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MSK Fracture > Fracture > Flashcards

Fracture Flashcards

1
Q

What is fracture?

A
  • any defect in the continuity of a bone
  • ranging from a small crack to complex fracture with multiple segments
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2
Q

Four general categories

A
  1. fracture by sudden impact (traumatic)
  2. stress or fatigue fracture
  3. insufficiency fracture
  4. pathologic fracture
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3
Q

Traumatic fracture

A
  • by sudden impact: assault, abuse, traumatic falls, or MVA
  • transverse, oblique, and spiral fracture lines are commonly found
  • high velocity injuries (MVA) often result in open fracture of the LE
  • in general population, radius or ulna fracture comprise the largest UE fracture
  • the most affected age group is 5-14 because of accidental falls at home
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4
Q

Stress or fatigue fracture

A
  • sometimes referred to as a stress reaction or bone stress injury
  • defined as a partial break (reaction) or complete break (fracture) caused by the bone’s inability to withstand stress applied in a rhythmic, repeated, microtraumatic fashion
  • most occur in the LE and affect the tibial shaft and metatarsal bones
    (occur at the pubic ramus, femoral neck, fibula or knee (ex. tibial plateau, proximal tibial shaft, femoral condyles))
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5
Q

Stress or fatigue fracture risk factors

A
  • an abrupt increase in the intensity of duration of training (ex. military trainees, track and field athletes, distance runners, and athletes preparing for marathons)
  • female recruits are at increased risk for pelvic and sacral stress fractures
  • the generally increased risk of bone stress injuries among women has been explained by anatomic (wide pelvis, coxa vara, genu valgum), hormonal, and nutritional factors
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6
Q

Compressive stress fracture

A

occur because of forceful heel strike during prolonged marching or running

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7
Q

Distractive stress fracture

A

occur because of muscle pull and can become more serious if displacement occurs

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8
Q

Insufficiency fracture

A
  • occurs if normal stress is applied to abnormal bone
    (result from a normal stress or force acting on bone that has deficient elastic resistance or has been weakened by decreased mineralization)
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9
Q

Insufficiency fracture reduced bone integrity can result from many factors but occurs most commonly from__

A
  • the effects of radiation
  • postmenopausal osteoporosis
  • corticosteroid-induced osteoporosis
    -other underlying metabolic bone disease (ex. hyperparathyroidism, osteomalacia, rickets, and osteodystrophy)
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10
Q

Insufficiency fracture arise insidiously or because of minor trauma

A

ex) weight bearing alone can be enough to transmit a traumatic force to the compromised spine

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11
Q

Pathologic fracture

A
  • occurs in bone rendered abnormally fragile by neoplastic or other disease conditions
  • insufficiency fractures can be thought of as a subset of pathologic fractures, occurring in bones with structural alterations owing to osteopenia, osteoporosis, or disorders of calcium metabolism
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12
Q

Pathologic fracture osteoporosis stages

A

healthy- osteopenia-osteoporosis-severe osteoporosis

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13
Q

Classification of fractures

A
  • transverse
  • oblique or spiral
  • comminuted
  • butterfly
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14
Q

Transverse fracture

A
  • the fracture line is a right angle to the long axis of the bone; usually produced by shearing force
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15
Q

Oblique or spiral fracture

A
  • occur following a twisting or torsional force fragments displace easily in the oblique fracture, whereas nonunion rarely occurs in a spiral fracture because of the wide area of surface contact
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16
Q

Comminuted fracture

A
  • the bone is broken into more than two fragments and segmental if a fragment of the free bone is present between the main fragments
  • Comminution describes a fracture with multiple fragments at the fracture site and can be associated with different fracture lines
17
Q

Butterfly fracture

A
  • the separation of a wedge shaped piece of bone
18
Q

Incomplete fractures

A
  • greenstick fracture
  • torus (or buckle) fracture (stress makes the outside layer of the bone bulge out)
  • crack or hairline fracture
19
Q

Unstable fractures

A
  • displaced, open fractures are more likely to be unstable
    ex) unstable pelvic fractures can cause rotational instability, vertical instability, or both
  • compressive or shear forces can cause stable fractures to shift, becoming unstable
  • unstable fractures are more likely to require surgery to stabilize them
20
Q

Epiphyseal fracture

A
  • occurs in the growth centers of children and adolescents, located in the long bones
  • growth can be arrested or altered, and immediate intervention is required
  • an articular fracture occurs on or near a joint and is described by the course of the fracture line
    (ex. T or Y shaped, transcondylar, supracondylar, intercondylar)
20
Q

5 types of growth plate fractures

A

type 1: transverse fracture through the growth plate

type 2: fracture through the growth plate, and the metaphysis

type 3: fracture through the growth plate, and the epiphysis

type 4: fracture through the growth plate, the metaphysis, and the epiphysis

type 5: compression fracture of the growth plate

21
Q

Vertebral compression fracture (VCF)

A
  • one of the most common osteoporosis related fragility fractures
  • often occurs with only minor trauma
  • the incidence increases with age and with decreasing bone density
  • only 20% to 25% of people who sustain a VCF develop symptoms severe enough to seek medical attention
22
Q

Etiology of fracture
(decreasing bone mass with age in men and women)

A
  • bone mass is known to reach its maximum size and density by reaching age 30 years
  • women tend to lose bone mass sooner than men, often beginning in their late 30s during the perimenopausal years
  • bone loss is accelerated for women during and after menopause
  • men are more likely to experience bone loss in their mid to late 60s
23
Q

Risk factors for fractures (Box 27.16)

A
  • trauma:
    ex. motor vehicle accidents, industrial or work related accidents, assault, history of falls; risk factors for falls, overuse (marathon runners, military); sudden changes in training (duration, intensity), participation in sports including dance (recreational or competitive)
  • advanced age
  • women: postmenopausal osteoporosis;
    military: stress fractures
  • men: hypogonadism (erectile dysfunction, prostate cancer)
  • any insufficiency or fragility fractures, especially vertebral fractures
  • residence in a long term care facility
  • poor self related health
  • low physical function:
    ex. slow gait speed; gait disorders or movement dysfunction; low level of physical activity, difficulty in turning while walking; inability to pivot, use of a walking aid (cane, walker), decreased quadriceps strength (ex. inability to rise from chair without using arms), increased postural (body) sway, impaired cognition, dementia
  • physical attributes
    ex. low physical fitness, decreased bone mineral density, bone geometry, height, leg length discrepancy, height, low body mass index; low muscle mass, poor nutrition; eating disorder; vitamin D deficiency
  • alcohol and/or substance use
  • other diseases or conditions
    ex. osteoporosis; failure to treat or undertreatment of osteoporosis, osteogenesis imperfecta, osteonecrosis, neoplasm; skeletal metastases; surgical resection for tumor
  • radiation treatment
  • high dose, long term use of proton pump inhibitors
24
Q

Fracture healing

A
  1. hematoma formation
  2. cellular proliferation
  3. callous formation
  4. ossification
  5. consolidation and remodeling
    some resources describe the phases of bone healing more succinctly as inflammatory, reparative, and remodeling
25
Q

Fracture healing (Review G&F ch 6)

A

see ppt 19

26
Q

The timeframe for fracture healing

A
  • initial (6-12 hours): bleeding ceases and a clot is formed
  • day 1-2: there is an acute inflammatory reaction and granulation tissue is formed
  • week 1-3: osteogenesis, fibrous union, and callous formation occur
  • week 6: there is continuity of the external callus
  • 4 months to 1 year: there is remodeling of the medullary canal and organized lamellar bone
27
Q

The factors hinder proper fracture healing

A
  • inadequate blood supply
  • poor general nutritional status
  • poor apposition of the fractured bone ends
  • presence of foreign bodies, infection, or necrotic tissue
  • corticosteroid therapy
28
Q

Clinical manifestations of fractures

A
  • pain and tenderness
    point tenderness over the site of the fracture (but not all fracture are equally painful)

increased pain on weight bearing or attempts to move the injuries limb (in the presence of a fatigue fracture (stress reaction), active movement is typically painless

resistive motions or repetitive weight bearing will cause pain, the area will be exquisitely tender to local palpation

nonspecific low back, groin, or pelvic pain if insufficiency fracture of the spine, pelvis, or sacrum

  • edema and ecchymosis (bruise)
  • loss of mobility and function of the involved body part
  • increased dependence on family and friends
  • decrease in the individual’s ability to perform ADLs
  • depression and anxiety (and sleep disorders in some people)
29
Q

Clinical manifestations of vertebral compression fractures

A
  • VCFs are often painless
  • when painful, the initial pain may be sharp and severe, but after a few days it may become dull and achy
  • the pain may be reproducible on examination with pressure over the spinous process of the involved level
  • pain tends to be postural
    ex. worse with spinal extension or even standing up straight; it can be debilitating enough to confine some older adults to a wheelchair or bed
  • associated with height loss and respiratory dysfunction
30
Q

Complications

A
  • deformity
  • malunion: the fracture may heal in the expected amount of time but in an unsatisfactory position, with residual bony deformity
  • delayed union: the fracture may heal, but this may take considerably longer than the expected time
  • nonunion: the fracture may fail to heal with resultant formation of either a fibrous union or a false joint (pseudarthrosis)
31
Q

Complications -fat embolism

A
  • a potentially fatal event
  • the fat globules from the bone marrow (or from the subcutaneous tissue at the fracture site) migrate to the lung parenchyma and can block pulmonary vessels, decreasing alveolar diffusion of oxygen
  • the risk of developing this condition is related to fracture of long bones and the bony pelvis, which contain the most marrow
32
Q

Other complications

A
  • Secondary to treatment, infection skin ulceration, growth disturbances, posttraumatic degeneration arthritis, soft tissue or connective tissue adhesions, arthrodesis (joint fusion), myositis ossificans, osteomyelitis, refracture, nerve injury and neurologic complications, and vascular compromise
  • From immobility
    constipation, deep vein thrombosis, pulmonary embolism, and pneumonia
32
Q
A

MSK Fracture (1 decks)

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