Cheung Part 6 Flashcards
what is an open fracture
when broken bone is exposed through the skin
orthopaedic emergency
what urgent things are required for an open fracture
tetanus and antibiotics
semi-urgent surgical debridement
high energy fractures are associated with what
extensie soft tissue damage, leading to disruption of healing pathways
not necessarily seen on X-ray
in high energy fractures what must be evaluated
other limbs and spine for occult injury
during the physical exam for a fracture one must examine the skin for what
any breaks, regional joint stability, and nerve and vessels for injury
what is normally seen on a physical exam of a fracture
tenderness, swelling, deformity, crepitation, and abnormal movement
stress fractures may take how long to show up on an X-ray
1-4 weeks
what is the most sensitive image modality for a fracture
MRI
what are the principles of a fracture (4 R’s)
Recognition
Reduce- set bone straight
Retain- keep the reduction with cast or surgery)
rehab
what bad things can come from a fracture (that aren’t emergencies
nonunion- bone does not heal
malunion- bone heals in unacceptable alignment
what medical emergencies can arise from a fracture
compartment syndrome
nerve and vessel damage
what is primary (intramembranous) fracture healing
rigid fixation from plates
direct healing with no callous
what is secondary (enchondral) fracture healing
controlled motion (Rods, casts) indirect formation of bone from uncommitted mesenchymal cells
what are the three stages (and how long are the) of enchondral ossification
inflammatory (48hours)
reparative (8 weeks)
remodeling (1 year)
what are the risk factors for nonunion fracture healing
smoking infection poor immobilization malnutrition NSAID poor blood supply high energy trauma
what is an osteogenic bone graft
bone forming
only autologous bone graft contains viable osteoblasts
what is osteoinductive bone graft
bone stimulation
encourages differentiation of mesenchymal cells into osteoblasts
BMP-2 and BMP-7
what is osteoconductive bone graft
bone scaffold
cancellous allograft
autografts from cancellous pelvis is what
osteogenic, osteoinductive, and osteoconductive
but PAINFUL
what bone graft is osteogenic, osteoinductive, and osteoconductive
autograft from cancellous pelvis
allografts are what kind of bone graft
conductive only
carry infection risk
demineralized bone matrix are what kind of bone graft
osteoinductive
expensive and not conductive
snythetic substitutes have what kind of bone graft
osteoinductive and osteoconductive
god compression strength
very expensive
external ultrasound have have what effect on fracture healing
may improve healing potential
what is an intra-articular fracture
involves joint surface
needs perfect reduction
early motion key
what is an extra-articular fracture
does not involve joint surface
needs good overall alignment
what are the pros of casting
undisturbed fracture milleu
no incisions
heals by endochondral ossification
what is endochondrial ossification
cells differentiate into chondrocytes and lay down cartilage which calcifies, osteoclasts absorb cartilage and osteoblasts lay down new osteoid
what are the cons to casting
no anatomic reduction
stiffness
what are the pros to traction
doesn’t disturb fracture mile
no risk of surgery
what are the cons to traction
poor reduction
pin site problems
fracture disease
what are the pros to external fixation
load bearing
small incisions
fracture milleu ok
early motion
what are the cons of external fixation
pin sites
pain in the ass
what are the pros to intramedullary nailing
load bearing
small incisions
periosteal blood supply ok
stimulates endosteal blood supply
what are the cons to intramedullary nailing
not anatomic
callus formation
too much movement
what are the pros to open reduction internal fixation (ORIF)
anatomic reduction
load SHARING
early motion
heals with intramembranous ossification
what is intramembranous ossification
undifferentiated cells become osteoclasts and lay down new osteoid
what are the cons to open reduction internal fixation (ORIF)
stripping increases nonunion
bigger wounds
what are the pros to ORIF locked
load BEARING internal ExFix early motion less stripping smaller wounds good for poor bone quality
what are the cons to ORIF locked
decreased healing due to lack of micro motion
cost
not anatomic reduction
weight bearing status pros
quicker return to function
stimulates bone growth
what are the cons to weight bearing status
may be more weight than fixation can handle
what are the pros to movement
faster return to function
decrease stiffness
faster healing
helps reduction of fractures
what are the cons to moment
wound problems
may overwhelm fixation repair
what type of fracture repair is load sharing
open reduction internal fixation (ORIF)
what type of fracture repairs are load bearing
ORIF, locked
external fixation
intramedullary nail
what is considered and internal ExFix
ORIF, locked
what are the signs and symptoms of compartment syndrome
pain with passive stress pulselessness parasthesias palor cold/numb
