Ch 10 - Long bones fractures Flashcards
What type of Salter Harris Fracture is the above?
Type I
Type II
Type III
Type IV
Type V
Type II
What sort of the periosteal reaction is commonly associated with a stress fracture?
Smooth
Lamellar
Thin-brush like
Sunburst
Smooth
At what point following fracture healing with appropriate apposition and implant will a ‘bridging callus’ typically form?
5 days
9 days
14 days
21 days
14 days
How long would you expect classical healing of a diaphyseal fracture to take in a < 3 month age patient
1-2 weeks
2-3 weeks
3-4 weeks
4-6 weeks
2-3 weeks
In a 3–6-month-old canine with a diaphyseal fracture, how long would the fracture take to heal by primary bone healing?
1 month
2-3 months
3-5 months
5-12 months
2-3 months
What percentage of apposition in fracture repair is considered adequate?
25%
35%
50%
75%
50%
Which of the following bones is had the highest incidence of fracture-associated tumours?
Tibia
Radius
Femur
Humerus
Femur
Stress fractures have been reported in which location in the Greyhound?
Proximal femur
Lateral humeral epicondylar crest
Acetabulum
Distal tibia
Acetabulum
In which bone is periosteal stripping more particularly see?
Humerus
Radius
Ulna
Femur
Tibia
Fibula
Femur
After how long can disuse osteopenia be seen on radiographs?
7-21 days
14-28 days
21-35 days
After 35 days
14-28 days
Which of the following is a feature of delayed union, rather than non-union?
Gap between fracture ends
Close medullary cavity
Uneven fracture surfaces
Sclerosis of fracture ends
Uneven fracture surfaces
Radiographic features of delayed union:
Persistent fracture line with evidence of healing
Open medullary cavity
Uneven fracture surfaces
No sclerosis of fracture ends.
Radiographic features of non-union:
* Gap between fracture ends
* Closed medullary cavity (unless pinned)
* Smooth fracture surfaces
* Sclerosis of fracture ends
* ± Hypertrophy or atrophy of bone ends.
What type of instability leads to the viable non-union in the above radiograph?
Rotational instability
Angular instability
Compressive instability
Tensile instability
Rotational instability
What type of non-union is represented in the above radiograph?
Dystrophic
Necrotic
Defect
Atrophic
Necrotic
Which bone has the highest relative incidence of fracture associated tumour?
Humerus
Femur
Radius
Tibia
Radius
Tibia
Femur
- Which type of Salter Harris fracture shows the image below?
Type I
Type II
Type VI
Type IV
Type I A close-up of a x-ray of a human pelvis
Which type of fracture is showing the image below, in terms of direction of the fracture line?
Comminuted
Segmental
Spiral
Oblique
Comminuted, several fragments and the fracture lines communicate. A segmental (or multiple) fracture is one in which the bone is broken into three or more segments such that the fracture lines do not communicate
Which is the cut off to differentiate a short oblique fracture from a long oblique fracture to determine if interfragmentary compression is applicable?
< Twice the diameter of the bone
< Twice the length of metaphysis
The proximal metaphyseal diameter adjacent to the level of the physis
The proximal epiphyseal diameter adjacent to the level of the physis
< Twice the diameter of the bone
Which of the following is NOT a common cause of bone fragility leading to pathological fractures?
Nutritional deficiencies, such as hyperparathyroidism due to a low-calcium diet
Metabolic diseases, such as renal disease causing hyperparathyroidism
Excessive exercise and muscle strain
Neoplastic conditions, such as osteosarcoma or metastatic disease
Excessive exercise and muscle strain
Where is NOT common to find stress remodelling (microfracture of the cortical bone as a result of chronic stress)?
Metacarpi
Metatarsi
Lateral humeral epicondylar crest
Greater tubercle of the humerus
Greater tubercle of the humerus
Which of the following long bones has higher relative incidence for primary bone sarcoma?
Tibia
Femur
Radius
Humerus
Radius
In type __ injuries the fracture line
travels exclusively through the physis (common in fractures
of the ___;)
Type I
proximal femoral physis
In type ___ the fracture line passes along the physis but then breaks out through the metaphysis (common in fractures of the __)
Type II
proximal tibial physis
Type __ injuries involve the physis and epiphysis (uncommon, but perhaps seen most often in ___ in immature dogs
Type III
medial humeral condylar fractures
In ___ injuries the fracture line passes through the epiphysis and metaphysis,
crossing the physis (common in fractures of the ____ in immature dogs)
type IV
distal humeral physis and lateral condylar fractures in
immature dogs
Type ___ injuries involve an
impaction fracture of part or all of the physis (common
in the ___)
Type V
distal ulnar physis
type ___ injuries involve periosteal bridging of the physis as a result of injury to the adjacent bone, a rare occurrence in small animal orthopaedics.
type VI
an incomplete fracture
of the distal radius is associated with a periosteal reaction medially that has bridged
the distal physis and will influence further growth at this point.
the zone of hypertrophy and the germinal
layer are affected in ALL physeal fractures in dogs. Hence, the type of injury does not influence the prognosis for future growth. T or F?
T
What is the difference among first-degree, second and third open fractures?
In first-degree open fractures the skin is punctured by a fracture fragment but there is virtually no soft tissue loss. In second-degree open fractures the skin is punctured from the outside and there is generally some
loss of soft tissue. In third-degree open fractures there is
gross contamination and loss of soft tissue or bone.
Depending on the extent of bone damage a fracture can be ____ fracture or ___ fractures, as in greenstick fractures of young animals or fissure fractures in mature animals
Complete/ incomplete
Depending on the direction of the fracture line a fractures can be:
1.T
2. O
3. S
4. S
5. C
Transverse, oblique, spiral, segmental, comminuted
A long oblique fracture will often have a spiral component
Depending on the relative displacement of the bone fragments:
An __ fracture is one in which a bone fragment is
distracted by the pull of the muscle tendon or ligament
that attaches to it
* An _____ fracture is one in which the fractured
bone ends are driven into one another.
* A _____ fracture refers, typically, to a fracture of
a vertebra where a compressive force has resulted in
shortening of the vertebra.
* A _____ fracture usually refers to skull fractures in
which the affected bone is ‘pushed in’, resulting in a
concave deformity.
Avulsion, impacted, compression, depression
Stress fractures of racing Greyhounds bring non-displaced frctures of the ____. Also affecting ____ and _____ bones.
Acetabulum, metacarpal and metatarsal bones.
Figure: Stress fracture of metacarpal V in a
racing Greyhound. Note the periosteal
reaction present at the time of fracture.
stress remodelling is recognized as a well
organized, regular periosteal reaction on the affected metacarpal/tarsal bone or ______.
lateral humeral epicondylar crest.
Post-treatment fracture evaluation, the “4As”
Apposition
Alignment
Apparatus
Activity
Intramedullary pins should occupy at least _____
of the diameter of the medullary canal at its narrowest
point when used alone, or in combination with cerclage
wires or an external skeletal fixator.
If used in combination with a bone plate (a plate–rod construct)
then the pin should occupy about ____ of the canal’s
width.
two-thirds
40%
Type of fracture healing: classical, primary or bridging osteosynthesis
Classical
Type of fracture healing: classical, primary or bridging osteosynthesis
Primary (a direct or contact healing) and b gap healing
Type of fracture healing: classical, primary or bridging osteosynthesis
bridging osteosynthesis
Bridging osteosynthesis carries with it the chance of
more rapid return of bone strength seen with classical
healing while allowing the limb function during healing
associated with primary union, by virtue of the injured
bone being protected. Conversely, it reduces the likelihood
of ‘fracture disease’, which is often associated with
methods of treatment relying on classical healing, and
avoids the prolonged reliance on orthopaedic implants
seen with primary healing.
adiograpic progression
Radiographic progression of fracture healing dependent on:
* Type of bone involved
* Type of fracture
* Age of patient
* Method of treatment
* Other systemic disease
* Vascular supply.
T or F
T
Cancellous bone has a more abundant blood supply
and a greater inherent cellular activity than cortical bone.
Therefore, a fracture involving the __ or ___ of a bone tends to heal more quickly than one involving the
____.
epiphysis, metaphysis, diaphysis
Which systematic diseases can lead to delayed fracture healing?
Hyperadrenocorticism (Cushing’s disease) or chronic
renal failure, or dietary inadequacies such as nutritional
secondary hyperparathyroidism
Which healing allow less time to achieve clinical union of a diaphyseal fracture?
Classical healing or bridging
