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INTRO TO ORTHO > fractures > Flashcards

fractures Flashcards

1
Q

what is a fracture?

A

a break in the continuity of a bone

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2
Q

if skin is intact - classification

A

closed/ simple fracture

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3
Q

if ends of bones have broken through skin / into one of body cavities - classifications

A

open/ compound fracture

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4
Q

when bone is broken in two pieces or more/ when bone is bent/ cracked & periosteum remains intact

A

two pieces = complete
bent/ cracked = incomplete

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5
Q

TRANSVERSE - complete fractures

A

usually stay in place after reduction, but they take longer to heal

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6
Q

OBLIQUE - complete fractures

A

difficult to keep in place but they heal more rapidly

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7
Q

SPIRAL - complete fractures

A

difficult to keep in place but they heal more rapidly

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8
Q

COMMINUTED - complete fractures

A

often unstable because it consists of two or fragments, making healing difficult

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9
Q

AVULSION - complete fractures

A

occurs when a ligament pulls portion of bone that it is attached to away from bone

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10
Q

OSTEOCHONDRAL - complete fractures

A

occurs when fragments of articular cartilage are sheared from joint surface often during a dislocation/ sprain

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11
Q

COMPRESSION - incomplete fractures

A

bone is crushed & usually occurs in cancellous bone (vertebral body)

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12
Q

GREENSTICK - incomplete fractures

A

bone is bent/ partially broken, as when breaking a green twig
-usually found in children younger than 10 yrs when bones are more pliable

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13
Q

PERFORATION - incomplete fractures

A

result of a missile wound, such as a bullet

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14
Q

STRESS - incomplete fractures

A

cracks in bone due to overuse / repetitive actions

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15
Q

COLLE’S - common fractures

A

-fracture of wrist where transverse fracture of radius just proximal to wrist allows fragment to rotate & displace dorsally
-gives wrist “dinner fork” deformity before it is reduced
*most common in older people
*usual mechanism = FOOSH
*can be difficult to reduce successfully

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16
Q

GALEAZZI - common fractures

A

-involves break of radial shaft & dislocation of inferior radioulnar joint
*mechanism = fall on hand with some rotational component

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17
Q

POTT’S - common fractures

A

-ankle fracture: affects one/ both malleoli
-distal fibula breaks close to lateral malleolus
*deltoid ligament may also rupture / avulse medial malleoli
*mechanism = eversion with some external rotation

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18
Q

DUPUYTREN’S - common fractures

A

-fibula fractures higher up, medial malleolus avulses & talus is pushed superiorly between tibia & fibula
*mechanism = eversion with some external rotation
*screws/ wires often used to reduce & stabilize ankle

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19
Q

common stress fracture sites

A

tibia
metatarsals
navicular
femur
pelvis

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20
Q

causes of a fracture

A

-trauma/ sudden force which creates more stress than bone can absorb
*direct force: bone breaks at point of contact
*indirect force: bone breaks at distance from site of force
-overuse/ repetitive wear, bone cracks
-pathologies: osteoporosis, tumours, local infections, bone cysts

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21
Q

FIRST stage of healing

A

-hematoma forms around ends of fractured bone within 72 hrs of initial trauma
-mesh of fibrin forms around injury site
-ends of bone die back several millimeters

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22
Q

SECOND stage of healing

A

-inflammatory reaction & a proliferation of osteoblasts at periosteum
-cells create fibrocartilaginous bridge between fragment ends

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23
Q

THIRD stage of healing

A

-soft callus/ point is formed from mass of proliferating osteoblasts
-osteoclasts also present, cleaning up dead bone & debris
-as fibrous, immature bone is gradually calcified, movement at fracture ends gradually increases
-union of fracture ends occur at about 4 wks
-repair is incomplete because callus is merely calcified & not yet mature bone

24
Q

FOURTH stage of healing

A

-consolidation occurs as immature woven bone is changed into mature lamellar bone
-consolidation is a complete repair -> callus now ossified
-may be several months before bone is capable of bearing normal loads
-no tenderness at fracture site

25
Q

FIFTH stage of healing

A

-remodelling of irregular outer surface & reshaping of space inside bone takes place through osteoclastic & osteoblastic activity
-process governed by WOLFF’S LAW: bone responds to mechanical stress by becoming stronger & thicker the more strenuous its function

26
Q

closed reduction - medical treatment of fractures

A

-manual traction applied & bone ends are realigned
-fracture held in place until fracture repair occurs

27
Q

open reduction - medical treatment of fractures

A

bone/ bone fragments are stabilized by devices such as screws, nails, wire, metal plates

28
Q

early complications

A

include: torn muscles & tendons, ligament damage, compartment syndromes, nerve injuries, vascular injuries, joint hemarthrosis, bone & soft tissue infections, DVT & problems caused by poorly fitting casts

29
Q

compartment syndrome - early complications

A

-can occur in forearm / leg following a fracture
-swelling that accompanies marked edema, hematoma / inflammation increases pressure within fascial compartment

30
Q

nerve compression - early complications

A

may be indicated by paresthesia in tissues under cast

31
Q

vascular damage - early complications

A

untreated vascular damage may be indicated by an increase in observable distal red, black or blue bruising

32
Q

bone & soft tissue infection - early complications

A

can occur with external fixation or skeletal traction along pin tract if proper wound care is not observed

33
Q

deep vein thrombosis (DVT) - early complications

A

may occur after a lower limb fracture indicated by pain, an increase in swelling local to calf & a slight increase in temperature

34
Q

pressure/ plaster sore - early complications

A

-occurs where cast chemically compresses skin over a bony prominence
-client initially feels a local burning pain under cast

35
Q

cast dermatitis - early complications

A

-may result from poor ventilation & hygiene of skin under cast
-allergic reactions to chemicals present in fibreglass casts are also possible

36
Q

loose cast syndrome - early complications

A

occurs when cast that is too loose rubs on bony prominence, causing skin abrasions

37
Q

late complications

A

include delayed union & non-union of fracture, malunion, myositis ossificans, nerve compression, nerve entrapment, bone necrosis, Volkmann’s ischemic contracture, joint stiffness & disuse atrophy

38
Q

delayed union - late complications

A

-occurs if bone does not unite within expected time frame
-may be due to inadequate circulation, insufficient splinting, excessive traction or infection

39
Q

non-union - late complications

A

-failure of bone to heal before repair process finishes
-may be caused by an overly large gap between bone ends whether due to bone destruction, bone less, excessive tractioning, inadequate fracture reduction, bone infection or soft tissue

40
Q

malunion - late complications

A

-unacceptable joining of bone ends so that a deformity occurs
-may be due to improper alignment of bone ends when fracture was reduced or displacement of bone ends while limb was casted

41
Q

myositis ossificans - late complications

A

-bone formation within muscle, which occurs weeks after intial trauma
-may also result from muscle injury
-heterotopic ossification is bone formation within soft tissue

42
Q

Volkmann’s ischemic contracture - late complications

A

-may eventually result after compartment syndrome or injury to an artery causes ischemic contracture of affected mm
-while over time ischemic mm in compartment are replaced by inelastic fibrous tissue, ischemic nerve may be able to recover partial function

43
Q

disuse osteoporosis - late complications

A

-may occur with prolonged immobilization
-reversible once full use of limb is regained

44
Q

symptom picture

A

-immediately after fracture occurs & before reduction is performed, unnatural mobility & deformity are present at fracture site
-shock, pain, bleeding, inflammation, swelling, loss of function, mm splinting & edema are present
-soft tissue also injured
-with stress fractures, fracture is painful upon compression

45
Q

symptom picture - during immobilization

A

-following closed/ open reduction, limb may be casted or immobilized
-pain present locally & possibly at a distance from fracture
-tissue repair & callus formation occurring at fracture site
-adhesions are developing around injury
-due to immobilization reduced circulation, edema, disuse atrophy & CT contracture occur in tissues under cast
-HT & TPs present in compensating structures
-short-term complications may occur

46
Q

symptom picture - immobilization removed

A

-fracture site is healing & remodelling
-decreased tissue health in tissue that has been under cast
-adhesions have matured around injury
-with open reduction, scars present
-HT & TPs present in mm crossing fracture site & in compensating structures
-mm weakness / disuse atrophy is likely present in mm crossing fracture site
-occasionally, pocket of chronic edema may remain local to injury
-long-term complications may occur

47
Q

observations - during immobilization

A

-antalgic gait if fracture is in lower limb
-affected limb may be casted or external fixation device may be used
-client may have crutches, cane / walking cast
-antalgic posture may be present
-edema present at fracture site & distal
-red, black or purple bruising may be visible at fracture site / distal to it
-pained / medicated facial expression

48
Q

observations - immobilization removed

A

-habituated antalgic gait & posture may be observed
-chronic edema may remain at fracture site & distal
-when cast is initially removed, skin that was under is likely dry, scaly or flaky
-disuse atrophy may be visible
-bruising should resolve to brown, yellow & green, then disappear
-if surgery was performed, scars present

49
Q

palpation - during immobilization

A

-heat & edema present at fracture site, although not palpable due to casting
-pain present local to fracture site & refers into nearby tissue
-protective mm spasm present in mm crossing fracture site
-HT & TPs present in compensating mm

50
Q

palpation - immobilization removed

A

-health of tissues that were under cast assessed in first few days following cast removal
-conditions may include disuse atrophy, dry or flaky skin, local paresthesia, reduced vasomotor control, signs of inflammation or tissue ischemia
-after one week, as tissue health returns, adhesions associated with fracture site are palpated
-HT & TPs present in compensating mm

51
Q

CI’s - during immobilization

A

-limb must not be tractioned before union occurrs
-hot hydro not placed distal or immediately proximal to cast
-if fracture was at site of mm attachment or if there was laceration or severance of tendon crossing fracture site, to avoid further soft tissue damage, AF & AR isometrics only performed with physician’s approval
-with open reduction, on-site work is avoided until skin has healed
-local techniques avoided until skin is fully healed if fracture was treated by open reduction & stabilized without cast

52
Q

CI’s - immobilization removed

A

-overpressure testing of involved joints is CI’d before union has occurred
-hydro temp extremes avoided on tissues that were under cast
-until tissue health & mm tone regained in mm that were under cast, it is CI’d to use deep longitudinal techniques on these mm
-if metal implants such as pins or plates have been used to repair fracture, avoid local hot hydro applications

53
Q

treatment - during immobilization

A

-do NOT interfere with healing process
-refer client to physician if complications are suspected
-positioning depends on location of fracture & client’s comfort
-limb elevated & secured so no stress is placed on fracture site
-hydro is cold application to limb, distal to cast
-reduce edema proximal to cast
-maintain local circulation proximal to injury
-maintain ROM with mid-range pain-free PR ROM to proximal & distal joints
-vibrations through cast over fracture site may help to decrease SNS
-work distal to cast is restricted

54
Q

treatment - immobilization removed

A

-positioning for comfort & accessibility to structures being treated
-mild contrast hydro used on tissues that were under cast, helps to normalize circulation & vasomotor tone
-once tone has returned, deep moist heat to increase flexibility of CT contractures & adhesions prior to treatment
-reduce edema proximally to injury site
-reduce HT & TPs proximal to injury
-in area that was under cast, textured mitten can be used to gently remove any dead, flaky skin & increase local circulation
-stimulating light techniques used on mm with disuse atrophy

55
Q

treatment reduction without casting

A

-with fracture that was medically treated by open reduction without cast, care must be taken to avoid interfering with healing process until union occurs
-with stress fracture that is not casted, on-site massage CI’d while fracture site is tender
-proximally, limb treated using techniques described in immobilization treatment
-once external fixation devices removed & pin tracks healed, work is done to decrease adhesion & scar formation
-after union, techniques focus on circulation, drainage & reducing adhesions indicated
-once consolidation has occurred, passive forced range & joint play as listed in immobilization removed section can be used to increase ROM

INTRO TO ORTHO (5 decks)

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