Fracture Physiology Flashcards
What are the stages of fracture healing?
- Haematoma - Soft callus - Bony callus - Remodelling
Outline the haematoma stage.
- 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
Outline the soft callus stage.
- Capillaries grow into the haematoma - Macrophages clear the debris - Fibroblasts make collagen - Osteoblasts make sponge bone
Outline the bony callus stage.
- Soft callus is reformed into a bony callus
Outline the remodelling stage.
- Bony callus remodelled into bone by osteoblasts and osteoclasts
How long can remodelling take?
Months to years
How can fractures be classified?
PAID Pattern Anatomical position Intra/extra-articular Deformity
What are the possible patterns of a fracture?
• Transverse • Oblique • Spiral • Multifragmentary • Crush • Greenstick • Avulsion
What deformities may be present (distal relative to proximal)?
• Translation • Angulation or tilt • Rotation • Impaction (shortening)
What classification is used in hip fractures?
Garden
What is Salter-Harris classification used for?
Fractures involving the growth plate of a bone
What classification is used in ankle fractures?
Weber’s
What is a Smith’s fracture?
- Radius #- Distal moves anteriorly/volar - Fall on flexed wrist
What is a Colle’s fracture?
- Radius #- Distal moves posteriorly (fork) - FOOSH (Extended wrist)
What is a monteggia fracture?
Fracture of the proximal third of the ulna with dislocation of the proximal head of the radius.
What are the 4 Rs of fracture management?
- Resuscitation - Reduction - Restriction - Rehabilitation
What does resuscitation involve?
- Stabilise patient - Assess NV injuries
What does reduction involve?
- Manipulation of displaced fractures (traction to disimpact and manipulate until realigned) - ORIF- partcularly if open, intra-capsular, multiple fragments etc.
What does restriction involve?
Preventing the bone ends from separating - Sling - Cast - External fixation - Internal fixation
What does rehabilitation involve?
Preventing bone and muscle mass decreases - Physio- exercises - OT- mobility aids - Social services- home help/meals on wheels
What are the 6 As of open fracture management?
- Assess (NVI, soft tissues, photograph) - Analgesia - Antiseptic e.g. betadine/irrigation - Alignment - Anti-tetanus (10 year booster) - ABx (fluclox and benzylpenicillin)
How would you manage an open fracture?
PIST - Photo - IV ABx and tetanus booster - Saline irrigation and gauze - Take to theatre
What are the tissue complications of fractures?
- Infection - Rhabdomyolysis (and AKI) - Haemorrhage
What are the anaesthesia complications of fractures?
- Anaphylaxis - Damage to teeth - Aspiration
What are the immobility risks?
- Infection e.g. chest or UTI - DVT/PE - Pressure sores/ulcers - Decreased BMD
What are the specific complications of fractures?
- NV damage - Compartment syndrome - Metalwork infection - Malunion - Arthritis - Avascular necrosis
What can cause malunion/delayed union?
- Poor alignment - Ischaemia - Infection - Disease e.g. malnut. or malignancy
Which fractures are at most risk of avascular necrosis?
- NOF (femoral head) - Scaphoid - Talus
What is myositis ossificans?
Ossification of muscle at the site of haematoma formation
How can Salter-Harris be remembered?
SALT C 1 Straight across 2 Above 3 Lower 4 Through 5 Crush
Outline the Salter-Harris Classification.
