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Locomotion > Fracture Repair > Flashcards

Fracture Repair Flashcards

1
Q

What two types of fracture healing can there be?

A

1) Indirect 2ndry - Natural, Callus formation.

2) Direct 1ry - Normally requires surgical intervention.

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2
Q

Outline the steps in Indirect Fracture Healing - Sequence of Increasing Stiffness

A

Inflammation, Haematoma, Granulation tissue, Connective Tissue, Fibrocartilage and cancellous bone, Bone.

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3
Q

When are growth factors released in fracture healing? What do they do?

A

Growth factors are released immediately. It is also further released when the bone ends get resorbed.

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4
Q

In callus formation, what is important when going from haematoma to callus?

A

Tissues have an increasing need for oxygen tension, and also more complex tissues need less movement to form.

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5
Q

What size gap in a fracture will cause indirect healing?

A

Anything >1mm

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6
Q

What size gap in a fracture will cause direct CONTACT healing?

A

Fragments have to be in contact with a tiny (<0.01mm) gap

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7
Q

What size gap in a fracture will cause direct GAP healing?

A

Fracture has to be <1mm

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8
Q

Which of the 3 fracture healing possibilities will tolerate some movement, and which will tolerate none?

A

Indirect tolerates some, both direct will not tolerate any.

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9
Q

What two categories can Direct (Primary) healing be split into?

A

Contact healing and Gap healing.

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10
Q

What is the difference between Contact healing and Gap healing?

A

Contact healing requires a smaller gap, and the fragments have to be in contact.

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11
Q

How does Direct Contact healing work?

A

Direct migration of Osteones (haversian system) over the fracture line.

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12
Q

How does Direct Gap healing work?

A

Layered bone forms across fracture gap. They are weak. Osteones can then cross the fracture gap.

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13
Q

Which of direct or indirect is weaker? Which takes longer?

A

Direct unions are weaker, and usually take longer.

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14
Q

What is a Malunion in fracture healing?

A

Bone unites correctly but in the wrong position.

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15
Q

What is a Non-union in fracture healing?

A

Failure or delay in bone healing.

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16
Q

What is a Viable and Non-viable Non union?

A

1) Viable - Physiology still works. Healing is happening but may be too slow etc.
2) Non viable - Healing is not occuring.

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17
Q

Where is a diaphyseal fracture?

A

In the middle of a long bone.

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18
Q

What are the most important forces acting on a diaphyseal fracture?

A

Compression, Tension, Shear and Torsion.

19
Q

What are some problems associated with Co-aptation of a Diaphyseal fracture?

A

Gives little stability, can result in fracture malalignment, cannot apply to fractures proximal to stifle/elbow.

20
Q

What different ‘modes’ can implants take in fracture repair? Explain them.

A

Compression - squeezes fracture together, Neutralisation - resconstruct fracture, used to protect. Buttress - Implant takes all forces.

21
Q

What three implant systems can be used in diaphyseal fractures?

A

Plates and Screws, External Skeletal Fixator or the Interlocking Nail.

22
Q

What does the External Skeletal Fixator (ESF) consist of?

A

Pins driven into bone that exit the skin, clamps connecting pin and connecting bar. Connecting bar runs length of bone. Normally indirect bone healing.

23
Q

What are the advantages and disadvantages of ESF?

A

Adv - Quick, relatively cheap, can do ‘closed’, can be adjusted. Disadv - Pins can loosen, difficult to compress.

24
Q

How do plates and screws work?

A

Metal plates attached to either side of the fracture with bone screws. Generate primary or secondary bone union.

25
Q

What are the advantages and disadvantages of Plates and Screws?

A

+ Any of the ‘modes’, can achieve perfect reduction, not bulky. - Lots of equipment and skills needed. Open surgery.

26
Q

How does the Interlocking nail work?

A

Intramedullary device, allow screws to lock into cortical bone.

27
Q

What are the advantages and disadvantages of Interlocking nail?

A

+ Can be used semi-closed, Very strong. - Specialist equipment, implants must ‘match’ bone. Not common in UK.

28
Q

Where is a diaphyseal fracture?

A

In the middle of a long bone.

29
Q

What are the most important forces acting on a diaphyseal fracture?

A

Compression, Tension, Shear and Torsion.

30
Q

What are some problems associated with Co-aptation of a Diaphyseal fracture?

A

Gives little stability, can result in fracture malalignment, cannot apply to fractures proximal to stifle/elbow.

31
Q

What different ‘modes’ can implants take in fracture repair? Explain them.

A

Compression - squeezes fracture together, Neutralisation - resconstruct fracture, used to protect. Buttress - Implant takes all forces.

32
Q

What three implant systems can be used in diaphyseal fractures?

A

Plates and Screws, External Skeletal Fixator or the Interlocking Nail.

33
Q

What does the External Skeletal Fixator (ESF) consist of?

A

Pins driven into bone that exit the skin, clamps connecting pin and connecting bar. Connecting bar runs length of bone. Normally indirect bone healing.

34
Q

What are the advantages and disadvantages of ESF?

A

Adv - Quick, relatively cheap, can do ‘closed’, can be adjusted. Disadv - Pins can loosen, difficult to compress.

35
Q

How do plates and screws work?

A

Metal plates attached to either side of the fracture with bone screws. Generate primary or secondary bone union.

36
Q

What are the advantages and disadvantages of Plates and Screws?

A

+ Any of the ‘modes’, can achieve perfect reduction, not bulky. - Lots of equipment and skills needed. Open surgery.

37
Q

How does the Interlocking nail work?

A

Intramedullary device, allow screws to lock into cortical bone.

38
Q

What are the advantages and disadvantages of Interlocking nail?

A

+ Can be used semi-closed, Very strong. - Specialist equipment, implants must ‘match’ bone. Not common in UK.

39
Q

What forces are acting on Non-Diaphyseal fractures?

A

Mainly compression (difficult to bend).

40
Q

Usual practice for Articular Fractures

A

Involving articular surface. Usually fixate (screw) to achieve an open reduction and primary bone union.

41
Q

Usual practice for Intracapsular and Non-Articular fractures

A

Some can be fixated due to helpful force distributions. (e.g. breaking off of head of femur)

42
Q

Usual practice for Extracapsular fractures

A

E.g. On major muscular insertions. Tension bands can be used to resist tension from muscle.

43
Q

How would you deal with fracture of both diaphysis and epiphysis?

A

Combination of implant techniques.

44
Q

What are the treatment goals in Limb deformities?

A

Good foot position and keep joints in correct line to keep painless. Monitor continuously.

Locomotion (4 decks)

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