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Bone > Cheung Part 6 > Flashcards

Cheung Part 6 Flashcards

1
Q

what is an open fracture

A

when broken bone is exposed through the skin

orthopaedic emergency

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2
Q

what urgent things are required for an open fracture

A

tetanus and antibiotics

semi-urgent surgical debridement

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3
Q

high energy fractures are associated with what

A

extensie soft tissue damage, leading to disruption of healing pathways
not necessarily seen on X-ray

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4
Q

in high energy fractures what must be evaluated

A

other limbs and spine for occult injury

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5
Q

during the physical exam for a fracture one must examine the skin for what

A

any breaks, regional joint stability, and nerve and vessels for injury

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6
Q

what is normally seen on a physical exam of a fracture

A

tenderness, swelling, deformity, crepitation, and abnormal movement

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7
Q

stress fractures may take how long to show up on an X-ray

A

1-4 weeks

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8
Q

what is the most sensitive image modality for a fracture

A

MRI

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9
Q

what are the principles of a fracture (4 R’s)

A

Recognition
Reduce- set bone straight
Retain- keep the reduction with cast or surgery)
rehab

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10
Q

what bad things can come from a fracture (that aren’t emergencies

A

nonunion- bone does not heal

malunion- bone heals in unacceptable alignment

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11
Q

what medical emergencies can arise from a fracture

A

compartment syndrome

nerve and vessel damage

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12
Q

what is primary (intramembranous) fracture healing

A

rigid fixation from plates

direct healing with no callous

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13
Q

what is secondary (enchondral) fracture healing

A 
controlled motion (Rods, casts)
indirect formation of bone from uncommitted mesenchymal cells
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14
Q

what are the three stages (and how long are the) of enchondral ossification

A

inflammatory (48hours)
reparative (8 weeks)
remodeling (1 year)

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15
Q

what are the risk factors for nonunion fracture healing

A 
smoking
infection
poor immobilization
malnutrition
NSAID
poor blood supply
high energy trauma
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16
Q

what is an osteogenic bone graft

A

bone forming

only autologous bone graft contains viable osteoblasts

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17
Q

what is osteoinductive bone graft

A

bone stimulation
encourages differentiation of mesenchymal cells into osteoblasts
BMP-2 and BMP-7

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18
Q

what is osteoconductive bone graft

A

bone scaffold

cancellous allograft

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19
Q

autografts from cancellous pelvis is what

A

osteogenic, osteoinductive, and osteoconductive

but PAINFUL

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20
Q

what bone graft is osteogenic, osteoinductive, and osteoconductive

A

autograft from cancellous pelvis

21
Q

allografts are what kind of bone graft

A

conductive only

carry infection risk

22
Q

demineralized bone matrix are what kind of bone graft

A

osteoinductive

expensive and not conductive

23
Q

snythetic substitutes have what kind of bone graft

A

osteoinductive and osteoconductive
god compression strength
very expensive

24
Q

external ultrasound have have what effect on fracture healing

A

may improve healing potential

25
Q

what is an intra-articular fracture

A

involves joint surface
needs perfect reduction
early motion key

26
Q

what is an extra-articular fracture

A

does not involve joint surface

needs good overall alignment

27
Q

what are the pros of casting

A

undisturbed fracture milleu
no incisions
heals by endochondral ossification

28
Q

what is endochondrial ossification

A

cells differentiate into chondrocytes and lay down cartilage which calcifies, osteoclasts absorb cartilage and osteoblasts lay down new osteoid

29
Q

what are the cons to casting

A

no anatomic reduction

stiffness

30
Q

what are the pros to traction

A

doesn’t disturb fracture mile

no risk of surgery

31
Q

what are the cons to traction

A

poor reduction
pin site problems
fracture disease

32
Q

what are the pros to external fixation

A

load bearing
small incisions
fracture milleu ok
early motion

33
Q

what are the cons of external fixation

A

pin sites

pain in the ass

34
Q

what are the pros to intramedullary nailing

A

load bearing
small incisions
periosteal blood supply ok
stimulates endosteal blood supply

35
Q

what are the cons to intramedullary nailing

A

not anatomic
callus formation
too much movement

36
Q

what are the pros to open reduction internal fixation (ORIF)

A

anatomic reduction
load SHARING
early motion
heals with intramembranous ossification

37
Q

what is intramembranous ossification

A

undifferentiated cells become osteoclasts and lay down new osteoid

38
Q

what are the cons to open reduction internal fixation (ORIF)

A

stripping increases nonunion

bigger wounds

39
Q

what are the pros to ORIF locked

A 
load BEARING
internal ExFix
early motion
less stripping
smaller wounds
good for poor bone quality
40
Q

what are the cons to ORIF locked

A

decreased healing due to lack of micro motion
cost
not anatomic reduction

41
Q

weight bearing status pros

A

quicker return to function

stimulates bone growth

42
Q

what are the cons to weight bearing status

A

may be more weight than fixation can handle

43
Q

what are the pros to movement

A

faster return to function
decrease stiffness
faster healing
helps reduction of fractures

44
Q

what are the cons to moment

A

wound problems

may overwhelm fixation repair

45
Q

what type of fracture repair is load sharing

A

open reduction internal fixation (ORIF)

46
Q

what type of fracture repairs are load bearing

A

ORIF, locked
external fixation
intramedullary nail

47
Q

what is considered and internal ExFix

A

ORIF, locked

48
Q

what are the signs and symptoms of compartment syndrome

A 
pain with passive stress
pulselessness
parasthesias
palor
cold/numb

Bone (19 decks)

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