Types of Fracture Short Question and Answers

Fractures General Principles Important Notes

1. Fracture – it is loss of continuity of bone
2. Types of fractures
   
   
3. Stages of healing of fracture
   • Stage of hematoma formation
   • Stage of cellular proliferation
   • Stage of callus formation
   • Stage of new bone formation
   • Stage of remodeling
4. Brain injuries
   
   
5. Sequele of contusion and laceration
   • Post traumatic amnesia
   • Cerebral irritation
   • Post contusional syndrome
   • Traumatic epilepsy of Jacksonian type
   • Cerebral compression
6. Lucid interval
   • In case of extradural haemorrhage when the hematoma has reached a considerable size it causes a sufficient rise in intracranial pressure to cause cerebral compression
   • This causes unconsciousness due to pressure on the reticular system of the midbrain
   • The time taken to form such a big hematoma is known as a lucid interval
7. Complications of head injury
   • Early complication
     • Leakage of CSF
     • Aerocele
     • Meningitis
     • Fat embolism
     • Brain stem injury
     • Posterior fossa injury
     • Pituitary failure
   • Late complication
     • Chronic subdural hematoma
     • Post-traumatic epilepsy
     • Headache
     • Hydrocephalus

Read And Learn More: General Surgery Question and Answers

Fractures General Principles Short Answers

Question 1. Clicking jaw

Answer:

Clicking jaw Causes:

• Normal jaw mechanics
• Temporomandibular joint disorders
• Masticatory muscles disorders
• Maxillo-mandibular alignment disorder
• Occlusal discrepancies
• Bruxism

Question 2. Black eye

Answer:

Black eye

• Feature of Lefort 2 fracture

Black eye Appearance:

• Presence of bilateral circumorbital edema
• Presence of bilateral circumorbital ecchymosis

Black eye Diagnosis:

• Difficult due to rapid development of swelling of eyelids

Question 3. Lefort I fracture

Answer:

Lefort I Clinical Features:

• Oedema of lower part of face
• Ecchymosis in buccal vestibule
• Bilateral epitaxis
• Mobility of upper teeth
• Disturbed occlusion
• Pain
• Upward displacement of fragment- telescopic fracture
• ‘Cracked cup’ sound on percussion of upper teeth
• ‘Guerin sign’- ecchymosis in the greater palatine region

Lefort I Management:

1. Reduction
   • Reduction of impacted fragment with the help of disimpaction forceps (Rowe’s and William’s forceps)
   • Placement of Rowe’s forceps:
   • The straight blade is placed into the nostrils
   • The curved blade is placed over the palate
   • Placement of William’s forceps:
   • Placed over the buccal aspect
   • Displaces maxilla in mesiodistal direction
2. Fixation:
   • Zygomatic suspension fixation is done
   • Holes are drill over the zygomatic arch
   • Pass wire through it
   • Bring it up to the arches
   • Twisted over are arch bars
   • 3.Inter Maxillary Fixation
   • IMF done for 3-4 weeks

Question 4. Extradural hematoma

Answer:

Extradural hematoma

• It is the hemorrhage in the space outside the dura mater but inside the skull

Extradural Hematoma Causes:

• Injury to main trunk of the middle meningeal artery
• Injury to middle meningeal vein
• Bleeding in the posterior cranial fossa
• Fractures of the anterior fossa
• Bleeding from one of the venous sinuses

Extradural Hematoma Clinical Features:

• Bleeding in the epidural spaces
• They can quickly expand and compress the brain stem
• Unconsciousness
• Abnormal posture
• Abnormal pupil responses to light

Extradural Hematoma Treatment:

• Blood may be aspirated surgically to remove the mass and reduce the pressure on the brain
• Hematoma is evacuated through a burr hole or craniotomy

Question 5. Subdural hematoma

Answer:

Subdural hematoma

• Subdural hematoma is a type of hematoma in which blood gathers within the outermost meningeal layer between the duranater which adheres to the skull and the arachnoid mater enveloping the brain

Subdural Hematoma Causes:

• Laceration of the cortex
• Rupture of superior cerebral veins

Subdural Hematoma Clinical Features:

• Severe brain damage
• No definite lucid interval
• Early unconsciousness
• Cerebral compression
• When subdural hematoma is less dramatic and delayed by several days, it is called sub acute subdural hematoma
• When subdural hematoma appears further late, it is called chronic subdural hematoma

Subdural Hematoma Treatment:

• Extensive craniotomy
• Hemorrhagic vessels are secured and ligated
• Hematoma are cleared off
• Subdural Hematoma

Question 6. Temporomandibular Dislocation

Answer:

Temporomandibular Dislocation

• Dislocation refers to the condition in which the condyle is placed anterior to the articular eminence with collapse of the articular space

Temporomandibular Dislocation Clinical Features:

• Pain
• Inability to close the mouth
• Tense masticatory muscles
• Difficulty in speech
• Excessive salivation
• Open bite
• Protuding chin
• Deviation of the lower jaw

Question 7. An immediate complication of fracture

Answer:

An immediate complication of fracture

• Anesthesia
  • Anaesthesia of lower lip occurs in case of neuropraxia, axonometric or, neurotmesis
• Malunion
  • Improper alignment of the fracture ends leads to malunion
• Infection
  • It may be initiated as a localized abscess but later progresses to osteomyelitis
• Superior orbital fissure syndrome
  • Hematoma within the fissure causes damage to the 3rd, 4th and 6th cranial nerves
• Nonunion
  • It is lack of bony fusion of the fractured ends
• Delayed union
  • If the fracture does not heal in 4-6 weeks, it is called delayed healing
  • It is temporary condition and can be corrected
• Derangement of occlusion
  • If there is traumatic occlusion it is corrected by selective grinding of teeth
• Ankylosis of TMJ
  • Prolonged immobilization causes ankylosis
• Other complications
  • Diplopia
  • Enophthalmos
  • Blockade of nares
  • Anosmia
  • epiphora

Question 8. Head injury management

Answer:

Head injury management

• Management of the head injury depends on Glasgow Coma Scale
  • Less than 8 score- indicate severe injury
  • Score 9-12- moderate injury
  • Score 13-15- mild injury
• Measures includes
  • Examination of the wound
  • Continued ventilation
  • Intensive care unit management of intracranial pressure
  • Oxygenation
  • Frequent neurological examination
  • CT scan

Question 9. Artificial Respiration

Answer:

Artificial Respiration

• Artificial respiration is required whenever there is arrest of breathing which occurs during
  • Accidents
  • Drowning
  • Asphyxia
  • Gas poisoning

Artificial Respiration Purpose:

• Ventilation of alveoli
• Stimulation of respiratory centers

Artificial Respiration Methods:

• Manual method
  • Mouth to mouth method
  • Holger Neilson method
• Mechanical methods
  • Drinker’s method
  • Ventilation method

Question 10. Cardiopulmonary resuscitation

Answer:

Cardiopulmonary resuscitation

• Cardiopulmonary resuscitation is done by external cardiac compression which is a rhythmic application of pressure over the lower half of the sternum

Cardiopulmonary Resuscitation Steps:

• Position yourself in kneeling position on the side of the patient
• Place the heel of one hand on the position of pressure
• Place the heel of other hand on top of first one and interlock the fingers
• Apply pressure to depress the sternum at least 11/2 – 2 inches
• The rate of compression should be 60 per min.
• Apply 15 compressions on the chest followed by 2 full ventilation
• Repeated to form 4 complete cycles in a minute

Cardiopulmonary Resuscitation Effects:

• Pressure in the thorax increases
• Thorax causes the blood from the periphery to flow back into the heart and refill the chambers
• This increases cardiac output

Question 11. Malunion

Answer:

Malunion

• Improper alignment of the fractured ends leads to malunion
• Usually it does not require any treatment
• But if it affects patient’s occlusion, function, and esthetics it should be treated

Malunion Treatment:

• Osteotomy of fragment segments
• Realignment
• Fixation
• Use of elastics to correct malocclusion

Question 12. Depressed fractured skull

Answer:

Depressed fractured skull

• Depressed fractured skull can be of two types
  • Open
  • Closed
• It may lead to
  • Dural tear
  • Pressure on the cerebral cortex
  • Underlying hemorrhage
  • Epilepsy
  • Pressure on dural venous sinuses

Depressed Fractured Skull Treatment:

• Shaving of the head
• Detect neurological deficit
• Debridement of the scalp
• A burr hole is made by the side of the fractured portion
• Through it an elevator is introduced and the underlying dura is gently separated
• The depressed fragments are lifted up and dura is inspected

Question 13. Cerebral concussion

Answer:

Cerebral concussion

• It is a type of brain injury

Cerebral Concussion Features

• Temporary physiological paralysis of function without organic structural damage
• Transient loss of consciousness, dizziness, or mild confusion followed by complete recovery
• May last from 1 min to hours or even a day

Question 14. causes of nasal bleeding

Answer:

causes of nasal bleeding

• Trauma
• Exposure to warm, dry air for long time
• Nasal and sinus infection n Allergic rhinitis
• Nasal foreign body
• Vigorous nose blowing
• Deviated nasal septum
• Cocaine use
• Use of anti-coagulant
• Hypertension
• Bleeding disorders

Fractures General Principles Viva Voce

1. The mass of new bone formation at the site of fracture is known as a callus
2. Crepitus is a sensation of grating which may be felt or heard
3. Perkin’s formula helps to estimate the time required for union of fracture and consolidation
4. If time taken for union for fracture is unduly prolonged it is called a delayed union
5. When bony union cannot takes place naturally without operation it is called non-union
6. Meningitis is very common complication of skull fractures
7. Post-traumatic amnesia is loss of memory for events after the occurrence of trauma
8. Retrograde traumatic amnesia means loss of memory for events before the occurrence of the accidents