29. Fractures Flashcards
What happens at the site of a bone fracture at the tissue/cell level?
- Bone breaks –> there is blood/hematoma
- usually surrounded by muscle or other soft tissue which can be a source of mesenchymal stem cells (MSCs)
- the MSCs do a few things:
- release trophic mediators (Bone Morphogenic Proteins)
- differentiate into osteoblasts, endothelial cells, chondrocytes. all these can become new bone.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/089/129/088/a_image_thumb.png?1659422204)
what kind of fracture?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/089/129/976/q_image_thumb.png?1659472015)
stress fracture.
what kind of fracture?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/089/130/128/q_image_thumb.png?1659472015)
fracture through the “waist” of the scaphoid bone (on the left side of the image)
Fracture on the left is called?
Fracture on the right is called?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/089/130/169/q_image_thumb.png?1659472016)
Left: simple/hairline
Right: comminuted
open v closed fracture: what do these words mean?
open = has broken the skin (either the bone has punched out, or the skin has been broken by trauma at the site of the break. skins is open either way)
closed = nothing has broken skin
Open fractures: what are the absolutes in terms of treatment?
- sterile dressing using saline (not betadine: it is caustic to tissue)
- Splint (immobilize to prevent further soft tissue damage)
- tetanus prophylaxis
- IV antibiotics
- this is a surgical emergency so irrigate a lot and debride wound
Classification of fractures by anatomic location: terms we use are
- intra v extra articular
- metaphyseal v diaphyseal
- prox, middle, or distal third
- remember that diaphyseal means the shaft/skinny part of the bone (diaphyseal has been on a diet).
- metaphyseal and epiphysis: see pic
- note he never used the word epiphysis, only metaphysis.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/089/132/365/a_image_thumb.png?1659422205)
what kind of fracture/what kind of force?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/089/133/116/q_image_thumb.png?1659472016)
transverse fracture. implies a failure under tension.
direct blow, high energy
what kind of fracture/what kind of force?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/089/133/283/q_image_thumb.png?1659472016)
f him, he only said that it was due to a low skiboot.
either oblique or spiral.
what kind of fracture/what kind of force?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/089/133/983/q_image_thumb.png?1659472017)
Butterfly fracture
bending prior to breaking.
which bone fragment do we use do describe if the displacement is medial/lateral or anterior/posterior?
typically use the distal fragment to describe.
ie, below would be described as anterior displacement.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/089/134/108/a_image_thumb.png?1659422205)
Describe this fracture
![](https://s3.amazonaws.com/brainscape-prod/system/cm/089/135/043/q_image_thumb.png?1659472019)
Skeletally immature, communited fracture. Open fracture (absence of soft tissue medially), valgus position, middle portion of bone.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/089/135/043/a_image_thumb.png?1659422205)
Special term to describe a fracture: what does greenstick mean? what population does this happen in?
in younger bones, with a bending mechanism, one cortex can fail by fracture, while the other cortex only bends (deforms plastically) and does not fracture, much like what happens when trying to break a “green” stick out in the woods.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/089/135/974/a_image_thumb.png?1659422206)
what is a buckle fracture?
once again, usually in young bones, with a compression type mechanism, one cortex fails by a forming a “wrinkle”, and the other cortex appears intact. VERY stable fractures, heal quite quickly
![](https://s3.amazonaws.com/brainscape-prod/system/cm/089/136/256/a_image_thumb.png?1659422206)
name 2 types of pathologic fractures?
why are they called this?
osteoporosis compression fracture, metastatic fracture
term used to describe a fracture that occurs in bone that is “weakened” by another process, such that the bone “fails” with much less of an insult.