Fracture And Fracture Healing Flashcards
4 bone developmental disorders
Agenesis- limb doesn’t form or not fully
Osteogenesis imperfecta - not enough collagen. Bone grows at correct rate and size but if growth plates disturbed growth is poor.
Spina bifida : spinous processes formed poor so spinal cord can protrude out , paralysis ?
Achondroplasia: not enough growth hormone produced so bones don’t develop properly and are short
Disorders of bone remodelling
CMAHG
Calcium and phosphate levels
Mechanical stress
Age
Hormones
Genetics and environmental
Endocrine bone disorders
Gigantism- too munch growth hormone as a child - very tall , sometimes larger features
Acromegaly- too much growth hormone once growth plates closed up= large features, hands and feet and bones in face are larger , increases bone density NOT LENGTH
Pituitary dwarfism= inadequate production of growth hormone so they’re very small
Hyper/hypo parathyroidism = parathyroid controls calcium levels in blood
Too much = too much calcium in blood
Too little= too little calcium in blood
Affects calcium levels in bones
Postmenopausal osteoporosis- hormone-related reduction in oestrogen
Nutritional issues
RICKETS (lack of vitamin D) Reduces calcitrol Not enough calcium in bones Children = rickets Adults = osteomalacia, so bones soften and bow
SCURVY (vitamin C deficient)
Needed for collagen production and stimulates osteoblasts
Lack of= bone remodelling poor lower bone mass
Symptoms = bleeding gums and loose teeth, weakness and tiredness
Age related :
OSTEOPENIA- bones reduce in density with age
Balance between bone building and clearing disturbed
Osteoblast declines but osteoclast stays same
After 40, women lose 8% bone mass a year
Men lose 3% bone mass a year
Slight loss of height, more likely to fracture limbs etc
OSTEOPOROSIS- greater reduction in bone mass than expected
Osteoclast activity more than blast activity
Common in= Female, over 70s, white and Caucasians
Long menopause or early menopause
Lack of weightbearing
Diagnosing osteoporosis?
X ray for fracture that is odd compared to injury they had = answer Frax
Dexa bone density scan- x rays can’t get through dense so if not dense they can get through
-1 to -2 is normal
Less than -2 can indicate osteoporosis
OSTEOPOROSIS
Female, over 70, white and Caucasians, hormone changes or vitamin D / calc deficient
PRIMARY- in older people or post menopause
Oestrogen controls osteoclasts and progesterone controls osteoblasts
Type 1- post menopause
Oestrogen decreases + trabecular bone
Susceptible to spinal and wrist fractures
Loss of bone strength and loss of spongy bone
Type 2- calcium deficiency Outer bone structure lost Spongy bone thins Due to age or hyperactivity of parathyroid hormone as risk factors Hip fractures
Secondary osteoporosis = medical conditions cause it
Eg, hyperactivity of parathyroid gland , neoplasm, myeloma. Some medications cause it eg, corticosteroids
Osteoporosis causes common fractures in which areas?
Hips femoral head and neck
Wrists
Vertebrae
FRACTURES
Caused by excessive mechanical stress and bone can’t cope and breaks
25% of people will have traumatic fracture at some point
Common in males 15-24 , tibia, Clavicle and humerus
Pathological fractures - bones wi5 underlying conditions like bone cancer (wrist, vertebrae and hips)
SEVERITY FRACTURES
Open/ compound - bone through skin so tissue involved
Closed/ simple - bone not through skin
Impacted- one fragment driven into other fragment
Displaced- more than 2 fragments move from original position
Comminuted- lots of different fractured pieces
Compressed- vertebrae fracture
SHAPE CATEGORIES
Spiral / torsion- rotation and twisting forces and type of complete fracture
Depressed- Skull bone depresses inferiorly
Oblique- twisting and direct force to ankle
Transverse- fracture horizontally across the bone (run over is common)
Green stick- children, bone bends and cracks
Fracture position
Distal / proximal 1/3
Head of bone
Neck of bone
Epiphseal plates
Physician name
Colles = distal end of radius Potts= one or both malleoli
FRACTURE HEALING
Haematoma formation
Fibrocartilaginous callus formation
Bony callus formation
Bone remodelling
HAEMATOMA FORMATION
Damage blood vessels, nutrient artery, periosteum and tissues and blood vessels around the bone.
Bleeding and blood clot forms in medullary cavity
Haematoma stage until 6-8 hrs
No blood supply to bone cells so they die
Inflammatory process + phagocytes clear debris
Osteoclast clear up dead bone cells
Clear up phase is 3-4 weeks
Angiogenesis forms new capillaries at injury site
Fibrocartilaginous callus formation
New capillaries organise and pro-callus forms
Fibroblasts produce + secrete collagen
Ends of bones connected by the fibrocartilage callus
Medically cavity and outside of bone
Weak and temporary
3-4 months usually
Formation of bony callus
Osteoprogenitor cells differentiate into osteoblasts
Spongy bone built on fibrocartilaginous callus
Bone grows until both ends connected with spongy bone callus
3-4 months
Fracture site firmly held
POP taken off
Bone remodelling
Cortical bone replaces spongy bone
Osteoclasts clear away spongy bone
Surface remodelled back to normal shape and size
Need normal mechanical stress
Sometimes palpable lump remains
Rate of healing depends
Spiral fractures heal fast- large SA
Upper limb heals faster than lower limb
UNION= fibrocartilaginous formation CONSOLIDATION= Bony callus formation
What factors determine rate of healing?
Age
Bone pathology
Site of fracture
Type of fracture
Movement of bone- small movements needed in POP to promote callus formations
Separation of bone ends
Infection - eg, compound fractures as they stick out
Vascular supply - eg, scaphoid has poor blood supply
Clinical features of fracture
Pain and tender
Severe swelling and bruising - disruption to blood vessels
Deformity and angulation
Impaired function - weight bearing or moving
Shock
TEST= x ray a-p and lateral views
TREATMENTS
Closed fracture= sling, cast or splint. Rehab can be done if needed once cast removed
Open- simple fractures that need more immobilisation eg, near a joint or comminuted fractures
Open reduction internal fixation= open surgery to set bones in place with plates and pins
Traction can realign broken femur
Rehab may commence immediately
Open- for compound fracture with tissue damage at risk of infection
Open reduced external fixation= compression device used to add pins and plates externally through fracture fragments. Less invasive and not surgical
May commence immediately
Fracture complications
Delayed - not healing in expected time frame
Malunion- not proper alignment
Non union- will not heal
Avascualr necrosis
Suceck’s atrophy= complex regional pain syndrome. Common in 40-60 females disturbs sympa NS
usually hands, wrist and feet and ankles
Compartment syndrome- too much bleeding and swelling at the fracture so cuts off blood supply in the compartment
Volkmann’s ischaemia= low blood supply to forearm muscles, increased pressure in forearm and decreased blood flow
Myositis ossificans- bone tissue grows in soft tissue or muscle, reabsorbed in a year
Blood vessel, nerve or visceral damage
Tendon injury
Fat embolus= long bone or pelvic fractures where yellow bone marrow sleeps into blood . Can be life threatening and blood blocked to brain - heart.
Osteoarthritis- Cartilage @ ends of bones worn down over time so joints stiff and painful
Growth impairment - if epiphyseal plates harmed in children
