Fracture Classification and Management

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Questions and Answers

Which type of open fracture has a wound less than 1 cm and minimal soft tissue injury?

Type 3A Open Fracture

Type 1 Open Fracture (correct)

Type 3B Open Fracture

Type 2 Open Fracture

What is NOT an indication for internal fixation of fractures?

Displaced long bone fractures

Fractures with vascular injuries

Unstable fractures

Wounds greater than 10 cm (correct)

What is a characteristic of Type 3C Open Fractures?

Moderate soft tissue damage

Arterial injury requiring repair (correct)

Inadequate soft tissue coverage

Wound less than 1 cm

What was a common practice in the management of open fractures in the last century?

Early amputation to prevent death Signup and view all the answers

Which of the following is NOT part of the S.T.A.N.D management strategy for open fractures?

Assess entire patient Signup and view all the answers

Which type of fracture stabilization is suitable for wounds that are clean with available soft tissue coverage?

Internal fixation Signup and view all the answers

What is the complication associated with the immediate time of injury that involves a risk of blood loss?

Haemorrhage Signup and view all the answers

How many liters of fluid does Anglen recommend for type 2 fractures during irrigation?

6 L Signup and view all the answers

What are the primary focuses of physiotherapy in rehabilitation following a fracture?

Muscle re-education and exercise Signup and view all the answers

Which late complication is associated with localized issues following a fracture?

Tissue necrosis Signup and view all the answers

What is the purpose of immobilization in fracture treatment?

To stabilize the fracture and minimize complications Signup and view all the answers

Which type of fracture is likely to require operative treatment?

Displaced fractures requiring realignment Signup and view all the answers

What type of traction is intended for short-term use?

Skin traction Signup and view all the answers

Which of the following is a method of conservative treatment for fractures?

Traction and counter traction Signup and view all the answers

What is the leading cause of death during the first four decades of life?

Trauma Signup and view all the answers

What does the acronym M.I.S.T stand for in the context of pre-hospital information?

Mechanism, Injury, Signs, Treatment Signup and view all the answers

During trauma care, what does the ‘C’ in the ABCDE approach refer to?

Circulation with hemorrhage control Signup and view all the answers

Which group requires different amounts of fluid and sizes of equipment during trauma care?

Pediatric patients Signup and view all the answers

What is the first priority in trauma care?

Saving the patient's life Signup and view all the answers

What is the focus of the secondary survey in trauma management?

A detailed physical exam and obtaining AMPLE history Signup and view all the answers

What does the 'E' in the ABCDE approach signify in trauma assessment?

Environmental control Signup and view all the answers

What is a common risk factor associated with elderly trauma patients?

Diminished physiologic reserve Signup and view all the answers

What does angulation refer to in the context of fractures?

The amount of bend at a fracture Signup and view all the answers

Which of the following is true about displacement due to shortening?

It is described as the amount a fracture collapses in centimeters Signup and view all the answers

What is the definition of a dislocation?

Separation of two bones at a joint Signup and view all the answers

What characterizes a subluxation?

An incomplete or partial dislocation Signup and view all the answers

When naming a dislocation, what should be included if there is a periarticular fracture?

Add 'fracture' to the name Signup and view all the answers

Which joint is NOT commonly associated with dislocation according to the content?

Wrist Signup and view all the answers

What is a common complication associated with a knee dislocation?

Injury to the popliteal artery Signup and view all the answers

What occurs in a sprain?

Stretching or tearing of a ligament Signup and view all the answers

Which term describes a disruption or break in the continuity of the structure of bone?

Fracture Signup and view all the answers

What is a likely outcome of a comminuted fracture?

The bone is broken into several pieces Signup and view all the answers

Which classification system is specifically used for fractures involving the growth plate?

Salter-Harris classification Signup and view all the answers

In the context of fracture management, what does 'translation' refer to?

The sideways motion of the fracture Signup and view all the answers

What aspects should be evaluated when describing a fracture?

Type, location, and whether it is open or closed Signup and view all the answers

Which of the following is a characteristic of an incomplete fracture?

Bone remains partially intact Signup and view all the answers

Which imaging technique is often used for a comprehensive evaluation of fractures?

CT scan vs. MRI Signup and view all the answers

Which term is NOT used to describe a type of fracture?

Tendon rupture Signup and view all the answers

Study Notes

Classification of Fractures and Fracture Management

Fractures are breaks in the continuity of bone structure
Dislocations are separations of bones in joints
Sprains are tears in ligaments
Strains are tears in muscles
Tendon rupture is a tear in tendons

Objectives

Differentiate between fractures, dislocations, and sprains
Recognize signs of fractures and dislocations
Categorize fracture types
Describe fractures according to radiographs
Understand the management of fractures, including open fractures

Fracture Description

Radiograph description is crucial
Fracture type needs identification
Fracture location is important
Displacement assessment (displaced or not)
Additional issues (joint involvement, other fractures, bone lesions), open or closed)

Why Classify Fractures

Facilitates communication among surgeons
Guides treatment decisions
Aids in prognosis assessment

Skeletal Anatomy

Includes knowledge of axial and appendicular skeletons
Bones, bone structures (epiphysis, metaphysis, diaphysis)

Bone Structures

Includes articular cartilage, spongy bone, compact bone, endosteum, periosteum
Medullary (marrow) cavity containing yellow marrow (adult) or red marrow (child)

Bone Terms (Ossification)

Epiphysis, epiphyseal plate, metaphysis, diaphysis

Radiological Evaluation (X-rays)

Two views are essential
Two joints should be seen
Two views of each side
Special views may be needed
Comparing CT scans and MRI scans

Types of Fractures (Complete vs Incomplete)

Incomplete fractures (common in children): bowing, torus, greenstick
Complete fractures: simple, comminuted, butterfly, segmental.

Fracture Lines (Simple Fractures)

Transverse, oblique, spiral, longitudinal

Special Fracture Features

Impaction, depression, compression

Uncommon Fractures

Stress fractures (fatigue fractures)
Pathologic fractures (pre-existing abnormality)

Salter-Harris Classifications

Used to classify fractures involving the growth plate (physis)

Salter Harris Fracture Classifications - Characteristics

Type 1 (S—slipped)
Type 2 (A—above physis)
Type 3 (L—lower than physis)
Type 4 (T—through physis)
Type 5 (E—erasure of physis)

Simple Fractures (Alignment and Displacement)

Medial, lateral displacement
Internal/external rotation
Medial/ lateral angulation
Overriding (bayonet apposition)
Distraction

Comminution

Measured by the number of fragments

Displacement- Translation and Angulation

Translation is sideways motion.
Angulation is bending at the fracture.

Displacement Shortening

Amount of fracture collapse, measured in centimeters.
Bayonet apposition is a type of shortening.

Signs and Symptoms of Fractures and Dislocations

History of injury
Pain, tenderness
Difficulty moving the joint
Swelling, bruising
Deformity
Unnatural movement
Numbness/paresthesia (tingling)
Wound
Shock

Joint Dislocations

Separation of bones at a joint
Displaced bones are no longer in normal position
Often associated with periarticular fractures

Subluxation

Incomplete or partial dislocation

Nomenclature for Dislocations

Name the joint
Position of distal fragment
Include fracture if present
State “open” if wound is involved

Examples of Dislocations/Subluxations

PIP (proximal interphalangeal) joint subluxation, elbow dislocation
Shoulder dislocation, hip dislocation, knee dislocation

Complications of Fractures and Dislocations

Immediate (brain, heart, nerve damage, compartment syndrome)
Late (tissue necrosis, wound infection, loss of alignment, malunion/non-union, joint stiffness, osteoarthritis, deep vein thrombosis, pulmonary embolism)

Management of Open Fractures in Emergency Room (ER)

ABCs (Airway, Breathing, Circulation)
Careful physical examination (PE) – neurovascular status
Sterile dressings and splinting
Tetanus toxoid
Antibiotics
Pain management
Debridement and local irrigation

Types of Fracture Stabilization

Splint (good option if operative fixation not needed)
Internal fixation (for clean wounds)
External fixation (for extensive soft tissue damage or dirty wounds)

Fracture Management Aims

Patient safety
Limb safety
Function restoration

Prehospital Information

Mechanism of injury
Injury sustained/suspected
Signs and symptoms
Treatments initiated

Inpatient Management (Treatment and Care)

ATLS (Advanced Trauma Life Support) protocols
Preparation and triage
Resuscitation
Primary and secondary surveys
Re-evaluation and definitive care
Tertiary survey (late complications)

Duration of Immobilization

Varies based on age and the affected body limb
Upper limb: Child (3–4 weeks), Adult (6–8 weeks)
Lower limb: Child (6–8 weeks), Adult (10–12 weeks)

Conservative Treatment of Fractures

Employed if fractures are undisplaced or minimally displaced
Closed reduction (under GA or local anesthetic)
Immobilization by using POP (plaster of Paris) casts, slabs, functional braces, or traction.

Operative Treatment of Fractures

ORIF (open reduction internal fixation)
Types of surgical fixation like pins, screws, plates, or intramedullary rods

Rehabilitation (After Fracture)

Physiotherapy for muscle re-education, exercises, and instructions on limb mobilization and gait training.

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Description

This quiz covers essential concepts of fracture classification, management techniques, and distinguishing between fractures, dislocations, and sprains. It also emphasizes the importance of radiograph descriptions and the implications for treatment and prognosis. Test your knowledge on skeletal anatomy and the different types of fractures.