Orthopaedic Trauma Overview
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Questions and Answers

What is the goal of stabilizing the pelvis with an external fixator in cases of pelvic fractures?

  • To prevent muscle atrophy
  • To promote bone healing
  • To save life by stopping haemorrhage (correct)
  • To prevent necrotising fasciitis
  • What is the main cause of compartment syndrome?

  • Fractures and gunshot wounds
  • Tight casts and bandages
  • Extravasation of IV infusion
  • All of the above (correct)
  • What is the commonest site of fracture in the elderly with osteoporosis due to minimal trauma?

  • Distal tibia
  • Pelvic ramus (correct)
  • Neck of femur
  • Metatarsal neck
  • Which limb is most commonly affected by compartment syndrome?

    <p>Thigh</p> Signup and view all the answers

    What is the 30-day mortality rate for neck of femur fractures?

    <p>6.5%</p> Signup and view all the answers

    What is the usual cause of patella fractures?

    <p>Direct blow onto the knee</p> Signup and view all the answers

    What is the main symptom of compartment syndrome?

    <p>Pain out of proportion to injury</p> Signup and view all the answers

    In cases of tibial shaft fractures, what determines the choice between conservative and surgical treatment?

    <p>Displacement and ability to straight leg raise</p> Signup and view all the answers

    Which condition may lead to irreversible muscle and neurovascular damage?

    <p>Compartment syndrome</p> Signup and view all the answers

    What is the pathophysiology of compartment syndrome?

    <p>Bleeding and tissue swelling leading to increased interstitial pressure</p> Signup and view all the answers

    What is the most common cause of femur fractures in nonambulatory infants?

    <p>Non-accidental trauma</p> Signup and view all the answers

    What is the most common cause of death in children due to deliberate actions against them?

    <p>Non-accidental trauma</p> Signup and view all the answers

    Which fracture pattern is considered a red flag for non-accidental injury?

    <p>Transphyseal separation of the distal humerus</p> Signup and view all the answers

    What is the most common cause of fractures in children under 1 year of age?

    <p>Non-accidental trauma</p> Signup and view all the answers

    Which type of fracture is usually treated conservatively, unless there is intra-articular disruption or avascular watershed area involvement?

    <p>Avulsion fracture of the base of 5th metatarsal</p> Signup and view all the answers

    What is the definition of a fracture?

    <p>Disruption in continuity of bone</p> Signup and view all the answers

    Which type of fracture suggests a twisting mechanism of injury?

    <p>Spiral</p> Signup and view all the answers

    What is the term for a fracture in which there are more than 2 pieces of bone?

    <p>Comminuted</p> Signup and view all the answers

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

    <p>Whether there is a skin breach</p> Signup and view all the answers

    What should be monitored specifically in certain fractures?

    <p>Compartment pressures</p> Signup and view all the answers

    Which type of fracture involves the growth plate in children?

    <p>Greenstick</p> Signup and view all the answers

    What is a characteristic difference between paediatric and adult fractures?

    <p>Cortical bone is more porous in paediatric fractures compared to adult fractures</p> Signup and view all the answers

    Which type of fracture exhibits plastic deformation in children?

    <p>Torus</p> Signup and view all the answers

    What is the most common type of fracture in the upper limb trauma of children?

    <p>Supracondylar humeral fracture</p> Signup and view all the answers

    When does remodelling occur in paediatric fractures after injury?

    <p>6 weeks after injury</p> Signup and view all the answers

    What is the reported rate of spontaneous recovery for secondary palsies associated with fracture manipulation?

    <p>70%</p> Signup and view all the answers

    What type of fractures present a higher risk of laceration or entrapment of the radial nerve?

    <p>Spiral fractures of the middle 1/3</p> Signup and view all the answers

    What can help determine the degree of nerve injury and monitor the rate of nerve regeneration?

    <p>EMG and nerve conduction studies</p> Signup and view all the answers

    What type of fractures are most commonly associated with neuropraxia?

    <p>Transverse fractures of the distal 1/3</p> Signup and view all the answers

    What is essential for an acceptable result in the nonsurgical treatment of humeral fractures?

    <p>Minimal angular deformity</p> Signup and view all the answers

    What is indicated for most forearm fractures?

    <p>Surgical intervention</p> Signup and view all the answers

    Which of the following is a common early symptom of necrotising fasciitis?

    <p>Intense and severe pain out of proportion to external signs of infection</p> Signup and view all the answers

    What is the most critical symptom of necrotising fasciitis, usually occurring within 4 to 5 days?

    <p>Severe fall in blood pressure</p> Signup and view all the answers

    What is the most important factor for survival in necrotising fasciitis?

    <p>Early diagnosis</p> Signup and view all the answers

    What is LRINEC used for in the context of necrotising fasciitis?

    <p>To facilitate early diagnosis</p> Signup and view all the answers

    Which of the following is a potential complication of necrotising fasciitis?

    <p>Renal failure and sepsis (rhabdomyolysis)</p> Signup and view all the answers

    What is a critical symptom of necrotising fasciitis usually within 4 to 5 days?

    <p>Severe fall in blood pressure and toxic shock from bacterial poisons</p> Signup and view all the answers

    What is the recommended management for necrotising fasciitis that progresses rapidly and can result in death?

    <p>All of the above options</p> Signup and view all the answers

    Which factor is most important for the survival of a patient with necrotising fasciitis?

    <p>Time to surgical debridement</p> Signup and view all the answers

    What characteristic fluid is typically observed during surgical debridement of necrotising fasciitis?

    <p>&quot;Dirty dishwater&quot; fluid with grey coloured tissues</p> Signup and view all the answers

    What complication is associated with necrotising fasciitis and may require amputation to save life?

    <p>Limb Threatening Injuries</p> Signup and view all the answers

    Study Notes

    Pelvic Fractures

    • Stabilizing the pelvis with an external fixator aims to reduce the risk of hemorrhage and improve overall stability of the fracture.

    Compartment Syndrome

    • Main cause is increased pressure within a closed anatomical space, leading to compromised circulation and function of tissues.
    • Commonly affects the anterior compartment of the lower limb.

    Osteoporosis and Fractures

    • The most common site of fracture in the elderly with osteoporosis is the hip, often due to minimal trauma.
    • Neck of femur fractures carry a 30-day mortality rate of about 10% to 30%.

    Patella and Tibial Shaft Fractures

    • Usual cause of patella fractures includes falls onto the knee or direct trauma.
    • In cases of tibial shaft fractures, the decision for conservative versus surgical treatment is based on fracture location, stability, and alignment.

    Muscle and Nerve Damage

    • Compartment syndrome may lead to irreversible muscle and neurovascular damage if not treated promptly.

    Childhood Fractures

    • The most common cause of femur fractures in nonambulatory infants is non-accidental injury.
    • Fracture patterns, such as spiral fractures, are red flags for potential non-accidental trauma.
    • Fractures in children under 1 year are typically caused by falls or abuse.

    Fracture Types and Mechanisms

    • Fractures involving the growth plate in children are classified as Salter-Harris fractures.
    • A definition of a fracture is a break in the continuity of bone.
    • Spiral fractures suggest a twisting mechanism of injury, while comminuted fractures involve more than two pieces of bone.

    Differences in Fracture Types

    • Open fractures involve a break in the skin, while closed fractures do not.
    • Pediatric fractures tend to heal faster than adult fractures and often exhibit plastic deformation before fracture.

    Upper Limb Fractures in Children

    • The most common type of fracture in upper limb trauma among children is a distal radius fracture.
    • Remodelling in pediatric fractures occurs over months post-injury, taking advantage of the growth potential in children.

    Nerve Injuries

    • Secondary palsies associated with fracture manipulation have a spontaneous recovery rate of around 60%.
    • Humeral shaft fractures present a higher risk of radial nerve injury which can cause neuropraxia.

    Humeral Fractures and Management

    • Essential for successful nonsurgical treatment of humeral fractures is proper alignment and stabilization.
    • Common management for forearm fractures includes casting or bracing, with surgical intervention reserved for unstable cases.

    Necrotising Fasciitis

    • Early symptoms include pain out of proportion to physical examination findings, with critical symptoms developing within 4 to 5 days.
    • The most critical factor for survival in necrotising fasciitis is prompt surgical intervention.
    • LRINEC score is used to assess the severity of necrotising fasciitis.

    Complications and Treatment

    • Complications from necrotising fasciitis can include systemic infections and may necessitate amputation to prevent death.
    • Characteristic fluid observed during surgical debridement is often necrotic tissue and malignantly appearing fluid.

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    Description

    This quiz provides an overview of orthopaedic trauma, covering topics such as fracture description, types of fractures, avulsion injuries, and sites of bone injury. The quiz is prepared by Mr Georgios Arealis, MD, PhD, FRCS.

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