Fractures

Question 1

Fractures may result from…

Answer 1

1. single, highly stressful, traumatic incident (traumatic #)
2. repetitive stress of normal degree persisting to point of mechanical fatigue (stress #)
3. normal stress acting on an abnormally weakened bone (pathological #)

Question 2

What are the fracture types?

Answer 2

• closed/open (simple/compound)
• complete/incomplete
• complicated

Question 3

Describe a closed fracture.

Answer 3

Bone doesn’t communicate externally

Question 4

Describe an open fracture.

Answer 4

Fractured bone or penetrating object communicates externally. Greater amount of soft tissue damage and issue of pathogens/infection.

Question 5

Describe a complicated fracture.

Answer 5

Blood vessels, nerves or organs suffer significant damage.

Question 6

Describe a complete fracture.

Answer 6

Bone is completely broken into 2 separate parts.

• Transverse
• Oblique
• Spiral
• Segmental
• Avulsion

Question 7

What is a comminuted fracture?

Answer 7

Bone is broken into more than two fragments.

Question 8

Describe an incomplete fracture.

Answer 8

Bone is divided but the periosteum remains in continuity. E.g. greenstick #, compression #, stress #

Question 9

What is a pathological fracture?

Answer 9

Due to a disease:

• osteoporosis
• Paget’s
• infection
• tumour

Question 10

What is a physeal fracture?

Answer 10

Damage through the growth plate that has long term consequences. Can cause progressive deformity. Harris-Salter classification system used.

Question 11

What are the symptoms of a fracture?

Answer 11

• swelling, ecchymosis and deformity
• localized persistent pain
• marked or total loss of function
• localized bone tenderness
• crepitus
• may be sudden or insidious onset depending on #

Question 12

How are fractures diagnosed?

Answer 12

• examination and palpation of tender point and surrounding tissue
• neurovascular assessment
• radiographs (new # may not show immediately)
• CT, spiral CT, MRI
• bone scans
• ultrasound or vibration

Question 13

What does fracture management involve?

Answer 13

Fracture reduction, immobilisation and rehabilitation

Question 14

How is a fracture immobilized?

Answer 14

• internal or external fixture
• splints/casts/strapping and walking aids
• screws, k-wires, plates

Question 15

How are fracture rehabilitated?

Answer 15

With joint mobilization and exercises.

Question 16

How are fractures reduced?

Answer 16

With an open (surgical) or closed procedure.

Question 17

What further treatment may complicated fractures require?

Answer 17

• antibiotic treatment
• debridement
• irrigation
• dressings

Question 18

How long does a fracture take to heal?

Answer 18

A fracture without complications will heal in 6-16 weeks.
Callus visible: 2-3 weeks
Union: 8-12 weeks
Consolidation: 12-16 weeks

Question 19

What osseous complications can arise from fractures?

Answer 19

• osteomyelitis
• delayed union, non-union or mal-union
• avascular necrosis
• joint problems
• shortening of the bone
• osteoarthritis

Question 20

What soft tissue complications can arise from fractures?

Answer 20

• nerve or vascular damage
• compartment syndrome
• CRPS

Question 21

What is a pilon ankle fracture?

Answer 21

of metaphysical area of distal tibia (and sometimes fibula) extending to articular surface.

Question 22

How are pilon ankle fractures classified?

Answer 22

RUEDI-ALLGOWER

1. malleolar # with large posterior plafond fragments
2. spiral extension #
3. central compression # w/ or w/o fibula #

Question 23

What is the Lauge Hansen Classification System?

Answer 23

A way of classifying ankle fractures by their MOI.

• Supination/adduction Injuries
• Supination/external rotation injuries
• Pronation/Abduction injuries
• Pronation/External Rotation injuries

Question 24

What is the Weber Classification System?

Answer 24

A classifications system for ankle joint fractures.

Question 25

What type of fractures can affect the talus?

Answer 25

- chip/avulsion - talar neck - taller body - talar dome - posterolateral process - lateral process - talar head

Question 26

What can complicated talar fractures?

Answer 26

Avascular necrosis as there is no nutrient artery within the talus.

Question 27

What are the complications of calcaneal fractures?

Answer 27

Possible permanent disability, residual pain and delayed return to normal function.

Question 28

What are the most common forefoot fractures?

Answer 28

Digital #'s.

Question 29

What happens if digital fractures are inadequately treated?

Answer 29

- haelomata - contracted digits - transverse plane deformities - metatarsalgia

Question 30

What is the cause of a stress fracture?

Answer 30

Generally overuse or pathological concerns.

Question 31

What are the symptoms of stress fracture?

Answer 31

insidious onset, painful over time, decreases with rest

Question 32

What bones in the foot are most commonly affected by stress fracture?

Answer 32

Navicular and metatarsals