Dr Beaver's tute - fracture healing Flashcards
callus formation
mineralisation seen around a healing bone on x-ray: the first stage of bone that you can see on an x-ray
woven bone which will later be converted into lamellar bone (mature bone)
how to describe a fracture
- which bone is involved
- how old is the patient
- which part of the bone is involved: epiphysis, metaphysis, diaphysis, physic
- closed or open: is the skin in tact
- is it comminuted: is it broken into more than 2 pieces
- what shape is the fracture: transverse, spiral, oblique
- displaced or undisplaced
- is it complicated: damage to nerves, vessels, joint surface, overlying skin
- segmental: two fractures in the same bone
- greenstick fracture?
- avulsion: ligaments or strong piece of muscle has pulled off a fragment of the bone
what is an avulsion fracture
ligaments or strong piece of muscle has pulled off a fragment of the bone
what does the periosteum do
a fibrous layer full of osteogenic cells that forms bone
a fracture may tear the periosteum or peel it off
how do you describe displacement
always describe the position of the distal fragment
(this rule is often broken in the hip and the spine)
words to use to describe position of bony fragments
displacement (translation)
angulation
shortening (includes impaction)
lengthening (distraction)
rotation
what are the directions of the forearm called
the forearm is complicated by pronation so posterior/anterior can’t be used to describe directions
dorsal (hairy side of arm)
volar (underside of forearm)
palmer (underside of hand)
radial (thumb side )
ulnar (pinky side)
what does a dinner fork deformity look like
what is a colles fracture
fall onto dorsiflexed wrist
extension fracture
colles fracture
features of a colles fracture
distal fragment is radially angulated and dorsally displaced
intraarticular extension is possible
? fracture ulnar styloid
what is a smith’s fracture
fall onto palmar flexed wrist
flexion fracture
smith’s fracture is often
often intra articular
smith fracture clinical features
distal fragment is volarly angulated and volarly displaced
intraarticular extension, neurovascular compromise, an/or instability are more likely than in colles fracture
what type of people get colles fracture
insufficiency fracture of the distal radius in osteopaenic bone
happens in elderly people
who gets smith’s fracture
young persons
smiths fracture occurs when
hand is landed on while pronated
clinical evaluation of distal radius fracture
neurovascular exam
- assess radial and ulnar artery pulses and capillary refill time
- median nerve injury, radial nerve injury, ulnar nerve injury
signs of nerve injury on clinical examintion
radial: wrist drop
ulnar: claw hand, froment sign
what is a greenstick fracture
infants or very young people
named after a ‘stick’ of a plant that is still alive and thus bends instead of snaps
the bone breaks only on one side because children’s bones have a lot more collagen
however, when an adult’s bone is subject to force it breaks because it is brittle
what happens to a child’s bone when put under pressure
it will bend and the convex side of the bend may break first
if enough force Is applied the other side may break as well
even if the bone fragments are lined up, the plastic deformation will persist
Monteggia fracture/dislocation
the ulnar shaft is fractured and it has pushed the radial head out of the joint in the elbow
radial head dislocation in elbow
proximal or middle ulnar fracture with concommittant dislocation of the radial head
clinical features of monteggiea
pain, crepitus, limited ROM at the elbow
radial head palpable in the ACF
shortened forearm
galeazzi
radial head is broken
subluxation of the distal radioulnar joint
night stick fracture
isolated ulnar fracture
defence injury - red flag
may be a sign of abuse/especially domestic violence
ask monica about the cow vs. man case
supra condylar fracture is a red flag for
median nerve damage and brachial artery
neurovascular damage
can cause compartment syndrome
what should you do with someone which the cupracondylar fracture
admit and watch (‘like a hawk’) for compartment syndrome
condylar fracture
through the condyle of the distal humorous
who gets a pulled elbow
toddlers being yanked by adults
what is a pulled adult
subluxation of radius
head of radius that gets pulled out of ligament that holds the radial head in place
how do you fix a pulled elbow
all the child to have a look at their arm and then pronate and supinate the arm very quickly which should click it back into place
don’t bother x-raying it just fix it
