F - Wk9 Fractures

Question 1

What are fractures and the causes of fractures?

Answer 1

1. complete or partial break in a bone
2. occurs when the physical force applied to the bone is stronger than the bone itself

Causes:
1. Trauma
- eg fall, sports injury, or motor vehicle crash

2. Overuse during repetitive activities
   - eg running or jumping
3. Conditions: osteoporosis or cancer
   - weaken bones -> spontaneous fractures

Question 2

What are the modifiable & nonmodifiable risk factors of fractures?

Answer 2

Modifiable:
- may weaken the bones
- low vitamin D, smoking, alcohol, and glucocorticoid use

Non-modifiable:
1. increasing age
2. congenital disorders
- osteogenesis imperfecta
- malabsorption problems -> impair the ability to absorb important nutrients for bone health: calcium & vitamin D

Question 3

What are the types of fractures?

Answer 3

1. Closed/simple fractures,
   - bone breaks & overlying skin remains intact
2. Open/ compound fractures
   - fractured ends pierce through the overlying skin
3. Greenstick fractures,
   - one side of the bone breaks, other side bends
4. Impacted fractures
   - a piece of one bone gets wedged into another bone
5. Comminuted fractures
   - bone breaks into multiple fragments
6. Spiral fractures
   - fracture line follows the projection of a strong, twisting force applied to the bone
   - commonly seen in non-accidental traumas, such as physical abuse, like when someone forcefully grabs and twists an arm

Question 4

Whats the healing process for fractures?

Answer 4

1. inflammatory phase
   - body responds to the trauma by sending immune cells to the location of fracture
   - Immune cells remove dead and damaged tissue
2. reparative phase
   - body activates osteoblasts -> callus = new bone tissue that connects the fractured ends
3. remodeling phase
   - callus is replaced by regular bone
   - healing process is completed

Question 5

What are the signs and symptoms of fractures?

Answer 5

1. localized pain
   - especially when trying to move,
2. swelling & bruising
3. If fracture is displaced, affected part of the body can look misaligned, shortened, or deformed

Question 6

What are the short term/acute complication of fractures?

Answer 6

1. Broken ends of the bone may damage surrounding structures
   - blood vessels -> bleeding
   - nearby nerves -> altered sensation
   - tears to the muscles or tendons
2. Compartment syndrome
   - bleeding / edema from fracture -> increased pressure inside the section of the limb that contains muscles, nerves, & BVs -> decreased blood supply -> tissue necrosis
3. Fractures of long bones may lead to fat embolism
   - piece of fat breaks off from the fractured bone -> travels through bloodstream -> lodged within a BV in organs like the heart, lungs, or brain, obstructing their blood flow

Question 7

What are the long term/chronic complication of fractures?

Answer 7

1. healing abnormalities may result in bone deformity
   - malunion: fractured ends are not adequately aligned
   - delayed union: bone requires more time to complete the healing process
   - nonunion: bone completely fails to connect broken ends of the bone.
2. mobility complications
   - joint stiffness or instability.
   - rare: contractures
   - muscles and tendons get shortened
   - ROM gets limited
3. immobilised pts
   - pressure injury over bony prominences like the sacrum or heels
   - at risk for developing DVT: typically occurs in deep veins of the lower extremities -> blood clot can break off and travel to the lungs -> pulmonary embolism

Question 8

What are the treatment methods of bone fractures?

Answer 8

1. rest & immobilization of affected limb + use removable splints/casts -> bone heal
2. displaced fractures need reduction = alignment of fractured ends into their proper position
   - Closed: alignment without surgery
   - open: with surgery
3. Once aligned, bones can be held in place using internal and external fixation
   - Internal: use metal devices
   - nails, pins, screws, and plates within the skin to hold the fractured ends in place

• external: pins, screws, and wires inserted into fractured bone
• held in place by a bar or ring outside of the skin