Extremity Fracture

Question 1

Phases of Bone Healing

Answer 1

Inflammatory Phase
Reparative Phase
Remodeling Phase

Question 2

Inflammatory Phase

Answer 2

1-2 weeks

• Increased vascularity and formation of fracture hematoma
• Cellular response: infiltration of neutrophils, macrophages, phagocytes, osteoclasts

Question 3

Reparative Phase

Answer 3

Months

• Cell differentiation: bone callous formed by chondroblasts and fibroblasts, osteoblasts mineralize the soft callous
• Radiographic evidence of fracture line diminishes, but bone is immature and at risk for delayed union/nonunion

Question 4

Remodeling Phase

Answer 4

Months to years

• Reformation of medullary canal
• Delayed remodeling with compromised blood flow, periosteal stripping, highly comminuted fractures, extensive associated soft tissue injury

Question 5

Healing Factors

Answer 5

Age, Location and Configuration, Extent of Initial Displacement, Blood Supply,

Question 6

Fractures surrounded by _______ heal faster

Answer 6

Muscle

Question 7

Does cancellous or cortical bone heal faster?

Answer 7

Cancellous

Question 8

Compartment Syndrome - Acute

Answer 8

Increased pressure within fascial compartment due to edema or hematoma within closed space

• Painful
• Edematous, tight
• Absent or significantly diminished pulse

Question 9

Compartment Syndrome - Chronic

Answer 9

Due to muscular expansion or decreased size of anatomical compartment

Question 10

Heterotropic Ossification

Answer 10

1. Soft tissue ossification, usually periarticular

2. Most commonly involves hip or knee

Question 11

Heterotropic Ossification Risk Factors

Answer 11

• Neurologic involvement
• Open wounds/burns
• Sepsis
• Prolonged critical illness
• Aggressive ROM

Question 12

Fractures are described by:

Answer 12

• Anatomic location
• Fracture location
• Direction
• Alignment
• Articular involvement
• Open/Closed

Question 13

Main types of fractures

Answer 13

Transverse, Oblique, Spiral, Longitudinal, Comminuted, Impacted, Depressed (skull), Avulsion (more common in children)

Question 14

Why is Cortical bone susceptible to fracture?

Answer 14

• Tolerant to compression and shear force
• Fractures represent tension forces
• Cortical bone is more flexible in children

Question 15

Why is Cancellous bone susceptible to fracture?

Answer 15

Susceptible to compression forces

Question 16

Growth Plate Injuries

Answer 16

Type 2 - doesn’t disrupt growth plate
Type 3,4,5,6 - growth plate involvement
Type 3 - longitudinal fracture
Type 4 - affects metaphysis, growth plate, physis and epiphysis
Type 5 - often missed, most damaging - growth plate is being crushed

Question 17

Closed Reduction

Answer 17

w/o surgery

Question 18

Open Reduction

Answer 18

w/ surgery

Question 19

Immobilization techniques

Answer 19

Casting, Splinting, External Fixation, Internal Fixation (pins, screws)