Fracture management Flashcards
Bone healing:
There is first a ___ and cell injury leading to release of ___ and so there is ___. The repair process then begins. ___ tissue is laid down, this is then replaced by ___ tissue i.e. ____. This is then replaced by ___ bone tissue aka ___ callus (week___), which then ___ to form ___ callus. ___ then occurs from about week __.
The process of bone remodelling occurs because mesenchymal precursors differentiate to ___ which then lay down the osteoid (___ callus)
Haematoma Cytokines Inflammation Granulation Connective Cartilage Primitive Soft 2-3 Ossifies Hard Remodelling
Osteoblasts
Soft
Two categories of fracture in abnormal bone? And what causes each?
Insufficiency fracture - osteoporosis
Pathological fracture - tumour/infection/metabolic
What is a callus??
AA mass of new bone at a fracture site
4 factors that promote bone healing
Nutritional status e.g. Vit D
Loading and micro motions
Good blood supply
Local growth hormones
Disease that impairs bone healing?
Diabetes
3 treatments that impair bone healing?
Steroids
NSAIDs
Radiotherapy
When can you get primary bone healing, ie where there is no callou formation?
When the fracture is held rigidly in place
- surgery: rigid internal fixation
- nature: when there is no movement at the fracture site e.g. vertebral disk collapse
While most bone unites correctly, some bone can unite slowly, somee can unite incorrectly and some can not unite. What are the 3 reasons for the latter situation?
Hypertrophic (flared bone end, callus ++)
Atrophic (withered bone end, no callus)
Infected
Rule of thumb for union time:
Most bones? Lower limb? Shaft? High energy? Child?
6 weeks Double Double Double Half
What patient lifestyle factor impairs bone healing?
Smoking
What is each of the following:
Epiphysis
Physis
Metaphysis
Diaphysis
Rounded end of bone at joint with adjacent bones
Growth plate/epiphyseal plate
Wide section of bone beneath the physis
Bone shaft (narrow)
How do small bones grow?
From the centre…?
Which views do you norm xray a fracture from?
Lateral and AP
Fracture desccription
- name bone
- part of bone: into 1/3s, or into 4 diff parts of bone?
- Intra or extra ____?
- Immature vs mature skeleton
- Pattern of fracture (3). When does each occcur.
Epiphysis, physis, metaphysis, diaphysis
Articular
Transverse: bending or tensile force, (>30 degree angle) oblique (compression), spiral (torsion)
When describing displacement, to which bit of a fragment are you referring to?
Distal
