8. Fractures

Question 1

Recall the changes in bone structure from foetus to 2 year-old infant

Answer 1

In utero foetus lays down as much calcium-rich bone as possible - it is very dense but ill-structured
Following birth, in accordance with when the child begins to walk, the trabeculae realign to provide strength
Ca++ laid down before birth as mother has very little Ca++ to give in breast milk

Question 2

Recall the T score that is diagnostic of osteoporosis

Answer 2

Less than 2.5SDs below the mean

Question 3

Why is early-life exercise so important for bone health?

Answer 3

Helps you to lay down as much bone as possible so that when it starts to depreciate you will have enough left that you won;t get issues

Question 4

Recall the body’s primary bone healing process following a fracture

Answer 4

Blood supply from medullary canal (periosteal and metaphysial vessels)
Haematoma forms containing all your healing cells

Question 5

Recall the surgical intervention into primary bone healing following a fracture

Answer 5

Remove haematoma
Realign bone to reduce angulation
Hold it in place by rod/ plate and screws/ plaaster cast - it needs to be stable to heal

Question 6

How can bone reform when there is absolute realignment and zero movement following fracture?

Answer 6

No callous, perfect reformation = PRIMARY bone healing

Question 7

Describe the healing of a fracture that has relative stability

Answer 7

Secondary bone healing

Callous develops which eventually develops into bone, leaving a little lump

Question 8

Summarise the events of the 4 stages of bone healing

Answer 8

1. Inflammation and progenitor infiltration
2. PtG involvement, soft callus
3. Type 1 collagen production and calcification, angiogenesis to produce woven bone
4. Remodelling to lamellar bone, reformation of medullary canal

Question 9

Recall the 5 classifications of fracture you have to know

Answer 9

Spiral
Oblique
Communitive
Transverse
Greenstick

Question 10

Recall the sort of injury that produces a spiral fracture

Answer 10

Twisting arm in arm wrestle

Question 11

Recall the sort of injury that produces an oblique fracture

Answer 11

Blunt trauma

Question 12

Recall the sort of injury that produces a communitive fracture

Answer 12

Blunt trauma with whiplash

Question 13

What is a communitive fracture?

Answer 13

Fracture which produces multiple “bits”

Question 14

Recall the sort of injury that produces a transverse fracture

Answer 14

Hitting something with blunt force and then withdrawing

Question 15

Recall the sort of injury that produces a greenstick fracture

Answer 15

Not a clean snap - this is a paediatric fracture

Question 16

What is an important sign of child abuse orthopaedically?

Answer 16

Non-greenstick paediatric fracture - indicative of very strong force