Extremity Fracture Flashcards
Content: 3 phases of bone healing (with time frame)
- Inflammatory phase, 1-2 wkls
- Reparative phase, months
- Remodeling phase, mo-yrs
Q: What occurs during the inflammatory phase?
Increased vascularity and formation of fracture hematoma
Q: What is the cellular response during the inflammatory phase? (4)
- Neutrophils 2. Macrophages 3. Phagocytes 4. Osteoclasts
Q: What occurs during the reparative phase?
Cell differentiation - chondroblasts are mineralized by osteoblasts to form a soft callus
Q: What can be seen radiographically during the reparative phase?
Fracture line diminishes
Q: What is the risk during the reparative phase?
Delayed union or non-union
Q: What occurs during the remodeling phase?
Reformation of the medullary canal
Diagram: Fill in the following table
Content: 4 factors of bone healing
- Age
- Location and configuration
- Extent of initial displacement
- Blood supply
Q: Remodeling is _____ ________ in children and _____________ _____________ after early adulthood.
Very, rapid, relatively, constant
Q: What is the femoral shaft healing time for the following ages? Birth, 8 yo, 12 yo, 20 yo
3 wks, 8 wks, 12 wks, 20 wks
Q: Fractures surrounded by __________ heal faster
Muscle
T/F: Cortical bone heals faster than cancellous bone
False, flip it
T/F: Long oblique and spiral fractures heal faster than transverse fractures
True
Q: Non-displaced fractures with ________ periosteal sleave heal _______ as fast as displaced fractures.
Intact, twice
Q: Greater initial displacement = ?
More extensive
Q: Periosteal sleeve disruption = ?
Prolonged healing time
Q: What is the healing prognosis is all fracture fragments have blood supply?
Excellent
Q: If only some fragments have blood supply, what is the course of action?
Rigid immoblization to allow for vascularized fragments to serve as “hosts” to unvascularized fragments
Content: Initial complications due to local injuries to… (5)
- Skin
- Vascular
- Neurologic
- Muscular
- Visceral
Content: Early complications - local (3)
- Infection, gangrene, septic arthritis
- Compartment syndrome
- Osteomyelitis, avascular necrosis
Content: Early complications - remote (3)
- Thrombus/embolus formation
- Pneumonia
- Tetanus
Content: Late complications - joint (2)
- Persistent pain or stiffness
- Post-traumatic DJD
Content: Late complications - bony (5)
- Abnormal healing
- Growth disturbance
- Persistent ostemyelitis
- Osteoporosis
- Complex regional pain syndrome (CRPS)
Content: Late complications - muscular (2)
- Myositis ossificans
- tendon rupture
Defn: Increased pressure with fasical compartment (esp. anterior LE) due to edema or hematoma within closed space
Acute Compartment syndrome
Q: What are the 3 signs of acute compartment syndrome?
- Painful
- Edematous, tight
- Absent or significantly diminished pulse
Q: How is chronic compartment syndrome different than acute?
Chronic is due to muscular expansion or decreased size of anatomical compartment
Content: Heterotropic ossification (3)
- Soft tissue ossification, usually periarticular
- most commonly involves hip or knee
- unknown etiology
Content: 5 risk factors for heterotropic ossification
- Neurologic involvement
- Open wounds/burns
- Sepsis
- Prolonged critical illness
- Aggressive ROM
Content: 6 ways fractures are described
- Anatomic location
- Fracture location
- Direction
- Alignment
- Articular involvement
- Open/Closed
Diagram: Identify the type of fracture
Transverse
Diagram: Identify the type of fracture
Oblique
Diagram: Identify the type of fracture
Spiral
Diagram: Identify the type of fracture
Longitudinal
Diagram: Identify the type of fracture
Comminuted
Diagram: Identify the type of fracture
Impacted
Diagram: Identify the type of fracture
Depressed
Diagram: Identify the type of fracture
Avulsion
T/F: Avulsion fractures are more common in children, esp. at growth plates.
True
Content: Fracture mechanics - cortical bone (2)
- Tolerant to compression and shear forces
- Fractures due ot tension - bending, twisting, pulling
Q: Who is cortical bone more flexible in?
Children
Q: A cortical bone fracture caused by an angulatory tension force (in children) is called a?
Greenstick fracture
Q: What type of forces are cancellous bone susceptible to?
Compression forces
Diagram: Salter-harris classificaiton of growth plate injuries
Content: Salter Harris Classification - Type 1 (Description, Tx, Px)
D: run directly along the growth plates, vital portions of growth plate remain attached to the epiphysis
Tx: Rarely reduced, immobilization to fully heal
Px: Excellent if blood supply is intact
Content: Salter Harris Classification - Type 2 (Description, Tx, Px)
D: Runs along the grwoth plate and includes a triangular metaphyseal fragment
Tx: Reduction and immobilization
Px: Good
Q: Which type of Salter-Harris classification is most common?
Type 2
Content: Salter Harris Classification - Type 3 (Description, Tx, Px)
D: Run along part of growth plate and turn perpendicularly into the joint
Tx: Surgery to restore joint surface
Px: Good if blood supply to separated portion is intact
Content: Salter Harris Classification - Type 4 (Description, Tx, Px)
D: Run from epiphysis across the growth plate and into the metaphysis
Tx: Surgery to restore joint surface and align growth plate
Px: May cause premature focal fusion and joint deformity
Content: Salter Harris Classification - Type 5 (Description, Px)
D: Compression of growth plate results in a growth disturbance
Px: Poor
Q: What type of Salter-Harris Classification is not often recognized at the time of injury?
Type 5
Q: What Salter-Harris classification is an injury to perichondrial ring may cause physis to tether to bone, hindering growth?
Type 6
Q: What are the two main types of fracture management?
Reduction and immobilization
Content: 2 types of fracture reduction
- Open
- Closed
Content: 4 types of immobilization
- Casting
- Splinting
- External fixation
- Internal fixation
Q: What 4 things should be considered for a PT fracture intervention?
- MOI
- Age
- Functional needs/demands
- Type of immobilizaiton/orthopedic plan of care
Q: What 5 things does a PT fracture intervention entail?
- Preserve/Improve ROM
- Increase mobility
- ADL training
- Education
- Wound care
Q: What can cause an avulsion fracture?
Musculature is stronger than the developing bone can handle
