Fracture Healing And Management

Question 1

What is a fracture

Answer 1

A breach in the continuity of bone

Question 2

Why do fractures occur

Answer 2

Non-physiological loads are applied to normal bone
Physiological loads are applied to abnormal bone

Question 3

Why might a fracture occur in abnormal bone

Answer 3

Due to a tumour
Due to a metabolic bone disease such as osteoporosis, pager’s disease or osteogenesis imperfecta

Question 4

How would you describe a fracture to another medical professional

Answer 4

Describe the site, pattern, displacement or angular ion, joints involved and skin involved

Question 5

What are the 3 parts of bone

Answer 5

Proximal 1/3
Middle 1/3
Distal 1/3

Question 6

What type of fracture is this

Answer 6

Transverse fracture

Question 7

What type of fracture is this

Answer 7

Oblique fracture

Question 8

What type of fracture is this

Answer 8

Spiral fracture

Question 9

What type of fracture is this

Answer 9

Comminuted

Question 10

What type of fracture is this

Answer 10

Segmental

Question 11

What type of fracture is this

Answer 11

Avulsed

Question 12

What type of fracture is this

Answer 12

Impacted fracture

Question 13

What type of fracture is this

Answer 13

Green stick fracture

Question 14

What is an open fracture

Answer 14

A breach in the skin that communicated with the bone

Question 15

Why does an open fracture require urgent treatment

Answer 15

So no infection can get inside the bone

Question 16

What are the stages of fracture healing

Answer 16

Haematoma
Inflammation
Repair
Remodelling

Question 17

What is involved in the haematoma stage of fracture healing

Answer 17

Bleeding
Decreased blood flow
Periosteal stripping
Osteocyte death

Question 18

What is involved in the inflammation stage of fracture healing

Answer 18

Fibrin clot organisation
Neovascularisation
Cellular invasion - haematopietic cells, osteoclasts and mesenchymal stem cells

Question 19

What is involved in the repair stage of the fracture healing

Answer 19

Callus formation
Progressive matrix mineralisation
High vascularity

Question 20

What is involved in the remodelling stage of fracture healing

Answer 20

Woven bone structure replaced by lamellar bone
Increased bone strength
Vascularity returns to normal
Healing without unique scar

Question 21

What are the principles of fracture management

Answer 21

Reduce the fracture
Immobilise the part
Rehabilitate the patient

Question 22

What are the different types of fracture fixation

Answer 22

Slings
Casts
Splints
Intra-medullary devices
External fixations

Question 23

What are the factors which can influence fracture healing

Answer 23

Patient
- age
- nutrition
- smoking
- drugs
Tissue
- bone type
- bone site
- vascularity
- bone pathology
Treatment
- apposition of fracture
- stability
- micromotion

Question 24

What can be the consequences of early fractures

Answer 24

Local
- vessel damage
- nerve damage
- compartment syndrome
- infection

General
- hypovolaemic shock
- ARDS
- VTE
- Fat embolism

Question 25

What are the consequences of a late fracture

Answer 25

Local
- malunion
- non-union
- avascular necrosis
- ischaemic contractures
- joint stiffness
- myosotis ossificans
- complex regional pain syndrome
- osteoarthritis

General
- poor mobility
- functional disability
- social isolation
- pressure sores
- disuse osteoporosis
- loss of income or job