreated fractures?

Answer 11

1- hematoma formation (soon after fracture)
2- soft callus formation
3- hard callus formation
4- remodeling

Question 12

How to diagnose a fracture with history?

Answer 12

• patient complains of pain and inability to use limb
  ONSET
• specific trauma incident OR gradual onset?
  if TRAUMA
• mechanism of injury
• circumstance of the event? work related?
• severity pf symptoms at time of injury & progression

Question 13

What may be present while you are inspecting a fracture patient?

Answer 13

• swelling
• ecchymosis
• deformity
  if fracture is open
• bleeding
• protruding bone

Question 14

What physical examination should be done for a fracture patient?

Answer 14

Palpation: bony tenderness 
RULE OUT
- neurovascular injury 
- compartment syndrome 
- associated MSK injuries by examining joints above and below

Question 15

What imaging should be used for fractures?

Answer 15

X-ray GET MINIMUM 2 orthogonal viewa

include 1 joint above and 1 joint below injury

Question 16

What should be done BEFORE getting an x-ray?

Answer 16

immobilize patient in a backslab in the most effective way to relieve pain from a fracture

Question 17

Which fractures may not be apparent on x-ray immediately?

Answer 17

undisplaced or stress fractures

Question 18

What are the secondary signs of fracture on x-ray?

Answer 18

• soft tissue swelling
• fat pad sign
• periosteal reaction
• joint effusion
• cortical buckle

Question 19

How to describe a fracture?

Answer 19

CLINICAL PARAMETERS
- open vs closed 
- neurovascular status 
- presence of clinical deformity 
RADIOGRAPHIC
- location 
    - which bone 
    - which part of bone
            - epiphysis (intra-articular?
            - metaphysis 
            - diaphysis (divide into 1/3)
            - use anatomic landmarks 
- pattern 
    - simple vs comminuted 
    - complete vs incomplete 
    - orientation of fracture line 
- displacement 
    - position of distal fragment relative to proximal 
    - expressed as a percentage 
- angulation 
    - deviation from normal alignment 
    - direction of angulation 
    - expressed in degrees 
- shortening

Question 20

What should be done to treat a fracture?

Answer 20

• reduction IF fracture is displaced
  
  • to realign fracture fragments
  • to minimize soft tissue injury
  • can be considered definitive if fragments’ position is
    accepted
    - should be followed by immobilization
• immobilization
  - to hold reduction in position
  - to provide support to broken limb
  - to prevent further damage
  - CONTROL PAIN
• definitive treatment
  - if reduction cant be achieved at initial stage it should
  be attempted in surgery
  - plate & screws OR IM nail OR EX-fix
• rehabilitation (to ensure return of function)
  - motion as early as possible without jeopardizing
  maintenance of reduction
  - weght baring restriction for short period
  - move unaffected areas