*Fractures

Question 1

What are the FIVE key components to include when describing a fracture on exam or imaging?

Answer 1

“Broken Leg Please Describe Immediately”

**B **– Bone involved

**L **– Location within the bone

**P **– Pattern of fracture

D – Displacement

I - Integrity of skin (± open vs closed)

Question 2

Name FOUR common fracture patterns.

Answer 2

Transverse, oblique, spiral, comminuted

[Also acceptable: segmental, impacted, greenstick, buckle]

Question 3

How do you describe fracture location within a long bone?

Answer 3

Epiphysis, metaphysis, or diaphysis (proximal/middle/distal third).

Question 4

Name FOUR descriptors of displacement.

Answer 4

Translation (medial/lateral, anterior/posterior)

Angulation (in degrees + direction of apex)

Shortening/overriding

Rotation

Question 5

What is the difference between an open and a closed fracture?

Answer 5

Open fracture = communication between fracture and external environment

Closed fracture = no skin breach

Question 6

What are the 6 orientation types of a fracture?

Answer 6

Tranverse: perpendicular line

Oblique: angular line

Spiral: rotational force

Communited: more than two fracture fragments

Intra-articular: fracture line crosses articular cartilage

Green-stick: incomplete fracture of one cortex

Question 7

Name the 5 stages of fracture healing

Answer 7

0 - 3 weeks - Hematoma surrounding fracture

3 - 6 weeks: Callus formation

6 - 12 weeks: bone formation within callus

6 - 12 months: Cortical gap is bridged

1 - 2 years: normal architecture is resumed

Question 8

Name 3 early fracture complications

Answer 8

Compartment syndrome
Neurovascular injury
Infection
Sepsis
DVT/PE

Question 9

Name 3 late complications of fractures

Answer 9

Mal/non-union
Avascular necrosis
Osteomyelitis
Heterotrophic ossification
Arthritis

Question 10

Name the 5 initial steps of fracture management

Answer 10

1 - ABCs + primary survey
2 - AMPLE hx (Allergies, Meds, PMHx, Last Meal, Events)
3 - Physical exam (neurovasc status, joint above and below)
4 - Analgesia
5 - Imaging

Question 11

Name three specific fractures that may not show on acute imaging

Answer 11

Scaphoid
Elbow
Growth plate
Stress fractures

Question 12

What is the general management for buckle fractures?

Answer 12

Splint/cast for 3 weeks

Question 13

How long should a person be casted for distal ulnar and radial fractures?

Answer 13

4 - 6 weeks

Question 14

Name two mechanisms that can cause scaphoid fractures

Answer 14

FOOSH
Extreme dorsiflexion of the wrist + compressive force on the radial side of palm

Question 15

Name two structures that should be palpated if suspicions of scaphoid fracture

Answer 15

Snuffbox
Scaphoid tubercle

Question 16

What is the management of a suspected scaphoid fracture regardless of X ray?

Answer 16

Short-arm thumb spica x 14
(then re-image)

Question 17

What is the mechanism of a toddler’s fracture

Answer 17

Twisting injury while tripping/stumbling/falling

Question 18

3 S+S of a toddler’s fracture

Answer 18

Limping
Refusing to walk/bear weight
Tenderness at the site

Question 19

T or F: a toddler’s fracture is diagnosed clinically

Answer 19

True
(repeat X ray in 10 - 14d)

Question 20

What is the general management of a toddler’s fracture?

Answer 20

Imobilization (splint)
Remove after 3 - 4 weeks

Question 21

Name the Ottawa knee rules (5)

Answer 21

X ray if:
- Age > 55
- Isolated patellar tenderness
- Tenderness of the head of fibula
- Inability to flex 90 degress
- Inability to weight bear 4 steps immediately and in the E.R.

Question 22

What is the most serious early complication of a supracondylar humerus fracture in children?

Answer 22

Brachial artery injury (risk of compartment syndrome)

Question 23

What fracture is classically described as a “dinner fork deformity”?

Answer 23

Colles fracture (distal radius with dorsal displacement)

Question 24

What is the most important complication to rule out in a femoral neck fracture?

Answer 24

Avascular necrosis of the femoral head

Question 25

What fracture is most associated with osteoporosis in elderly women after a fall on an outstretched hand?

Answer 25

Distal radius (Colles) fracture

Question 26

Which fracture requires urgent IV antibiotics and surgical washout?

Answer 26

Open fracture

Question 27

What are the SIX Ps of compartment syndrome?

Answer 27

Pain out of proportion Pallor Paresthesia Pulselessness Paralysis Poikilothermia

Question 28

Two additional options for elderly patient with acute changes in mobility showing no fractures

Answer 28

Bone scans CT

Question 29

What is the preferred initial antibiotic for an open fracture?

Answer 29

**Cefazolin** [Add gentamicin for severe/Grade III injuries; add penicillin if concern for soil/farm contamination (Clostridium).]

Question 30

What is the most common nerve damaged in a Colles fracture?

Answer 30

Median nerve

Question 31

Name one key difference between a **Colles fracture** and a **Smith fracture**.

Answer 31

* Colles: dorsal displacement * Smith: volar (palmar) displacement (reverse Colles) ## Footnote Understanding the displacement patterns is crucial for treatment.

Question 32

Name the wrist fracture caused by a **direct blow** or **FOOSH** that involves the distal radius with **volar displacement**.

Answer 32

* **Smith fracture** (“reverse Colles”) ## Footnote This fracture is characterized by the distal fragment being displaced volarly.

Question 33

Name the carpal bone fracture commonly seen after **punching** (axial load through 4th/5th metacarpals) and its key complication.

Answer 33

* **Hamate fracture (hook of hamate)** * Complication: **ulnar nerve injury** ## Footnote The hook of the hamate is susceptible to injury during impact activities.