Extremity Fractures Flashcards
Healing Factors (4)
- Age
- Location & Configuration
- Extent of Displacement
- Blood Supply
Initial Fracture Complications
- Local Injuries to skin, blood vessels, nerves, muscles and visceral structures (internal organs)
Early Fracture Complications - Local (3)
- Infection, gangrene, septic arthritis
- Compartment syndrome
- Osteomyelitis, AVN
Early Fracture Complications - Remote (3)
- Thrombus, embolus formation
- Pneumonia
- Tetanus
Late Fracture Complications - Joint (2)
- Persistent pain or stiffness
- Post-traumatic DJD
Late Fracture Complications - Bone (5)
- Abnormal healing
- Growth disturbances
- Persistent osteomyelitis
- Osteoporosis
- Complex regional pain syndrome (CRPS)
Late Fracture Complications - Muscular (2)
- Myositis ossificans
- Tendon rupture
Compartment Syndrome
Caused by swelling or other causes of decreased space within the fascial compartment resulting in reduced blood flow.
Acute Compartment Syndrome (3)
- Caused by edema or hematoma
- Signs include pain, edema (shiny, tight skin), blue color in distal limb, absent or diminished pulse
- EMERGENCY
Chronic Compartment Syndrome
- Usually due to increased muscle size or decrease in size of the anatomical compartment
- Not considered a medical emergency
Heterotropic Ossification
- Bone deposits in soft tissue areas
- Common sites are around knees and hips
Heterotropic Ossification Risk Factors (5)
- Neurological Injuries (SCI)
- Open wounds
- Sepsis
- Prolonged critical illness
- ** Aggressive ROM
Fracture Classification Areas (6)
- Anatomic location
- Fracture location on the bone (proximal, distal)
- Direction (transverse, longitudinal)
- Alignment (varus, valgus, displaced)
- Articular involvement
- Open/Closed
Transverse Fracture
Horizontal fracture across the bone
Oblique Fracture
- Diagonal fracture
- Usually caused by sharp angled blow
Spiral Fracture
- AKA torsion fracture
- Fracture “wraps” or spirals around the bone
- Commonly due to sports injury or child abuse
Longitudinal Fracture
- Fracture occurs vertically
Comminuted Fracture
- Fracture occurs in multiple directions, results in fragments
- Commonly caused by trauma and aging
- Often treated with ORIF or external fixation
Impacted Fracture
- Occurs when two bone surfaces are jammed together
- Often seen in hips of children
Depressed Fracture
- Fracture that causes bones to cave inwards
- Most commonly seen in the skull
- Commonly due to blunt force trauma
Avulsion Fracture
- Piece of bone is pulled off, usually due to repeated pulling on the bone by muscles
- More common in children, especially at growth plate
Salter Harris Fractures
- Fracture of the growth plate, can result in growth deficits
- Types I-VI
Salter Harris Type 1
- Fracture occurs along the growth plate on either side but does not cross growth plate
- Immobilized until fracture fully heals
- Excellent prognosis w/ good blood supply
Salter Harris Type 2
- Fracture occurs along the growth plate and extends up into metaphysis creating a triangular shaped fragment
- Requires reduction/immobilization
- Good prognosis
Salter Harris Type 3
- Fracture runs along growth plate and then crosses into the growth plate
- Surgery is required to rejoin joint surfaces
- Good prognosis if good blood supply
Salter Harris Type 4
- Fracture runs from metaphysis through the growth plate into the epiphysis
- Surgery required
- May cause growth deformity
Salter Harris Type 5
- Compression fracture of growth plate between metaphysis and epiphysis
- Poor prognosis
Salter Harris Type 6
- Compression fracture of growth plate results in bone tethering
- Poor prognosis
Reduction Fracture Management
- Realignment of fractured joint surfaces
- Closed (non-invasive)
- Open (surgical)
Immobilization Fracture Management
- Keeps realigned fracture site in the correct position
- Casting
- Splinting
- External/internal fixation (pins, screws, rods, prosthetics)
Ilizarov Procedure
- Type of external fixation of a fracture where micro fractures are created throughout the healing process to allow bone growth during fixation
- Allows for gradual bone lengthening
Describe a varus fracture.
The distal end of the fractured bone deviates medially.
Describe a valgus fracture.
The distal end of the fractured bone deviates laterally.
What should the PT consider before implementing a fracture management plan? (4)
- Patient’s age
- MOI
- Patient’s functional needs/demands
- Type of immobilization and orthopedist’s plan of care
What PT interventions are associated with fracture rehab? (5)
- Preserve and improve ROM
- Increase mobility
- ADL training
- Patient education
- Wound care
What is going on during the inflammatory stage of bone healing? (3)
- Increased blood flow to the area
- Formation of a fracture hematoma
- Infiltration of neutrophils, macrophages, phagocytes, and osteoclasts
What is going on during the reparative (subacute) phase of healing? (2)
- Bone callus is formed by chondroblasts/fibroblasts that is mineralized by osteoblasts
- Fracture diminishes but is still susceptible to delayed union/non-union
What is going on during the remodeling (chronic) phase of bone healing? (2)
- Medullary cavity is reformed
- Delayed remodeling can be caused by low blood flow, periosteal stripping, highly comminuted fractures, and extensive soft tissue damage
What are the functional limitations associated with the inflammatory phase? (2)
- Patient it totally restricted
- NWB, immobilization
What are the functional limitations associated with the early stages of the reparative phase?
PWB, PROM, and limited AROM
What are the functional limitations associated with the late stages of the reparative phase?
WBAT, increase AROM
What are the functional limitations during the remodeling phase?
- Patient is nearly back to normal
- FWB, full AROM, and RROM
T/F: Cortical bone heals faster than cancellous bone.
False, cancellous bone heals faster due to higher blood supply
___________ and _____________ fractures heal faster than _________ fractures.
Longitudinal, spiral, transverse
Prolonged healing time of displaced fractures is influenced by what 2 things?
- Greater amount of initial displacement
- Periosteal sleeve disruption
T/F: All bone fragments have to be vascularized or the fracture will not heal (non-union).
False, some of the bone fragments need blood flow and can then act as hosts for the fragments lacking blood flow.
- If all fragments lack blood flow then the fracture will NOT heal.
