Fracture Physiology Flashcards

1
Q

What are the stages of fracture healing?

A
  • Haematoma - Soft callus - Bony callus - Remodelling
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2
Q

Outline the haematoma stage.

A
  • Blood vessels in the broken bone tear and haemorrhage, resulting in the formation of clotted blood at the site of the break - The bleeding vessels then clot and stop
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3
Q

Outline the soft callus stage.

A
  • Capillaries grow into the haematoma - Macrophages clear the debris - Fibroblasts make collagen - Osteoblasts make sponge bone
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4
Q

Outline the bony callus stage.

A
  • Soft callus is reformed into a bony callus
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5
Q

Outline the remodelling stage.

A
  • Bony callus remodelled into bone by osteoblasts and osteoclasts
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6
Q

How long can remodelling take?

A

Months to years

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7
Q

How can fractures be classified?

A

PAID Pattern Anatomical position Intra/extra-articular Deformity

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8
Q

What are the possible patterns of a fracture?

A

• Transverse • Oblique • Spiral • Multifragmentary • Crush • Greenstick • Avulsion

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9
Q

What deformities may be present (distal relative to proximal)?

A

• Translation • Angulation or tilt • Rotation • Impaction (shortening)

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10
Q

What classification is used in hip fractures?

A

Garden

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11
Q

What is Salter-Harris classification used for?

A

Fractures involving the growth plate of a bone

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12
Q

What classification is used in ankle fractures?

A

Weber’s

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13
Q

What is a Smith’s fracture?

A
  • Radius #- Distal moves anteriorly/volar - Fall on flexed wrist
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14
Q

What is a Colle’s fracture?

A
  • Radius #- Distal moves posteriorly (fork) - FOOSH (Extended wrist)
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15
Q

What is a monteggia fracture?

A

Fracture of the proximal third of the ulna with dislocation of the proximal head of the radius.

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16
Q

What are the 4 Rs of fracture management?

A
  • Resuscitation - Reduction - Restriction - Rehabilitation
17
Q

What does resuscitation involve?

A
  • Stabilise patient - Assess NV injuries
18
Q

What does reduction involve?

A
  • Manipulation of displaced fractures (traction to disimpact and manipulate until realigned) - ORIF- partcularly if open, intra-capsular, multiple fragments etc.
19
Q

What does restriction involve?

A

Preventing the bone ends from separating - Sling - Cast - External fixation - Internal fixation

20
Q

What does rehabilitation involve?

A

Preventing bone and muscle mass decreases - Physio- exercises - OT- mobility aids - Social services- home help/meals on wheels

21
Q

What are the 6 As of open fracture management?

A
  • Assess (NVI, soft tissues, photograph) - Analgesia - Antiseptic e.g. betadine/irrigation - Alignment - Anti-tetanus (10 year booster) - ABx (fluclox and benzylpenicillin)
22
Q

How would you manage an open fracture?

A

PIST - Photo - IV ABx and tetanus booster - Saline irrigation and gauze - Take to theatre

23
Q

What are the tissue complications of fractures?

A
  • Infection - Rhabdomyolysis (and AKI) - Haemorrhage
24
Q

What are the anaesthesia complications of fractures?

A
  • Anaphylaxis - Damage to teeth - Aspiration
25
Q

What are the immobility risks?

A
  • Infection e.g. chest or UTI - DVT/PE - Pressure sores/ulcers - Decreased BMD
26
Q

What are the specific complications of fractures?

A
  • NV damage - Compartment syndrome - Metalwork infection - Malunion - Arthritis - Avascular necrosis
27
Q

What can cause malunion/delayed union?

A
  • Poor alignment - Ischaemia - Infection - Disease e.g. malnut. or malignancy
28
Q

Which fractures are at most risk of avascular necrosis?

A
  • NOF (femoral head) - Scaphoid - Talus
29
Q

What is myositis ossificans?

A

Ossification of muscle at the site of haematoma formation

30
Q

How can Salter-Harris be remembered?

A

SALT C 1 Straight across 2 Above 3 Lower 4 Through 5 Crush

31
Q

Outline the Salter-Harris Classification.

A