p.19
Management of Closed and Open Fractures
What indicates the need for open reduction in shoulder dislocation treatment?
Failed closed reduction, soft tissue interposition, greater tuberosity fracture, displacement >1cm after reduction, or large glenoid rim fracture.
p.5
Examination Techniques for Fractures
What does the 'FEEL' aspect of a local examination assess?
Temperature, tenderness, crepitation, bony irregularity, measurement of lower limbs, sensation, and vascular assessment.
p.12
Management of Closed and Open Fractures
What types of fractures can external fixation be applied to?
It can be used for long bones, pelvis, and almost any part of the skeleton.
p.12
Management of Closed and Open Fractures
What are the indications for using external fixation?
Severe soft-tissue damage, open fractures, severe comminuted & unstable fractures, pelvic fractures, fractures with nerve & vessel damage, and ununited fractures.
What is alignment in the context of fracture displacement?
Alignment refers to the fragment being tilted or angulated.
p.5
Examination Techniques for Fractures
What are the key components of a general examination?
Consciousness, position of the patient, breathing, attachments, and observation of skin/deformity.
p.5
Examination Techniques for Fractures
What does the 'LOOK' aspect of a local examination include?
Gait, obvious external fixation, swelling, skin integrity, skin color, limb posture, and limb shortening.
What are the three reasons for fracture displacement?
1. By the force of injury 2. By gravity 3. By the pull of muscles.
p.19
Complications and Post-operative Care
What are common late complications following a shoulder dislocation?
Recurrent dislocation, unreduced dislocation, and traumatic osteoarthritis (OA).
p.19
Fracture Displacement
What is the position of the head in inferior glenohumeral dislocation?
The head lies in the subglenoid position.
p.5
Imaging and Investigations for Fractures
What additional investigations are used for complex fractures?
CT/MRI and radioisotope imaging.
p.11
Management of Closed and Open Fractures
How should the Humeral Shaft Coaptation splint be applied?
Medially splint ends in axilla and must be well padded to avoid skin breakdown.
p.5
Examination Techniques for Fractures
What vital signs are typically assessed during an examination?
Pulse Rate (PR), Blood Pressure (BP), Respiratory Rate (RR), and Temperature.
p.12
Complications and Post-operative Care
What complications can arise from external fixation?
Damage to soft tissue structures, over distraction, and pin-track infection.
p.7
Management of Closed and Open Fractures
What is the aim of splinting in fracture management?
1. To prevent displacement 2. To restrict movement 3. To reduce pain 4. To promote soft-tissue healing 5. To allow free movement of unaffected parts
p.7
Management of Closed and Open Fractures
What are non-operative methods for managing fractures with intact soft tissues?
1. Sustained traction 2. Cast splintage 3. Functional bracing
p.4
Fracture Assessment and History Taking
What is usually the main complaint in a fracture history?
Pain, often followed by a history of trauma.
What is the primary mechanism of injury for a clavicle fracture?
Fall on the point of the shoulder.
p.1
Fracture Healing Process
What happens within 8 hours of a fracture?
Inflammatory cells appear in the haematoma.
p.9
Management of Closed and Open Fractures
What is the primary material used in a conventional cast?
Plaster of Paris (calcium sulfate, Gypsum).
p.26
Examination Techniques for Fractures
What are the special features of an elbow dislocation?
Deformity, pain, and swelling.
p.16
Fracture Displacement
How do the outer and inner fragments displace in a clavicle fracture?
Outer fragment displaces medially and downward; inner fragment displaces upwards.
p.17
Fracture Assessment and History Taking
What are common symptoms of acromioclavicular joint injury?
Pain and swelling localized to the acromioclavicular joint.
p.24
Examination Techniques for Fractures
What are the signs of a torn long head of the bicep during a physical examination?
Elbow flexion leads to a prominent lump, and bruising may appear over the front of the arm.
What causes a fracture of the lateral condyle?
Falls on the hand with elbow extended and forced into varus.
What is meant by fracture displacement?
Displaced means the broken end moves out of place.
What does translation refer to in fracture displacement?
Translation refers to a shift where the fragment is displaced and loses its surface contact.
What causes a transverse or comminuted fracture of the humerus?
A direct blow to the arm.
p.21
Management of Closed and Open Fractures
What is the primary treatment method for fractured humeral shaft?
Immobilization with an external cast.
p.23
Examination Techniques for Fractures
What is the Painful Arc Test used for?
To identify rotator cuff tear, particularly between 60-120 degrees of abduction.
p.3
Soft Tissue Damage in Fractures
How does the energy of the fracture impact soft tissue damage?
Low energy fractures cause moderate soft tissue damage, while high energy fractures cause severe damage.
p.6
Fracture Assessment and History Taking
What does the coagulation profile assess?
It assesses the blood's ability to clot, which is crucial before surgery.
p.15
Management of Closed and Open Fractures
What factors influence the method of fixation for fractures?
Degree of contamination, length of time from injury to operation, and amount of soft tissue damage.
p.10
Management of Closed and Open Fractures
How many layers of padding/ortho bandage should be applied during cast preparation?
At least 2 layers with 50% overlap.
p.4
Fracture Assessment and History Taking
What are common symptoms to assess in a fracture?
Pain, swelling, bruising, obvious deformity, and loss of function.
p.9
Management of Closed and Open Fractures
What are the advantages of using fiberglass for casts?
Strong, lighter, comfortable, cool, water-resistant, and radiolucent.
p.1
Fracture Healing Process
What type of bone is formed during callus formation?
Immature bone, also known as woven bone.
p.21
Fracture Assessment and History Taking
What clinical features indicate a humeral shaft fracture?
History of trauma followed by pain, gradually increasing in severity, and limited movement.
p.1
Fracture Healing Process
What happens in step 4 of the healing process?
Consolidation occurs, transforming woven bone into lamellar bone.
p.16
Complications and Post-operative Care
What are early complications of a clavicle fracture?
Injury to subclavian vessel or medial cord of brachial plexus.
p.4
Fracture Assessment and History Taking
What past medical history should be considered?
Previous anaesthesia, operations, injuries, and other musculoskeletal abnormalities.
p.6
Management of Closed and Open Fractures
What indicates the need for open reduction?
If closed reduction fails or when the fracture involves large articular fragments.
p.12
Management of Closed and Open Fractures
What are the benefits of external fixation?
It permits adjustment of length and angulation and allows reduction of the fracture in all three planes.
What kind of fracture is caused by a fall on the elbow with the arm abducted?
Oblique or transverse fracture.
p.5
Imaging and Investigations for Fractures
What types of X-rays should be taken in trauma cases?
Chest, pelvic, cervical, and concerned parts with 2 views (AP and lateral).
p.15
Management of Closed and Open Fractures
What is the first step in urgent wound and fracture debridement?
Maintain traction on injured limbs while replacing any dressing with a sterile pad and cleaning the surrounding skin.
p.24
Examination Techniques for Fractures
What are two special tests used to diagnose bicep tendon issues?
Speed test and Yergason test.
p.23
Examination Techniques for Fractures
What position is required for the Supraspinatus Test?
Seated or standing with arm abducted to 90 degrees and brought forward by 30 degrees.
p.3
Soft Tissue Damage in Fractures
Give an example of a low energy fracture.
A closed spiral fracture.
p.4
Fracture Assessment and History Taking
What factors regarding the injury's nature should be taken into account?
Velocity of injury, safety measures, and treatment received in A&E.
p.1
Fracture Healing Process
What is formed during step 3 of the fracture healing process?
Soft callus from cells changing into osteoblasts and osteoclasts.
p.21
Complications and Post-operative Care
What are some potential complications of a humeral shaft fracture?
Nerve injury (e.g., radial nerve palsy) and non-union.
p.26
Examination Techniques for Fractures
What must be examined in the hand during an elbow dislocation assessment?
Signs of vascular or nerve damage.
What are the classifications of clavicle fractures based on the site?
Group I (middle 1/3), Group II (lateral 1/3), Group III (medial 1/3).
p.17
Imaging and Investigations for Fractures
What does an X-ray show in acromioclavicular joint injuries?
Subluxation or dislocation at the affected site.
p.7
Complications and Post-operative Care
What is a potential complication of prolonged bed rest due to sustained traction?
Thromboembolism, respiratory problems, and general weakness.
p.25
Examination Techniques for Fractures
What are the clinical features of a lateral condyle fracture?
Swollen and deformed elbow, tenderness over the lateral condyle, painful passive wrist flexion.
p.13
Management of Closed and Open Fractures
When is internal fixation indicated?
For fractures that cannot be reduced non-operatively or are inherently unstable.
p.12
Management of Closed and Open Fractures
What is the principle of external fixation?
Bone is transfixed above and below the fracture with screws, pins, or tensioned wires clamped to a frame.
p.7
Management of Closed and Open Fractures
What indicates a successful reduction of a fracture?
1. Restoration of normal surface anatomy 2. Rapid improvement in pain & neurovascular deficits
p.1
Fracture Healing Process
What is the first step in the fracture healing process?
Tissue destruction and haematoma formation.
What is the commonest type of fracture in children?
Supracondylar humerus fracture.
p.19
Examination Techniques for Fractures
What should be checked before and after MRI for anterior dislocation management?
Check for axillary nerve intactness and sensation at the deltoid.
p.15
Complications and Post-operative Care
What antibiotics are used for prophylaxis in contaminated wounds?
Benzylpenicillin + Flucloxacillin or a second-generation cephalosporin, given every 6 hours for 48 hours.
p.17
Management of Closed and Open Fractures
What is a common cause of acromioclavicular joint injury?
Fall on the outer prominence of the shoulder.
p.23
Examination Techniques for Fractures
What does the Neer’s Sign test for?
Impingement of subacromial structures.
p.17
Management of Closed and Open Fractures
What may result from acromioclavicular joint injury?
Partial or complete rupture of the acromioclavicular or coraco-clavicular ligaments.
p.24
Soft Tissue Damage in Fractures
What history is often associated with SLAP lesions in the bicep tendon?
A fall followed by pain in the shoulder.
p.22
Rotator Cuff Syndrome
What activity might lead to the development of anterior shoulder pain?
Competitive swimming or a weekend of house decorating.
p.11
Management of Closed and Open Fractures
What is the purpose of the Sugar-Tong splint?
Used for the acute management of distal radial and ulnar fractures.
p.6
Management of Closed and Open Fractures
What are the two methods of reduction?
Closed reduction and open reduction.
p.4
Fracture Assessment and History Taking
What systemic reviews should be performed after a fracture?
CNS, CVS/RS, GIT, and GUT assessments.
p.8
Examination Techniques for Fractures
What is an advantage of a smooth Steinman pin?
Stronger but can slide if angled.
p.26
Management of Closed and Open Fractures
What should be done after the reduction of an elbow dislocation?
Put the elbow through the full range of movement to check stability.
p.14
Management of Closed and Open Fractures
What are the suggested activities for managing fractures?
Active exercise, assisted movement (continuous passive motion), and functional activity (everyday tasks).
p.25
Complications and Post-operative Care
What complication can arise from a fracture of the medial epicondyle?
Recurrent dislocation and stiffness of the elbow.
p.1
Fracture Healing Process
What is formed in the medullary cavity during remodelling?
The medullary cavity is reformed.
p.2
Complications and Post-operative Care
What are some potential complications of a fracture?
Involvement of surrounding soft tissues, joint issues, local edema, inflammation, severe tissue damage, and vascular impairment.
What is a common cause of traumatic fractures?
A single highly stressful, traumatic incident causing a break at the point of impact.
p.20
Complications and Post-operative Care
What may occur in 3-part and 4-part proximal humerus fractures?
Vascular and nerve injuries.
p.20
Management of Closed and Open Fractures
How can shoulder stiffness after a proximal humerus fracture be minimized?
By starting exercises early.
p.19
Management of Closed and Open Fractures
What is the initial conservative treatment for shoulder dislocation?
Reduction under sedation or GA followed by immobilization in a chest arm bandage for 3 weeks.
p.19
Complications and Post-operative Care
What is a common complication of shoulder dislocation, particularly in the early phase?
Axillary nerve injury resulting in paralysis of the deltoid and anesthesia over the lateral aspect of the shoulder.
What is a common fracture affecting all age groups?
Fracture of the clavicle.
p.8
Management of Closed and Open Fractures
What is the principle behind fixed traction?
Same principle as balanced traction, but without counter-traction.
p.25
Fracture Displacement
Which direction is the displacement most likely in a supracondylar humerus fracture?
Posterior displacement is greater than anterior displacement.
p.7
Management of Closed and Open Fractures
What are operative methods for fractures with severe soft tissue damage?
1. External fixation 2. Internal fixation
p.3
Soft Tissue Damage in Fractures
What are examples of high energy fractures?
Segmental and comminuted fractures, either open or closed.
p.15
Management of Closed and Open Fractures
How should uncontaminated wound types I and II be treated?
Sutured within a few hours of injury after debridement and incision.
p.13
Management of Closed and Open Fractures
What is one advantage of internal fixation?
Precise reduction and immediate stability.
p.8
Complications and Post-operative Care
What are some complications associated with skeletal traction?
Pin infection, nerve, and vascular injury.
p.21
Fracture Assessment and History Taking
What differential diagnoses should be considered for stiffness after a humeral shaft fracture?
Post-traumatic stiffness, disuse stiffness, regional pain syndrome, and arthritis.
p.26
Management of Closed and Open Fractures
What is the first step in treating an uncomplicated elbow dislocation?
Patient should be fully relaxed under anaesthesia.
p.11
Management of Closed and Open Fractures
What are the benefits of fracture bracing?
Allows for early functional range of motion and weight bearing, while relieving soft tissues and maintaining alignment.
p.10
Complications and Post-operative Care
What should a patient do immediately if they experience numbness, tingling, or increased pain after cast application?
Come immediately for assessment.
p.24
Soft Tissue Damage in Fractures
What is a common presentation of bicep tendon lesion in middle-aged or elderly individuals?
Degeneration and disruption often associated with rotator cuff problems.
What does rotation indicate in fracture displacement?
Rotation indicates that the bone looks straight but the limb has torsion deformity.
How can altered length affect a fracture?
Altered length can result in shortening of the bone due to muscle spasm.
p.6
Fracture Assessment and History Taking
What is the purpose of a full blood count in fracture management?
To check for hemoglobin (Hb) and evaluate overall blood health.
What is a common cause of elbow dislocation?
Fall on the outstretched hand.
p.24
Management of Closed and Open Fractures
What can help relieve pain in cases of bicep tendinitis?
Rest, local heat, and deep transverse frictions.
p.6
Management of Closed and Open Fractures
What is the primary aim of reduction in closed fractures?
To achieve adequate apposition and normal alignment of bone fragments.
p.7
Management of Closed and Open Fractures
What is the principle of sustained traction?
Traction is applied to the distal limb of the fracture, exerting a continuous pull along the long axis of the bone.
p.10
Management of Closed and Open Fractures
What should you do to the plaster before application?
Soak plaster in water at room temperature until air bubbles cease.
p.4
Fracture Assessment and History Taking
What can indicate nerve involvement in a fracture?
Numbness, movement, and sensation of the distal part.
p.9
Management of Closed and Open Fractures
What are the disadvantages of Plaster of Paris?
Heavy, fragile when in contact with water, and radio-opaque.
p.8
Examination Techniques for Fractures
What are the two types of traction pins mentioned?
Thin wire and Steinman pin.
p.17
Management of Closed and Open Fractures
What is the treatment for Grade I acromioclavicular joint injury?
Rest in a triangular sling and analgesics.
p.16
Management of Closed and Open Fractures
What treatment is ideal for an undisplaced clavicle fracture?
Conservative treatment with a cuff and triangular sling.
Who is most commonly affected by proximal humerus fractures?
Osteoporotic individuals after middle age.
p.13
Management of Closed and Open Fractures
What is an interfragmentary screw used for?
Fixating small fragments onto the main bone.
p.6
Management of Closed and Open Fractures
List the steps in the reduction process.
1. Reduction, 2. Hold, 3. Exercise.
p.22
Rotator Cuff Syndrome
What occurs occasionally after a sprain or jerking injury of the shoulder?
A full thickness rotator cuff tear.
What classification is used for the location of the humeral head in dislocation?
Preglenoid, subcoracoid, subclavicular for anterior dislocation; subcromial, subglenoid, subspinous for posterior dislocation.
p.26
Management of Closed and Open Fractures
What type of fixation may be required for unstable elbows after treatment?
Hinged external fixation.
What is a pathological fracture?
A fracture caused by normal stress acting on abnormally weakened bone, such as in osteoporosis or bone tumors.
What is a physeal fracture?
A fracture through the growing physis that damages the cartilaginous growth plate and can lead to progressive deformity.
p.12
Complications and Post-operative Care
What should be done if a pin-track infection occurs?
Immediate care of the pin-site and administration of antibiotics.
p.5
Imaging and Investigations for Fractures
What is the importance of the rule of 2 in X-ray assessment?
To take additional views for difficult-to-detect fractures, particularly in severe force injuries.
p.15
Management of Closed and Open Fractures
What is the recommended irrigation method for a wound?
Irrigate thoroughly using copious amounts of warm normal saline, potentially needing 6-12 liters for long bone injuries.
p.24
Soft Tissue Damage in Fractures
What is the typical symptom sharp localization in bicep tendon lesion?
Pain and tenderness over the bicipital groove.
p.10
Management of Closed and Open Fractures
What is the first step in the cast application process?
Clean skin and apply dressing if there is a wound.
p.21
Management of Closed and Open Fractures
When should ORIF (Open Reduction and Internal Fixation) be performed?
If the fracture is unstable, the patient is obese, or there is prolonged discomfort.
p.25
Complications and Post-operative Care
What is a potential early complication of a supracondylar humerus fracture?
Injury to the brachial artery or median and radial nerves.
p.23
Examination Techniques for Fractures
What indicates a positive test in the Hawkins Sign?
Pain when the arm is flexed to 90 degrees and internally rotated.
p.25
Complications and Post-operative Care
What is a late complication of a supracondylar humerus fracture?
Malunion leading to gunstock deformity.
p.7
Management of Closed and Open Fractures
What are the advantages of sustained traction?
Can move joints, allowing for muscle exercise, and is safe if not excessive.
p.15
Complications and Post-operative Care
What should be done post-operatively if a wound is left open?
Inspect again after 2-3 days; if there's significant skin loss, consider plastic surgery.
p.6
Management of Closed and Open Fractures
What is required for successful closed reduction?
Anaesthesia, muscle relaxation, and X-rays before and after the procedure.
What is a common cause of glenohumeral dislocation?
A fall on an outstretched hand with the shoulder abducted and externally rotated.
What commonly causes a rupture of the proximal humerus?
A fall on the outstretched hand.
What is the typical mechanism of injury for posterior dislocation?
A direct force pushing the humerus head out of the glenoid cavity.
p.13
Complications and Post-operative Care
What is a common complication of poor internal fixation technique?
Iatrogenic infection leading to chronic osteomyelitis.
p.13
Complications and Post-operative Care
What causes non-union in fractures?
Excessive damage to soft tissues, inadequate blood supply, or rigid fixation.
p.14
Soft Tissue Damage in Fractures
What is the principle of soft tissue care in open fractures?
Elevate and exercise; never dangle or force.
p.14
Management of Closed and Open Fractures
What is the treatment principle when dealing with contaminated open fractures?
Early debridement and early antibiotics.
p.24
Soft Tissue Damage in Fractures
What might be involved in the impingement syndrome related to the bicep tendon?
Bicep tendon lesions, including tendinitis and torn long head of the bicep.
p.1
Fracture Healing Process
What occurs at the fracture site during the first step?
Tissue damage and bleeding, leading to haematoma formation.
What is a common cause of a supracondylar humerus fracture?
Fall on an outstretched hand or direct fall on the elbow.
p.5
Examination Techniques for Fractures
What should be avoided during the movement examination?
Never move a broken bone; only relevant joints should be moved, especially in unconscious patients.
p.23
Examination Techniques for Fractures
In the Infraspinatus and Teres Minor Test, how is the patient's arm positioned?
Arms at the sides with elbows flexed to 90 degrees.
p.6
Management of Closed and Open Fractures
When is reduction considered unnecessary?
When there is little or no displacement of the fracture.
p.15
Complications and Post-operative Care
What indicates the need for plastic surgery in wound treatment?
Wound type III requiring more than one debridement and extensive skin loss over the fracture.
p.4
Fracture Assessment and History Taking
What signs may indicate vascular involvement?
Skin colour changes, temperature variation, pulse presence, and collagenosity.
p.9
Management of Closed and Open Fractures
When should a splint be used instead of a cast?
For soft tissue injuries, acute management awaiting orthopedic intervention, or selected types of fractures.
p.1
Fracture Healing Process
What is the final step in fracture healing?
Remodelling of the newly formed bone to resemble normal structure.
p.14
Management of Closed and Open Fractures
What is the primary objective of exercise in fracture management?
To reduce oedema (swelling) and preserve joint movement.
p.25
Management of Closed and Open Fractures
What is the treatment for a displaced supracondylar humerus fracture?
Open reduction and internal fixation (ORIF).
p.4
Fracture Assessment and History Taking
Why is social history important in fracture assessment?
To evaluate support systems, lifestyle factors like smoking or alcohol use, and financial status.
p.8
Examination Techniques for Fractures
What is a necessary step before inserting a traction pin?
Create a sterile field with limb exposed.
p.20
Examination Techniques for Fractures
What are some special features of proximal humerus fractures?
Pain, large bruise in the upper arm, signs of axillary nerve or brachial plexus injury.
p.22
Rotator Cuff Syndrome
What might indicate the need for surgery in cases of rotator cuff syndrome?
Progressive fibrosis and disruption of the cuff.
What is a key characteristic of a transverse fracture of the proximal humerus?
It extends across the surgical neck and the greater tuberosity.
p.13
Complications and Post-operative Care
What is the minimum recommended time before considering removal of metal implants?
1 year, safer after 18-24 months.
p.20
Fracture Displacement
What happens to the shaft in a proximal humerus fracture?
It is usually impacted into the head in an abducted position.
p.25
Examination Techniques for Fractures
What are some clinical features of a posteriorly displaced supracondylar humerus fracture?
Swelling, S-shaped deformity, distal humeral tenderness, and unusual posterior prominence at olecranon.
p.16
Fracture Assessment and History Taking
What are common clinical features of a clavicle fracture?
Pain, swelling, deformity, crepitus, and inability to raise the shoulder.
p.7
Management of Closed and Open Fractures
In which type of fractures is sustained traction particularly useful?
Spiral fractures of long bone shafts, such as the femur and tibia.
p.6
Management of Closed and Open Fractures
What is the main challenge during the first 12 hours post-fracture?
Swelling of soft tissues, which can complicate reduction.
p.15
Complications and Post-operative Care
What are the signs of dead muscles?
Purplish color, failure to contract, and failure to bleed when cut.
p.10
Management of Closed and Open Fractures
How should the plaster be molded during application?
Evenly, rapidly, and without intervention using the palm, not fingers.
p.13
Complications and Post-operative Care
What factors influence the risk of infection in internal fixation?
Patient condition, doctor's skill, and facility standards.
p.9
Management of Closed and Open Fractures
What are the rules for applying a Plaster of Paris cast?
Length from one joint above to one joint below, specific number of layers for upper and lower limbs, and specific width measurements.
p.22
Rotator Cuff Syndrome
What procedure can help diagnose a rotator cuff tear?
Injecting local anesthetic into the subacromial space.
p.11
Management of Closed and Open Fractures
What injuries is the Volar/Dorsal forearm splint used for?
Soft tissue injuries to hand and wrist, acute carpal bone fractures (excluding scaphoid/trapezium), and childhood buckle fractures of the distal radius.
p.10
Complications and Post-operative Care
What local complication can occur due to a tight cast?
Vascular compression, leading to diffuse pain and bluish discoloration of digits.
p.26
Complications and Post-operative Care
What should be done at 3 weeks post elbow dislocation treatment?
Discard the collar and cuff.
p.11
Management of Closed and Open Fractures
What condition does the Mallet finger splint address?
Extensor tendon avulsion from the base of the distal phalanx.
p.11
Management of Closed and Open Fractures
What is a functional brace used for?
It prevents joint stiffness while allowing fracture splintage and loading.
p.10
Management of Closed and Open Fractures
What should be assessed after the cast application?
Pulse and capillary refill.
p.1
Fracture Healing Process
What proteins drive the process of callus formation?
Fibroblast growth factors, transforming growth factors, and bone morphogenic protein.
p.26
Management of Closed and Open Fractures
What is used to support the arm after an elbow reduction?
A light cast with elbow flexed to just above 90 degrees.
What is the definition of a fracture?
A break in the structural continuity of bone, which may include cracks, crumpling, splinting, or complete breaks.
p.9
Management of Closed and Open Fractures
What is a disadvantage of using a cast?
Higher risk of complications and more technically difficult to apply.
p.11
Management of Closed and Open Fractures
Which fractures does the Ulnar gutter splint typically support?
4th and 5th proximal/middle phalangeal shaft fractures and the 1st metacarpal fracture.
What leads to stress or fatigue fractures?
Repetitive stress of normal degree that persists to the point of mechanical fatigue.
p.11
Management of Closed and Open Fractures
What is the function of a Patella Tendon Bearing (PTB) splint?
Molding around tibia condyles to lock the tibia when the patient is able to partially weight bear.
In younger patients, how may the proximal humerus fracture?
The proximal end may be broken into several pieces.
p.9
Management of Closed and Open Fractures
What functional positions should the elbow and wrist be in when applying a cast?
Elbow in 90° flexion and wrist in 25° extension.
p.22
Rotator Cuff Syndrome
What are the symptoms of a complete rotator cuff tear during active abduction?
Active abduction is impossible.
p.13
Management of Closed and Open Fractures
What is the purpose of intramedullary nails?
To stabilize long bone fractures, especially in femur and tibia.
p.14
Management of Closed and Open Fractures
What should be addressed in the hospital for open fractures?
Any life-threatening conditions and wound inspection.
p.14
Management of Closed and Open Fractures
What are the different types of open fractures based on wound size?
Type I: Puncture wound (<1cm); Type II: Skin damage (>1cm); Type III: Severe, big wound (>10cm).
p.13
Complications and Post-operative Care
What can lead to implant failure in internal fixation?
Excessive stress at the fracture site before union occurs.
What differentiates a closed fracture from an open fracture?
A closed fracture has intact overlying skin, while an open fracture has breached skin, increasing the risk of contamination and infection.
What is a greenstick fracture?
A type of fracture where the bone is buckled and bent, typically seen in children.
p.1
Fracture Healing Process
What role do osteoclasts play in the consolidation phase?
They burrow through debris at the fracture site.
p.9
Management of Closed and Open Fractures
What is the reason for immobilizing in functional anatomy?
To maintain proper joint function while providing immobilization.
p.10
Complications and Post-operative Care
What is a potential systemic complication associated with plaster casts?
Deep vein thrombosis (DVT) leading to pulmonary embolism.
p.10
Complications and Post-operative Care
What are some complications associated with improper cast application?
Joint stiffness, skin abrasion, and plaster breakage.
p.14
Complications and Post-operative Care
What is the risk of infection for different types of open fractures?
Type I: >2%; Type III: >10%.
p.11
Management of Closed and Open Fractures
When is a functional brace applied during fracture healing?
It is used when fractures begin to unite, typically after 3-6 weeks of traction or restrictive splintage.
Which type of dislocation is more common in the glenohumeral joint?
Anterior dislocation is more common than posterior dislocation.
p.14
Management of Closed and Open Fractures
What is the initial management step for an open fracture at the scene of an accident?
Splinting the limb and covering the wound to reduce risk of further contamination.
p.11
Management of Closed and Open Fractures
What is the Thumb spica splint primarily used for?
Injuries to scaphoid/trapezium and stable thumb fractures.
p.14
Complications and Post-operative Care
What should be assumed about open fractures regarding contamination?
Always assume to be contaminated; aim to prevent infection.
What characterizes a comminuted fracture?
It is characterized by the bone being broken into more than two fragments.
