Exam 4: Skeletal System - Fractures

Question 1

fracture

Answer 1

refers to a broken bone

Question 2

occurs internally without penetrating through skin

Answer 2

simple or closed fracture

Question 3

penetration through skin and expose damaged bone to outside environment
- this makes bone vulnerable to infection and may introduce serious complications with healing

Answer 3

compound or open fractures

Question 4

rare infection of bone that can occur as result of compound fracture or from systemic infection

Answer 4

osteomyelitis

Question 5

2 ways to get osteomyelitis

Answer 5

1. through compound fracture not responding to antibiotics

2. someone who already has sepsis - not broken but very vascular and bacteria gets in

Question 6

greenstick fracture

Answer 6

• most common in children: not full bone structure finished
• incomplete break
• bending of bone - since still flexibility in bone as kids

Question 7

epiphyseal fracture

Answer 7

• breakage in growth plate
  epiphyseal plate
• needs specialized treatment to avoid disruption of growth
• if broke when young you can see diff in length of legs

Question 8

spiral fracture

Answer 8

• result of torsional stress
• red flag for abuse : someone could have had arm twisted
• can be accidental

Question 9

transverse fracture

Answer 9

• breakage at a right angle to the length of the bone
• can be from sharp direct blow or prolonged stress
• due to a direct hit or if fall and hit perpendicular object

Question 10

compression fracture

Answer 10

• crushing of vertebrae
• can occur from hard fall
• can be related to osteoporosis
• can heal on own but may need surgery depending on severity

Question 11

comminuted fracture

Answer 11

• breakage results in shattering into 3 or more pieces
• requires surgery and pins
  putting it together like a puzzle
• car accident or falling

Question 12

colles fracture

Answer 12

• distal radius fracture
• results in putting arm down to “break fall”
  most common in winter

Question 13

Pott’s fracture

Answer 13

• ankle fracture
• bimalleolar : lateral and medial
• occurs in sports involving running and jumping
• swelling pain, nasty looking

Question 14

avulsion fracture

Answer 14

• muscle/tendon tension fractures insertion point on bone
• excessive force due to over-contraction of muscle
• most commonly a sports injury
• patella not where it should be
  rip portion of off the bone

Question 15

what are the stages to fracture healing

Answer 15

1. hematoma and inflammation
2. soft callus
3. hard callus
4. remodeling

Question 16

stage 1: hematoma and inflammation

Answer 16

• immediately to 1 week
• hematoma forms at fracture site
• macrophages, neutrophils, platelets migrate to site and stimulate inflammation
• platelets and WBC secrete cytokines, interleukins, PDGF, TGF
• BMP and tissue growth factors stimulate proliferation and differentiation of progenitor cells to chondroblasts and osteoblasts
• progenitor cells in endosteal and periosteal regions

Question 17

endosteal vs periosteal

Answer 17

endosteal: inside the bone
periosteal: between bone and connective tissue wrapping around it
- heal bone from both the inside and outside

Question 18

stage 2: soft callus

Answer 18

• 2nd week to 1 month
• endochondral bone formation begins
• sets down stronger fibrocartilage to connect broken ends
• formation of bridging callus (soft callus)
• osteoblasts begin to put down woven bone

Question 19

formation of cartilage is dependent on ______

Answer 19

gap distance and immobilization of broken ends

Question 20

stage 3: hard callus

Answer 20

• several months
• fibrocartilage replaced by woven bone
• type II collagen replaced by type I collagen
• formed 3-4 weeks after fracture; may continue several months until secure connection established

Question 21

stage 4: remodeling

Answer 21

• up to a year or more
• woven bone replaced by compact bone
• bone collar may remain
  bad damage - large area of bone collar - thicker than bone around it

Question 22

application: fracture healing
stress fractures
what type of bone formation is this?
will healing time inc or dec?

Answer 22

intramembraneous ossification

will heal faster - does not have to do cartilage part

Question 23

stress fracture

Answer 23

small fractures, not a big gap, two ends not completely aart - thin fracture line on bone

• commonly in legs and feet
• do not need intervening cartilage

Question 24

application: spinal fusion and laminectomy

Answer 24

• common in lumbar region
• laminectomy only if pressure on spine or nerves
  bone grafts:
• shard of bone between two vertebrae helps heal - sets distance so you do not compress it