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MSK > Fractures > Flashcards

Fractures Flashcards

1
Q

Define fracture

A

Breach in continuity of bone

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2
Q

Why do fractures occur

A

Non-physiological loads applied to normal bone

Physiological loads applied to abnormal bone

Imbalance between force applied to bone and ability of bone to resit this

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3
Q

What are the reasons for fractures in abnormal bones

A

Tumour
- benign
- malignant
- metastatic

Metabolic bone disease
- osteoporosis
- Paget’s disease
- Osteogenesis imperfecta

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4
Q

How do you describe fractures

A

Site
Pattern
Displacement/angulation
Joint involvement
Skin involvement

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5
Q

How do you describe the site of a fracture

A

Bone

Part of bone
- proximal 1/3
- middle 1/3
- distal 1/3

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6
Q

What are the different patterns of fractures

A

Transverse
Oblique
Spiral
Comminuted
Segmental
Avulsed
Impacted
Torus
Greenstick

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7
Q

How do you describe displacement/angulation of fractures

A

Displacement %

Angulation - of distal part

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8
Q

How do you describe joint involvement in fractures

A

Extra-articular - does not involve the joint
Intra-articular - involves the joint (damage to the cartilage)

Fracture which involves the joint is more likely to cause a problem

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9
Q

What are the different types of fractures - skin involvement

A

Open/close

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10
Q

Describe open fracture

A

Breach in the skin with communicates with breaks (bone of the fracture is involved with the air)

  • orthopaedic emergency
  • required urgent treatment
  • soft tissue injury determines outcome
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11
Q

How are fractures different in children

A

Epiphyses open and bone more ‘plastic’

Heal quickly
Increase deformity remodelling

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12
Q

What are the stages of fracture healing

A

Haematoma (hours)

Inflammation (days)

Repair (weeks)

Remodelling (months to years)

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13
Q

Describe haematoma stage

A

Bleeding - endosteal and periosteal vessels, muscles etc.

Decreased blood flow

Periosteal stripping

Osteocyte death

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14
Q

Describe inflammation stage

A

Fibrin clot organisation - platelets rich in chemo-attractants

Neovascularisation

Cellular invasion

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15
Q

Describe cellular invasion during inflammation

A

Haematopoietic cells
- clear debris
- express repair cytokines

Osteoclasts
- reabsorb dead bone

Mesenchymal stem cells
- building cells for repair

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16
Q

Describe repair stage

A

‘Callus’ formation

Progressive matrix mineralisation

High vascularity

17
Q

Describe ‘Callus’ formation

A

Fibroblasts produce fibrous tissue (high strain)

Chondroblasts from cartilage (strain <10%)

Osteoblasts form osteoid (strain <1%)

18
Q

Describe remodelling stage

A

Woven bone structure replaced by lamellar bone - osteonal remodelling

Increased bone strength

Vascularity returns to normal

Healing without scar - unique

19
Q

What are the principles of fracture remodelling

A

Reduce (the fracture)

Immobilise (the part)

Rehabilitate (the patient)

20
Q

What are the types of fracture fixation

A

Slings

Casts and splints

Extra-medullary device - plates and screws

Intra-medullary device - nails

External fixation

21
Q

What are the three main factors which influence fracture healing

A

Patient

Tissue

Treatment

22
Q

How does the patient effect fracture healing

A

Age

Nutrition

Smoking

Drugs e.g. NSAIDs, steroids

23
Q

How does tissue influence fracture healing

A

Bone type - cancellous vs. cortical

Bone site - upper limb vs. lower limb

Vascularity/soft tissue damage

Bone pathology - breaks in metastatic deposit does not heal

Infection

24
Q

How does treatment influence fracture healing

A

Apposition of fragments

Stability - ability to resist force without deforming

Micromotion (<1mm)

25
Q

What are the 4 complications of fractures

A

Early
Late

Local
General

26
Q

What is early local complications

A

Vessel damage

Nerve damage

Compartment syndrome

Infection

27
Q

Describe early general complications

A

Hypovolaemic shock

ARDS

VTE

Fat embolism

28
Q

Describe late local complications

A

Malunion

Non-union

Avascular necrosis

Ischaemic contractures

Joint stiffness

Myositis ossificans

Complex regional pain syndrome

Osteoarthritis

29
Q

Describe general late complications

A

Poor mobility

Functional disability and social isolation

Pressure sores

Disuse osteoporosis

Loss of income/job

30
Q

Break of what bone causes a high mortality and morbidity

A

Fractures of the femur

31
Q

What is a comminuted fracture

A

More than two bits which are not together

32
Q

What is segmental fracture

A

Two breaks involved in each other

33
Q

What is an avulsion fracture

A

Usually caused when ligament pulls which is stronger than bone

34
Q

What are the low energy breaks

A

Transverse
Oblique
Spiral
Avulsion
Impacted

35
Q

What are high energy breaks

A

Comminuted
Segmental

36
Q

What are examples of children fractures

A

Tolus
Greensick

Usually for children when there is less calcium in the bone - bone is less brittle

MSK (13 decks)

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