ASHT - fractures Flashcards
what makes up Bone Anatomy?
Epiphysis - rounded end of long bone + growth plate.
Diaphysis - mid section/shaft
Metaphysis - between epi and dia.
Periosteum - thin layer of dense connective tissue around bone but not in joint.
Endosteum - lines medullary cavity (inside bone)
what are 2 types of bone?
Cortical Bone (compact bone) Diaphysis of long bone 80% of skeletal mass.
Cancellous bone (spongy bone) Ephiphysis and Metaphysis of long bones, 20% of skeletal mass, metabolic turnover is greater and heals faster
what is Primary bone healing?
- no callus formation
- direct apposition of bone ends with compression
- rigid fixation substitutes for callus
what is Secondary bone healing?
- callus formation,
- slight movement “micromotion”
what are the Phases of Fracture Repair?
Inflammatory 0-2 weeks: - accumulation ofhematoma, bone necrosis, proliferation of fibroblasts and osteoblasts, invasion of leukocytes and macrophages.
Reparative Phase (1-8 weeks): - hematoma organizes forming fibrin scaffold, - external callous forms from periosteum - gradual increase in stability toward clinical union - new bone and osteogenic cells bridge fracture site.
Remodeling phase (2-6 months): - process of continuous bone resorption and formation, osteoclasts reabsorb callous, can be influenced by stress
what are Pediatric Fractures (3 types)?
Buckle or Torus - incomplete fx, bulging of the bone;
Greenstick - partial break (incomplete);
Physeal fractures - involving growth plate
what is Salter-Harris Fracture Classification ?
pediatric fracture classification involving growth plate. Types 1-5 where 5 is the worst.
1- separation through growth plate
2- injury through physis with part of metaphysis attached
3- injury through physis, longitudinal fracture through epiphysis
4- longitudinal fracture through metaphysis physis epiphysis
5 - crush injury with a premature closure of growth plate> bones won’t reach mature length
what are Indications for surgical management of fractures?
-unstable fx
- fx requiring early motion (ie. thumb fx)
- fx with high incidence of non-union (ie. scaphoid proximal pole)
- avulsion fractures (central slip, jersey finger)
- intraarticular
- fractures with step off
- joint subluxation
what are Complications of internal fixation ?
-soft tissue injury
- periosteal stripping ( dec blood supply)
- hardware irritation,
- adhesions
- tendon ruptures
what is External fixation?
Ligamentotaxis - traction to preent fracture shortening or angulation
what are Common complications of Fractures?
- non union
- malunion/bone length alteration
- delayed union
- edema
- pain
- stiff joint
- tendon adhesions
- decreased strength
- nerve entrapments or compressions
- posttraumatic OA
- CRPS
- frozen shoulder
- acute compartment syndrome
what are Signs of Compartment Syndrome?
- pain
- paresthesia
- Pallor
- paralysis
- pulselessness
- pressure (6Ps)
what is a Colle’s fracture?
DRFx, extra-articular, distal radius with DORSAL displacement, FOOSH/wrist extension 80% need reduction
what is a Smith’s fracture?
DRFx, extra-articular, distal radius with VOLAR displacement, Fall on flexed wrist
what is a Barton’s fracture?
DRFx displaced fracture with dislocation of RADIALCARPAL JOINT.
Rim of distal radius fracture with volar or dorsal displacement. usually OR
what is a Chauffer’s fracture?
DRFx oblique intra-articular fx, generally require OR
In DrFx rehab, what are substitution patterns to watch for (2)?
EDC for wrist extensors
FPL adherence over volar plate - add isolated thumb IP flexion blocking
what are Complications post wrist fracture?
- stiffness, swelling, pain
- malunion/radial shortening
- DRUJ dysfunction
- CRPS
- median n. compression
- radiocarpal arthritis
- weakness
- carpal instability(undetected ligament injuries)
- shoulder stiffness
what is DrFx Malunion, radial shortening?
Most common, disabling condition. Slight shortening changes axial forces across wrist.
> 6mm affects flexion/UD/pronation/grip
<6mm affects forearm rotation.
Dorsal tilt >10* decreases wrist flexion
what is the Carpal Fractures Frequency?
1/10th as frequently as DRFx;
scaphoid 60-70%, Triquetrum/lunate 20%
others 7-10%
trauma on ulnar side of hand leads to what carpal fracture?
hammate or pisiform
what are the Types of Hammate fracture?
- hook - long-stick injuries from golf or baseball
- Dorsal hammate
what causes Scaphoid Fractures?
90% from FOOSH, scaphoid vulnerable to injury bc spans both carpal rows, principal bone to block extreme wrist extension, difficult to diagnose
