Fractures Flashcards
What are the 2 fracture extents?
- complete (360 of bone circumference)
- incomplete (seen mostly in children)
- Greenstick fracture
- buckle fracture
What type of fracture does tension lead to?
transverse
what type of fracture does compression lead to?
oblique
What type of fracture does torsion lead to?
spiral
What type of fracture does bending lead to?
triangular BUTTERFLY fracture (wedge)
What is a comminuted fracture?
fracture with 3 or more segments
What is a segmental fracture?
2 fractures that separate a bone segment
What are the mechanisms of fractures?
- high energy vs low energy
- multiple injuries vs isolated injury
- pathological fracture weakened bone (tumor, osteoporosis, infection)
- stress fracture: normal bone subjected to repeated load
What is considered an open fracture?
any skin breach in proximity of a fracture is an open fracture until proven otherwise
Why should we splint fractures?
1- to alleviate pain
2- to ensure union takes place in a good position
3- permit early movement of the limb and a return of function
What are the 4 stages of indirect bone healing (endochondrial ossification) occuring in untreated fractures?
1- hematoma formation (soon after fracture)
2- soft callus formation
3- hard callus formation
4- remodeling
How to diagnose a fracture with history?
- patient complains of pain and inability to use limb
ONSET - specific trauma incident OR gradual onset?
if TRAUMA - mechanism of injury
- circumstance of the event? work related?
- severity pf symptoms at time of injury & progression
What may be present while you are inspecting a fracture patient?
- swelling
- ecchymosis
- deformity
if fracture is open - bleeding
- protruding bone
What physical examination should be done for a fracture patient?
Palpation: bony tenderness RULE OUT - neurovascular injury - compartment syndrome - associated MSK injuries by examining joints above and below
What imaging should be used for fractures?
X-ray GET MINIMUM 2 orthogonal viewa
include 1 joint above and 1 joint below injury
What should be done BEFORE getting an x-ray?
immobilize patient in a backslab in the most effective way to relieve pain from a fracture
Which fractures may not be apparent on x-ray immediately?
undisplaced or stress fractures
What are the secondary signs of fracture on x-ray?
- soft tissue swelling
- fat pad sign
- periosteal reaction
- joint effusion
- cortical buckle
How to describe a fracture?
CLINICAL PARAMETERS
- open vs closed
- neurovascular status
- presence of clinical deformity
RADIOGRAPHIC
- location
- which bone
- which part of bone
- epiphysis (intra-articular?
- metaphysis
- diaphysis (divide into 1/3)
- use anatomic landmarks
- pattern
- simple vs comminuted
- complete vs incomplete
- orientation of fracture line
- displacement
- position of distal fragment relative to proximal
- expressed as a percentage
- angulation
- deviation from normal alignment
- direction of angulation
- expressed in degrees
- shorteningWhat should be done to treat a fracture?
- reduction IF fracture is displaced
- to realign fracture fragments
- to minimize soft tissue injury
- can be considered definitive if fragments’ position is
accepted
- should be followed by immobilization
- immobilization
- to hold reduction in position
- to provide support to broken limb
- to prevent further damage
- CONTROL PAIN - definitive treatment
- if reduction cant be achieved at initial stage it should
be attempted in surgery
- plate & screws OR IM nail OR EX-fix - rehabilitation (to ensure return of function)
- motion as early as possible without jeopardizing
maintenance of reduction
- weght baring restriction for short period
- move unaffected areas
