Types of Fractures

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Questions and Answers

What is the primary function of the sacro-tuberoso and sacro-spinoso ligaments in the pelvis?

To provide flexibility to the pelvic structure

To stabilize the acetabulum

To support the femoral head

To form the floor of the pelvis (correct)

What is the effect of removing the central 'keystone' in the pelvic structure?

The pelvis becomes more stable

The pelvis becomes less stable (correct)

The acetabulum is compromised

The sacro-iliac joint becomes subluxated

What is the consequence of a sacral fracture?

The pubic symphysis is fractured

Instability of the entire pelvis (correct)

The femoral head becomes dislocated

Stability of the acetabulum is compromised

What is the role of the anterior and posterior columns in the acetabulum?

They function as the walls and roof of the acetabulum Signup and view all the answers

What is the consequence of a high-energy impact on the pelvis?

The ligaments are torn, including the sacro-tuberoso and sacro-spinoso Signup and view all the answers

What is the shape of the acetabulum often compared to?

An inverted Y Signup and view all the answers

What is the characteristic of an incomplete fracture of the neck?

It can be treated non-surgically Signup and view all the answers

What is the consequence of a fracture that is scomposta in varo?

It tends not to heal Signup and view all the answers

What is the characteristic of an ingranata in valgo fracture?

It is incastrata and can heal Signup and view all the answers

What is the treatment for an elderly patient with a fracture?

Replace the femoral head with a prosthetic device Signup and view all the answers

What is the goal of treatment for a young patient with a fracture?

Preserve the femoral head and stabilize the fracture Signup and view all the answers

What type of fracture is classified as being between the greater and lesser trochanter?

Intertrocanteriche Signup and view all the answers

What is the characteristic of most pertrocanteriche and sottotrocanteriche fractures?

They are always unstable Signup and view all the answers

What is the risk of a fracture that is scomposta in varo?

All of the above Signup and view all the answers

What is the treatment approach for a patient with a prosthetic joint infection?

Remove the prosthetic joint and insert a spacer that releases antibiotics Signup and view all the answers

What is the main reason for the increase in periprosthetic fractures?

Increase in the number of elderly people Signup and view all the answers

What is the term used to describe the type of fractures that occur around the prosthetic joint?

Periprosthetic fractures Signup and view all the answers

What is the percentage of patients who survive a hip fracture and return to their pre-fracture functional level?

40-60% Signup and view all the answers

What is the main complication of hip fractures that leads to institutionalization?

Disability and loss of independence Signup and view all the answers

What is the term used to describe the fragile bone surrounding the prosthetic joint?

Pastafrolla bone Signup and view all the answers

What is the approach to treating a patient with a dislocated prosthetic joint?

Reduce the dislocation and reset the prosthetic joint Signup and view all the answers

What is the significance of hip fractures in terms of mortality?

Hip fractures can lead to mortality, especially in the elderly population Signup and view all the answers

What percentage of men experience sexual dysfunction of various types?

61% Signup and view all the answers

What is the percentage of excellent results in the next 5 years after acetabular fractures?

75-80% Signup and view all the answers

What type of fractures are often associated with polytrauma?

Femoral shaft fractures Signup and view all the answers

What is the region of the femur that is 5cm distal to the lesser trochanter?

Subtrochanteric region Signup and view all the answers

What is the age group most affected by femoral shaft fractures?

15-35 years old Signup and view all the answers

What is the term for the contraction of pelvic floor muscles that prevents vaginal penetration?

Dispareunia Signup and view all the answers

What is the percentage of people who may require a prosthesis after acetabular fractures?

20% Signup and view all the answers

What is the term for fractures that occur in the middle third of the femur?

Diaphyseal fractures Signup and view all the answers

What is the primary reason for stabilizing a polyfractured patient with a fixator?

To improve immunocompetence Signup and view all the answers

What is a common complication of femur fractures?

Infection of exposed fractures Signup and view all the answers

Why is it important to mobilize the patient with a femur fracture soon after the injury?

To prevent articular rigidity Signup and view all the answers

What is the most common direction of femoral head displacement in hip dislocations?

Posteriorly Signup and view all the answers

What is the characteristic position of the limb in posterior hip dislocation?

Flexed, adducted, and internally rotated Signup and view all the answers

What is the primary mechanism of injury in hip dislocations?

High-energy trauma Signup and view all the answers

What is the benefit of wearing a seatbelt in preventing hip dislocations?

It limits the mobility of the pelvis and reduces the risk of hip dislocation Signup and view all the answers

What is the characteristic of isolated femur fractures that are not exposed?

They tend to heal well Signup and view all the answers

Study Notes

Fractures of the Femur

Fractures can be:
- Incomplete: can be treated non-surgically or with two screws to stabilize
- Scomposta in varo: tends not to heal, and every time the patient walks, it tends to scomporsi
- Ingranata in valgo: it's stuck, and the patient loses 1 cm of femur length, but it can heal because it becomes a compression force on the fracture instead of a distraction force
Classification of fractures according to sbobine canale A, aa 19-20:
- Lateral fractures can be classified as:
  - Sottotrocanteriche: below the small trochanter
  - Intertrocanteriche or pertrocanteriche: between the large trochantere and the small trocantere
- Can be stable or unstable, with most pertrocanteriche and sottotrocanteriche fractures being unstable by definition
Complications:
- Infection: remove the prosthesis and insert a spacer that releases antibiotics
- Embolism
- Problems related to acetabular corrosion
- Periprosthetic fractures: increasing due to the aging population and the rigidity of the implant
Take-home point: femur fractures are not just an orthopedic problem, but a significant cause of disability; only 40-60% of patients who survive return to their previous activities

Fractures of the Pelvis

PUNTI DI ROTTURA DEL BACINO (points of rupture of the pelvis)
- The pelvis can break anywhere, and ligamentous lesions can be associated
- Fractures can occur posteriorly, with possible lesions of the pubic symphysis and/or anterior branches
- The pubic symphysis can break, with possible rupture or subluxation of the sacro-iliac joint
Important concepts to take home:
- The sacrum is fundamental! In case of sacral fracture, there is instability of the entire pelvis
- The acetabulum (articular surface) can be thought of as an upside-down Y
  - The acetabulum is supported by two fundamental structures: the anterior column and the posterior column
  - Other structures act as walls and a roof to the acetabulum, which is a dome, but stability-wise, it's essential to focus on the two columns
Complications:
- In men, 61% have sexual dysfunction of various types
- In women, there can be dyspareunia (involuntary contraction of pelvic floor muscles that prevents penetration) and urological disorders
- Acetabular fractures can heal very well, up to 80%
- Prognosis of acetabular fractures is better with 75-80% excellent results in the next 5 years
- A 20% residual articular defect may require a prosthesis

Fractures of the Femoral Diaphysis

Fractures of the femoral diaphysis are high-energy fractures that occur 5 cm or more below the small trochantere
They are often associated with polytrauma and can have other serious injuries, such as pulmonary or cerebral lesions
Incidence:
- Mainly affects young, active males between 15 and 35 years old
- Incidence in women increases constantly from 60 years of age
Complications:
- The femur can bleed heavily (shock), have embolisms, exposed fracture infections, or not heal
- The reason for putting in a nail and letting the patient walk the next day is that the joints (knee and hip) will not recover extension if kept still
- Isolated, non-exposed fractures of the femur tend to heal well, but may have more problems in the elderly, especially if comminuted or with imperfect reduction

Complications of Femur Fractures

Chiodo piegato (bent nail)
Fractures isolated del femore non esposte (isolated, non-exposed fractures of the femur) tend to heal well
In the elderly, there may be more problems, especially if comminuted or with imperfect reduction
Where there is a femur fracture, there is often a high-energy damage mechanism: it's essential to search for possible adjacent fractures

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Description

This quiz covers the different types of fractures, including incomplete fractures, varus fractures, and valgus fractures. It explains the characteristics and treatment options for each type.