classification of fractures

Question 1

Bone does not break through the skin

Answer 1

Closed or simple fracture

Question 2

Fragments of the broken bone break through skin

Answer 2

Open or compound fracture

Question 3

Open fractures have three grades of severity

Answer 3

Grade I: least severe injury, with minimal skin damage
Grade II: moderately severe injury, with skin and muscle contusions (bruises)
Grade III: most severe injury (wound larger than 6 to 8 cm), with skin, muscle, blood vessel, and nerve damage

Question 4

Caused by either repeated or prolonged stress

Answer 4

Stress fracture

Question 5

pulling away of a fragment of a boneby a ligament or tendon and its attachment

Answer 5

avulsion

Question 6

a fractuture in which bone has splintered into several fragments

Answer 6

communited

Question 7

a fracture in which damage also involves the skin or mucous membranes

Answer 7

compound

Question 8

a fracture in which bone has been compressed seen in vertrebral fractures

Answer 8

compression

Question 9

a fracture in which fragments are driven inward seen frequently in fracture of skull and facial bone

Answer 9

depressed

Question 10

a fracture through the epiphyseal

Answer 10

epiphyseal

Question 11

a fracture in which one side of the bone is broken and the other side is bent

Answer 11

greenstick

Question 12

a fracture in which a bone fragment is driven into another bone fragment

Answer 12

impacted

Question 13

a fracture occurring at an angle across the bone

Answer 13

oblique

Question 14

a fracture that occur though the area of diseased bone

Answer 14

pathologic

Question 15

a facture that remains contained and does not break the skin

Answer 15

simple

Question 16

a fracture twisting around the shaft of the bone

Answer 16

spiral

Question 17

a fracture that is straight across the bone

Answer 17

transverse

Question 18

A bone begins to heal as soon as

Answer 18

an injury occurs

Question 19

New bone tissue formed to repair the fracture, resulting in a

Answer 19

sturdy union between the broken ends of the bone

Question 20

Stage 1: hematoma formation

Answer 20

Immediately after a fracture, bleeding and edema occur

In 48 to 72 hours, a clot or hematoma forms between the two broken ends of the bone

Question 21

Stage 2: fibrocartilage formation

Answer 21

Hematoma that surrounds fracture does not resorb, as it does in other parts of the body
Instead, other tissue cells enter the clot, and granulation tissue replaces the clot
The tissue then forms a collar around each end of the broken bone, gradually becoming firm and forming a bridge between the two ends

Question 22

Stage 3: callus formation

Answer 22

Within 1 to 4 weeks after injury, granulation tissue changes into a callus, which is made up of cartilage, osteoblasts, calcium, and phosphorus. The callus is larger than the diameter of the bone and serves as a temporary splint

Question 23

Stage 4: ossification

Answer 23

Within 3 weeks to 6 months after the break, a permanent bone callus, known as woven bone, forms
During this stage the ends of the broken bone begin to knit

Question 24

Stage 5: consolidation and remodeling

Answer 24

Consolidation occurs when the distance between bone fragments decreases, then closes
During bone remodeling, immature bone cells are gradually replaced by mature bone cells
Excess bone is chiseled away by stress to the affected part from motion, exercise, and weight bearing
Bone then takes on its original shape and size

Question 25

from contamination of the open wound associated with a fracture or from contamination of indwelling hardware used to repair the broken bone

Answer 25

Osteomyelitis

Question 26

In deep, grossly contaminated wounds

Answer 26

gas gangrene may develop

Question 27

gas gangrene

Answer 27

Necrosis or death of tissue, usually due to deficient or absent blood supply. infected by a gas bacillus [often Clostridium perfringens] Part of bone that dies is known as sequestrum and must be removed before healing can take place.)

Question 28

Complications of FracturesInfection

Signs and symptoms

Answer 28

Local pain, redness, purulent wound drainage, chills, and fever
With gas gangrene, foul-smelling watery drainage with significant redness and swelling

Question 29

Treatment

Complications of FracturesInfection

Answer 29

IV antibiotics may be given for 4 to 8 weeks, followed by 4 to 8 weeks of oral drug therapy
Wound care: irrigation, treatment with antibiotic beads, and surgical removal of dead bone tissue and/or hardware

Question 30

Fat globules released from marrow of broken bone into bloodstream, then migrate to the lungs (24-48 hrs after Fx)
Age groups: 20-40 yo males; 70-80 yo elderly
They lodge in capillaries and obstruct blood flow
The fat particles break down into fatty acids, which inflame the pulmonary blood vessels, leading to pulmonary edema
Common with fractures of the long bones, multiple fractures, and severe trauma

Answer 30

Complications of Fractures Fat Embolism

Question 31

is the first sign of a fat embolism, followed by

Answer 31

Respiratory distress is the first sign of a fat embolism, followed by tachycardia, tachypnea, fever, confusion, and decreased level of consciousness

Question 32

Treatment:

Complications of Fractures Fat Embolism

Answer 32

bed rest, gentle handling, oxygen, ventilatory support, and fluid restriction and diuretics for pulmonary edema

Question 33

Venous stasis, vessel damage, and altered clotting mechanisms contribute to formation of blood clots (thrombi), most commonly in deep veins of the legs
DVT increased with immobility often associated with a fracture
Thrombi can break off and travel to the lungs, causing a pulmonary embolism

Answer 33

Complications of Fractures Deep Vein Thrombosis

Question 34

A condition in which a structure such as a tendon or nerve is contritced in a confined space, it affects nerve innervation leading to subsequent palsy

Answer 34

compartment syndrome

Question 35

Compartments are located in the

Answer 35

muscles of the extremities. These enclosed spaces are made of muscle, bone, nerves, blood vessels wrapped by fibrous membrane may lead to volkmanns contractions

Question 36

compartment syndrome

Answer 36

Internal pressure from bleeding/edema into a compartment; there is nowhere for the drainage to go.
Increased fluid puts pressure on tissues, nerves, and blood vessels, so that blood flow is decreased, resulting in pain and tissue damage. Needs immediate treatment. In as little as 4-6 hrs, permanent damage can occur

External pressure also can decrease blood flow to the area
e.g. external pressure from a cast or tight dressing

Question 37

sign an symptoms

compartment syndrome

Answer 37

Primary symptom is pain, especially with touch or movement, that can’t be relieved with opioids
Other signs and symptoms: edema, pallor, weak or unequal pulses, cyanosis, tingling, numbness, paresthesia, and finally, severe pain

Question 38

treatment

compartment syndrome

Answer 38

is to relieve pressure
When internal pressure, a surgical fasciotomy, which entails making linear incisions in the fascia, may relieve pressure on the nerves and blood vessels
For external pressure, cast or dressings are replaced

Question 39

Complications of Fractures Shock

Answer 39

After fracture, a risk of excessive blood loss

Trauma may rupture local blood vessels; internal organs may be punctured; results in internal bleeding

Loss of blood leads to shock, evidenced by tachycardia, anxiety, pallor, and cool, clammy skin

Immobilizing fractures reduces risk of hemorrhage

If severe external bleeding, external pressure should be applied and medical assistance summoned immediately

Question 40

Complications of Fractures Joint Stiffness and Contractures

Answer 40

Joint fractures or dislocations may be followed by stiffness or contractures, especially in older adults, due to immobility associated with fracture
Prevention requires appropriate positioning and progressive exercise programs
Treatment may employ splints, traction, casts, surgical manipulation, and aggressive physiotherapy