Fractures Flashcards
Define fractures.
Disruption in the integrity and continuity of bone associated with soft tissue injury.
Explain the aetiology of fractures.
Trauma: Force applied to bone exceeds its strength. Direct force (penetrative, crushing) or indirect (tension, compression or rotation injuries).
Greenstick: Incomplete fracture with angulation on the opposite side due to stronger fibrous periosteum in children.
Pathological: Minor force causes fracture secondary to underlying bone weakness (malignancy, congenital).
What are the risk factors for fractures?
Contact sports
Trampoline use
RTA
Osteogenesis imperfecta
Non-accidental injury
What is the Salter-Harris classification for fractures?
Epiphyseal injuries: involve growth plate, types I–V depending on involvement of the physis, metaphysis and epiphysis.
What is Salter-Harris Type 1?
Through the growth plate
(Straight through)
What is Salter-Harris Type 2?
Through growth plate and metaphysis,
(Above)
What is Salter-Harris Type 3?
Through growth plate and epiphysis.
(Lower)
What is Salter-Harris Type 4?
Through all three elements (metaphysis, growth plate, epiphysis)
(Through Everything)
What is Salter-Harris Type 5?
Crush injury of growth plate.
(cRush)
Summarise the epidemiology of fractures.
Very common. Males more than females.
What are the symptoms for fractures?
Usually a history of trauma.
Need to assess if there is a history of non-accidental injury:
Time elapsed, force, possibility of glass contamination, associated head injury, medications and previous fractures.
What are the signs for closed fractures?
Pallor and swelling over fracture site, obvious deformity.
What are the signs for open fractures?
Bleeding and bruising over fracture, associated soft tissue injury.
What are some tests for fractures?
Neurovascular status: Assess for distal numbness, tingling, paralysis or loss of pulse.
Musculoskeletal examination: Examine joint above and below for crepitus, effusion and pain.
Tuning fork test: Exacerbates pain over small stress fractures.
What are some approriate investigations for fractures?
X-ray (usually in two views frontal and lateral)
Repeat x-ray.
MRI and Bone scan
Genetics for bleeding disorders and osteogenesis imperfecta.