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Hands & UE Exam 1 > Fractures > Flashcards

Fractures Flashcards

1
Q

What is the Difference Between Primary & Secondary Healing?

A

Primary Healing (Outside-In): Rigid Bone connects with internal fixation to heal
- No Callus
- Open Reduction (internal/external fixation)
- Direct
- AROM usually immediately

Secondary Healing (Inside-Out): bone is regenerated through secondary intention (endochonral ossification)
- Callus Formation
- Close Reduction
- Indirect
- AROM s/P 3-6 wks

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2
Q

What are all the phases of Secondary Healing?

A

Inflammatory
Endochondral Ossification
Remodeling

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3
Q

What occurs in each phase of Secondary Healing?

A

Inflammatory: begin to form hematoma for protection
▪ Osteogenic Osteogenic periosteum & endosteum cells
▪ Osteoclasts and macrophages: remove necrotic tissue
▪ Precursor osteoblasts and chondrocytes: form soft callus

Endochondral Ossification- Repair (occurs ~2 wks)
▪ Fibrins & granulation tissues create scaffold for cell migration
▪ Callus formation outside of periosteum (no bone yet)
▪Blood Supply Forms →Capillary Buds grow into callus
HARD CALLUS: give mechanical integrative (@4-16wks)

Remodeling:
▪ internal&external callus join – more strength
▪ bone is smooth and breakthrough callus

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4
Q

What factor might impede healing fractures?

A

age, comorbidities, medications, social factors (ie. smoking), nutrition, fracture type, trauma, local factors

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5
Q

What impact does smoking having on healing fractures?

A

Smoking can slow down the process of bone healing

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6
Q

What is the difference between Closed & Open Reduction?

A

Closed Reduction: Cast, Splint (Secondary Healing)
▪takes longer than open reduction (7-10wks longer)

Open Reduction: surgical interventions thru internal/external fixations (primary healing)

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7
Q

What is the difference between External Fixation and Internal Fixation?

A

External Fixation: longitudinal traction prevent shortening or angulation, holding 2 bone ends to maintain length-tension (prevent fragment from collapsing onto each other)
▪Allow movement and is not rigid

Internal Fixation: rigid fixation, there is no flexibility

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8
Q

Why might external fixtures be used?

A

▪ allow muscle tendon unit function across
▪ variable compression/distraction
▪ significant tissue loss/injury – gunshot wounds

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9
Q

Why might internal fixtures be used?

A

▪ displaced & articular fractures
▪ fractures required mobilization
▪ fractures prone to mal/non-union (scaphoid, ulna, radius)
o Malunion = fracture heals but not really well
o Nonunion = fracture has no bone growth/union at all, continues to look like a fracture

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10
Q

What is the wrist compromised of?

A

8 Carpal Bones
Distal Radius
Ulna
Associated joint capsule
Several ligaments

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11
Q

What are the 2 axes of motion on the radiocarpal joint?

A

wrist/extension
radial/ulnar deviation

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12
Q

What is the Distal Radius Ulna Joint (DRUJ)?

A

forearm rotation (supination and pronation)
hand &carpus move in conjunction with

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13
Q

What does the distal radius articulate with?

A

scaphoid & lunate→ palmar tilt

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14
Q

What is the normal palmar tilt?

A

10-15°

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15
Q

What is Triangular fibrocartilage complex (TFCC)?

A
  • cartilage and ligament structure that stabilizes the DRUJ
  • distributes force between distal ulna and proximal carpal row (ulnar head and triquetrium)
    *distal ulna doesn’t articulate with proximal carpal row
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16
Q

What is ulnar variance?

A

how distal/proximal ulna is in comparison to radius
*impacts pronations & supination

Norm: 1-2 mm → norm function

17
Q

What is the difference between positive, neutral & negative ulnar variance?

A

● Positive ulnar deviance = ulna placed too distally towards the carpus
● Neutral ulnar deviance = ulna and radius at equal level, line up
● Negative ulnar variance = ulna placed too proximally

18
Q

When is the pain experienced with positive and negative ulnar variance?

A

(Positive)Pain experienced when:
pronating
gripping/weightbearing at ulnar aspect

(Negative) Pain experienced when:
radial aspect - supination
gripping/weightbearing
*RCP is absorbing too much force ⇨ osteoarthritis

19
Q

What is the difference between the displacements associated with Colles vs/ Smiths Fx?

A

Colles (FOOSH): fracture of distal radius with dorsal displacement
- required ORIF/External Fixation
- Most common

Smiths: fracture of distal radius with palmar displacement
- ORIF

20
Q

What is ligamentotaxis?

A

two ends of two bones of a fracture are pulled and held in place with an external fixator

21
Q

What are the rehabilitation guidelines for distal radius fx - Nonoperative protocols?

A

cast immobilization for non-displaced, stable fractures
- <=20° wrist flexion & ulnar deviation
- well-padded cast with MPs free
- Address issues with cast - avoid complications
- Blocking
-External Fixation
-Internal Fixation

22
Q

What are strategies for regaining ROM?

A

o Tenodesis (demonstrate on unaffected side)
▪ so that they don’t use digital extensors for wrist extension (as a substitution pattern)
▪ use pure wrist extensors to perform wrist extension and grasp with digits
o Common substitution pattern = wrist extension with the aid of digital extensors
o PROM (when appropriate)
o Joint mobilizations (prn and only with physician involvement)
o Modalities prn (ie. heat, cold)
o Gradual addition of PREs when appropriate
o Continual upgrade and revision of home program

23
Q

What are the scaphoid fractures?

A

Scaphoid Tubercle

Scaphoid Waist: most common area (70% of scaphoid fx)

Proximal Pole: Poor Blood Supply (PPP); due to mal/non-union lack of blood supply
* leads to necrosis
*worst type of scaphoid

24
Q

How common are scaphoid fractures?

A

Most common!
60-70

25
Q

What is the scaphoid supplied by?

A

Radial artery, recurrent arterial blood supply

26
Q

What is the association between Kienbocks disease & lunate bone?

A

During Lunate Fractures

avascular necrosis of lunate – blood supply is compromised and an issue

27
Q

What is SALTER HARRIS?

A

pediatric fracture of the epiphyseal growth plate

28
Q

What are the types of metacarpal fracture?

A

Boxer’s fracture = an extraarticular MCP neck fracture
caused: compression force/direct blow w

MCP shaft fractures = immobilization for 3-5 weeks
*same posture as Boxer’s fracture (safe
position)

MCP head fractures – usually require ORIF

MCP base fractures =
uncommon; 2nd and 3rd digits usually stable; 4th or 5th digits
*not correctable but functional

▪ Bennett fracture = 1st MCP base fracture (thumb)

▪ Rolando fracture = 1st MCP base fracture (thumb), involving 3 fragments

29
Q

What are the phalangeal fractures?

A

P1: Proximal Fx - most are nondisplaced/ stable fixtures
P2: Middle Fx - deforming forces at FDS & Central Slip on Extensor Side
* monitored for swan neck, DIP extensor
P3: Distal Fx - injury or avulsion to terminal tendon
most common
Monitor: DIP extensor lag

Hands & UE Exam 1 (6 decks)

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