Describing a Fracture Flashcards
What is a complete fracture?
the bone is broken through its full circumference and two or more bone fragments are created as a result
What is an incomplete fracture?
a fracture where the bone may only be broken part of the way around the circumference of the bone (not as common in older animals, aka “Greenstick Fracture”)
Short vs. long oblique fractures–>
Long is more than 2x diameter of the bone and short is less than 2x the diameter of the bone
oblique means fracture is at an angle across the short axis of the bone
Spiral oblique is a ____ oblique with a ____
Long oblique with a twist
______ _____ fractures are intended to assess prognosis, a descriptive term, prognosis also implied. Originally a human pediatric term
Salter-Harris Fracture
KNOW SALTER HARRIS FX PICS
!!!!
What is the most common salter harris fx?
4
Which salter harris fx has the worst prognosis because growth plates are damaged so stunted growth leading to angular limb deformity?
Salter harris 5
Salter harris ___ and __ does not go across jt surface
Salter harris 1 and 2
What are the different types of external coaptation?
Robert jones bandage, modified robert jones bandage, Splint (lateral)
Robert jones bandage-
used to immobilization of fractures and injuries distal to elbow and stifle; decreases and prevents edema formation and is used short term. Protects the limb, use large volume of cotton +/- splint material
Modified Robert Jones Bandage-
aka soft padded bandage, which has the same goals but is not as large, often for longer term immobilization and support
Splinting-
lateral splints are usually used, mason meta splints are splints with palmar/plantar application aka “spoon splints”, not used as lateral support; used for additional support and protection to the injured site, they are placed between gauze and tertiary layer
What are the different components of external coaptation? (2)
Axillary coaptation and definitive coaptation
used post op, generally short term use for a day days to a week or two is referred to as _____ _____
Axillary coaptation
What is definitive coaptation?
casts, splints, goal is to immobilize the joint proximal and distal!!! Good fit needed to prevent injury to soft tissues (like from cast sores), monitor closed because they will need to be protected from wet, and beware that it will shift/patient will grow, reduce patient’s activity in this coaptation
What are the advantages of external coaptation?
protection, minimal risk of contamination, less expensive, easy to apply, great for greenstick aka incomplete fractures, useful when concurrent soft tissue injuries are present to decrease swelling
What are the disadvantages of external coaptation?
Limited to only using in fractures distal to the stifle or elbow. Some false sense of security, increased risk of malunion or nonunion, requires frequent changes, “Fracture Disease” may occur which includes stiffness, osteoarthritis (OA), cast sores, or contracture
What are the possible coaptation-related complications?
Monitor all case on rads q 4 wks, swelling and edema, odor, non-union or malunion, soft tissue injury from muscle contracture or skin abrasion and dermatitis, muscle atrophy
Fracture severity from least to most—->
- incomplete (less severe)
- simple- 2 piece fracture
- comminuted- 2 segments of long bone but multiple little bone fragments
- segmental- 3 or more circumferentially intact segments
_____ fractures are always considered severe due to ____ damage and long term arthritis
Articular; cartilage damage
Difference between primary and secondary bone healing:
Primary healing involves not much strain/distance between the fragments of bone unlike secondary healing which does involve strain, and increased distance between bone ends +/- much movement between bones.
Influenced via interfragmentary strain across the fracture gap
Occurs when larger gap, increased motion, or higher strain occurs. Blood supply is damaged in the center causing a fx hematoma = _____ bone healing
Secondary bone healing
What are the events occuring during the phases of bone healing?
Inflammation phase, repair phase, callus formation, remodeling phase
Describe the inflammation phase-
i. Fracture hematoma forms after trauma, contraction and thrombosis of affected vessels minimize blood loss, then ischemia from interruption of blood flow, then local loss of radio-opacity of bone on rads (resorption of fragment ends mediated via prostaglandins and macrophages clean up the site), then bone gap will reappear and widen in 5-7 days after injury due to formation of new collagen via Fibroblast Factor
Describe the repair phase-
Granulation tissue formation within 2-4 d post-trauma, hematoma acts on osteoconductive spacer (scaffolding for osteoblasts, fibroblasts, and chondrocytes to grow on), fibroblasts and chondrocytes migrate to site and begin to lay down the callus which is like a big bone scab made of cartilage that will hold things together temporarily and then go away (takes weeks to form a callus)
Describe callus formation-
Repair phase
“soft” callus forms within first 3 weeks, loosely organized collagen fibers, then mesenchymal stem cells form periosteum, endosteum, bone marrow, and adjacent soft tissue differentiate into chondrocytes–> “bridging callus” –> “hard callus” after mineralization of periosteum which CAN be seen on rads unlike bridging callus
Describe the remodeling phase–
takes months to years, characterized by osteoclastic resorption and osteoblastic deposition of new bone, external callus gradually disappears and new bone is re-built via cutting cones which move across the fracture ends and produce osteoid which mineralizes to form longitudinally-oriented lamellar bone known as Haversian Remodeling
What is biological healing and what is its goal?
Open but do not touch method, preserve the environment and do not disrupt the fx hematoma, goal is to align the fracture while minimally disrupting the surrounding extraosseous blood supply to maintain intraosseous bf and limit disruption of endosteum and periosteum
What results from biological healing?
Secondary bone healing with earlier formation of callus
BPM’s and growth factors include…
Bone morphogenetic proteins and platelets, WBCs, Prostaglandins and interleukins and TNFs
___ stimulates stem cells to differentiate into chondrocytes or osteoblasts
BMP’s
We can speed up bone healing by inserting ____ in the fracture at time of surgery to accelerate the healing process
BMPs
What are some graft sources?
Autograft (from same p), allograft (from same species), xenograft (from diff. species), synthetic (non living source, commonly used)
