Fractures

Question 1

Complete fracture

Answer 1

Both sides of cortex are breached

Question 2

Salter-Harris classification I

Answer 2

I - Fracture through the physis only (x-ray often normal)

Question 3

Salter-Harris classification II

Answer 3

Fracture through the physis and metaphysis

Question 4

Salter-Harris classification III

Answer 4

Fracture through the physis and epiphyisis to include the joint

Question 5

Salter-Harris classification IV

Answer 5

Fracture involving the physis, metaphysis and epiphysis

Question 6

Salter-Harris classification V

Answer 6

Crush injury involving the physis (x-ray may resemble type I, and appear normal)

Question 7

Toddlers fracture

Answer 7

Oblique tibial fracture in infants

Question 8

Plastic deformity

Answer 8

Stress on bone resulting in deformity without cortical disruption

Question 9

Greenstick fracture

Answer 9

Unilateral cortical breach only

Question 10

Buckle fracture

Answer 10

Incomplete cortical disruption resulting in periosteal haematoma only

Question 11

What is the Salter-Harris classification system used for?

Answer 11

Physeal fractures

Question 12

What is the Garden classification system used for?

Answer 12

Hip fractures of the femoral neck - blood supply disruption is most common in types III and IV

Question 13

Garden type I

Answer 13

Stable fracture with impaction in valgus

Question 14

Garden type II

Answer 14

Complete fracture but undisplaced

Question 15

Garden type III

Answer 15

Displaced fracture, usually rotated and angulated, but still has boney contact

Question 16

Garden type IV

Answer 16

Complete boney disruption

Question 17

Ottawa rules for ankle x-rays

Answer 17

Ankle x-ray is required only if there is any pain in the malleolar zone and any one of:

• bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to 6 cm below the posterior border of the fibula)
• bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to 6 cm below the posterior border of the tibia)
• inability to walk four weight bearing steps immediately after the injury and in the emergency department

Question 18

Undisplaced intracapsular fracture management

Answer 18

If no comorbidities - internal fixation (especially if young)
If major illness or advanced organ specific disease - hemiarthroplasty

Question 19

Displaced intracapsular fracture management

Answer 19

<70 with no comorbidities - internal fixation (if possible), hip arthroplasty if not
>70 with no comorbidities - total hip arthroplasty
Major comorbidities or immobile - hemiarthroplasty

Question 20

Extracapsular fracture management

Answer 20

Non special type - dynamic hip screw

Reverse oblique, transverse or sub trochanteric - intramedullary device