bone repair Flashcards

1
Q

how bones break

A
repetitive force
single force
- load
- rate
- direction
- bone properties
- soft-tissue forces
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

classifications of fractures

A
broken 
fractured
cracker/hairline
greenstick
buckle
avulsion

’ a soft itssue injury complicated by a broken bone’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

why classify?

A
Immortality
Information sharing (#)
Guide treatment
Guide prognosis
Research
	allow direct comparison
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

anatomical, mechanism and descriptive classification of a fracture

A
Anatomical
	Proximal, Mid, Distal
	Intra/extra-articular
	Displaced/Undisplaced
	Open/closed
	Simple/Multifragmentary
Mechanism of injury
	Bending
	Shearing
	Compression
	Rotation
Comprehensive (descriptive)
	AO Muller
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

displacement

A

S hortening- distance
T ranslation- %
A ngulation- degrees
R otation- degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

diagnosis and imaging

A
History - mechnism
Examination
	look
	Feel
	Move
Investigations
	Xray
	USS
	CT
	MRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

XRays

A
2D representation of 3D structure
Rule of 2s
	2 views
		AP and Lateral
	2 Joints
		Above and Below
	2 Times
		Before and After
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ultrasound scan USS

A

Haematoma
Joint effusion
Tendon/Vascular injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CT

A

3D reconstruction
Joint surface
Comminution
Angiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MRI

A
Associated injuries
	Ligament
	Cartilage
	Tendon
Occult fractures
Stress fracture
	The “dreaded black line”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

treatment principles

A
4 Rs
Resuscitate
Re-align
	Joint surface anatomical
Restrict
	Minimise further soft tissue damage
	Stable biological fixation
Rehabilitate
	Early weight bearing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

bone healing

A
How do I want this to heal?
	Primary
	Secondary (with callus)
Adjuncts
	Osteo conductive
	Osteo inductive
	Osteo genic

How should I fix this?
Absolute stability
Relative stability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

perren’s Strain theory

A

Perren’s Strain Theory
Amount of fracture movement relative to fracture gap
Different tissues tolerate different amounts of movement
Up to 100% - Granulation tissue
Up to 17% - Fibrous Connective tissue
2-10% - Fibrocartilage
< 2% - Bone

Within range for bone
fracture ends resorbed
strain reduced
leads to differentiation of callus

Above threshold bone forming
process impaired
leads to non-union

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

principles of fixation

A
Manipulation
Restore
	Length
	Rotation
	Stability
	Articular surface
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

treatment options

A
Non-surgical
	Analgesia
	Cast/splint/sling
Surgical
	Internal fixation
			K-wires
			Plate/screws
			Intramedullary nail
	External fixation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

external fixation

A

temporary procedure

correction of deformity

17
Q

LC-DCP

A

allows linear compression across fracture gap .
footprint on bone reduced ~ 50%
minimises periosteal compression

18
Q

compression plate biomechanics

A
Fracture reduced to plate
Relies on large friction forces
Rigid fixation / absolute stability
Direct healing with no callus
Prone to failure
19
Q

locking plate

A

Angular and Axial Stability
Flexible Internal Fixation
Fixed angle construct

20
Q

locking plate biomechanics

A

Surrogate cortex
Angular and Axial stability
No friction (Bone/Plate) required
Periosteal blood flow unrestricted
Flexible elastic fixation with fragments splinted (Biological fixation)
Indirect Healing similar to external splinting Ex-fix and IM devices
Load shared across each bone/screw interface
Cut-out of screws is now or nothing

21
Q

LCP

A

Combination Holes
Linear compression
Angular and axial stability

22
Q

IM nail

A

Minimise soft tissue injury

Only available for certain fractures

23
Q

what influences fracture healing

A
Injury factors
	Energy
	Environment
Patient factors
	Compliance
	Comorbidities
Surgical factors
	Suitability
	Stability
24
Q

fracture complications

A
Immediate
	Haemorrhage
Short term
	Compartment syndrome
	Neurological injury
	Fat embolus
Mid term
	Infection
	Delayed/non-union
Long term
	Loss of function
	Growth disturbance
	Arthritis
25
fat embolism syndrome FES
serious manifestation of fat embolism occasionally causes multi system dysfunction, the lungs are always involved and brain is next
26
special cases
Growth plate injury Non-accidental injury Fragility fractures
27
hip fractures
``` Increasingly common Rising socio-economic burden £3.6-£5.6 Billion per annum (2033) 8-10% die within 30 days 15-30% die within 1 year 75% die within 5 years 1/3 return to premorbid function 1/4 need full-time Nursing Home care Up to 50% deaths avoidable ```