Fractures

Question 1

Open / compound?

Answer 1

Breaks through skin

Question 2

Impacted?

Answer 2

2 bones impacting into each other.

Question 3

Comminuted?

Answer 3

Many pieces of bone shattered.

Question 4

Close / simple?

Answer 4

Skin not broken.

Question 5

Displaced?

Answer 5

2+ more fragments that have been moved from original position (e.g. muscle spasm) and no longer together.

Question 6

Compression fracture? (Think OP)

Answer 6

Osteoporosis - vertebrae collapses under each other

Question 7

Spiral / Depressed / Oblique / Transverse / Greenstick
Colle’s vs Smith’s fracture
Boxer’s

Answer 7

Colle’s - dorsal displacement of distal radius

Smith’s - ventral displacement of distal radius

Question 8

Healing of fracture - what are the 4 stages?

Answer 8

1) Hematoma formation (inflammation) < 48 - 72 hours. Clot produced in 6-8 hours. Bone cells die. Phagocytic cells arrive to clear debris.
2) Fibrocartilaginous callus formation (2-4 weeks) cartilage bridge ajoining the two pieces of bone, new blood vessels form, external callus. Fibroblasts invade PROCALLUS and lay down collagen, making ends of bone united but is still weak. Chondro-progenitor cells differentiate into chondroblasts. Fracture site is weak.
3) Bony callus formation (3-4 months) like the proliferation stage. Osteoprogenitor cells differentiate into osteoblasts that secrete spongy bone that join broken ends of bone together. Fracture is firmly held and can hold itself. External fixation (if any) can be removed. We need micro movement inside the fracture site to encourage new bone laid down.
4) Bone remodelling - deposition of new bone - feel a bump - shows up white on Xray. Compact bone replaces spongy bone in bony callus. Osteoclast resorbs trabecular bone. Lump remains. Up to 1 year.

Question 9

What factors affect rate of frature healing? (Name 8)

Answer 9

Type of, site of, vascular supply, age, movement at the bone surfaces, separation of bone ends, infection, bone pathology / comorbidities, immobilisation.

Question 10

Areas where avascular necrosis is more common / certain bones that have poor blood supply?

Answer 10

Head of femur

Scaphoid

Question 11

3 stages of bone fracture treatment? Red, Imm, Re

Answer 11

Reduction - aligned, manip, longitudnal force

Immobilisation - sling, cast, splint, traction bar in femur

Rehabilitation - once consolidation is achieved, physio required often for consequence of immobilisation

Question 12

Delayed, mal and non-union?

Answer 12

Delayed = not healed in expected time
Mal = not healing in right position (may need to rebreak)
Non = not healing at all