Fractures Flashcards
Definition
An interruption in continuity of bone and/or cartilage
Usually painful, not always
Usually accompanied by varying degrees of soft tissue injury
Fracture Dislocation
Fracture through or near a joint
Accompanied by dislocation of that joint
Pathological Fracture
Occurs through weak bone or abnormal composition
Results from normal use or mild injury to area weakened by underlying disorders
o Osteogenesis imperfecta o Spina bifida o Rickets o Polio o Tumor, cyst, infection etc.
Stress or Fatigue Fracture
- Produced by repeated overuse of a body part yet unaccustomed to the stress to which it is being subjected
- Commonly seen in new or very active participants in sports
- Examples
o Undisplaced crack such as “march” fracture of the metatarsal
o Avulsion such as occurs with tibial tubercle in Osgood-Schlatter’s disease
Simple Fracture
AKA Closed
Fracture where there is no open skin wound
Compound
AKA Open
Fracture that has an accompanying open skin wound at the fracture site
Complete
One which the fractured bone is separated into two discrete fragments
Incomplete
One in which some contact or continuity is maintained between the bony fragments
Types of Incomplete Fractures
Hairline or crack
Greenstick
Buckle or Torus (usually metaphyseal fractures and do not actually produce fragments)
Bowing
Permanent deformation of bone in young children
Undisplaced
No shift in normal alignment of the two or more bony fragments
Displaced
Two or more bony fragments become shifted out of their normal alignment
i. Lateral Translation
ii. Rotation
iii. Angulation
iv. Overiding
v. Compression
vi. Distraction
Importance of periosteum in reduction and healing
Fracture of largely intact periosteal sleeve or hinge will
o Heal more quickly
o Be easier to reduce
o Be more stable thereafter
Reduction
Correction of displacement of fracture fragments
Produces most successful results when performed within a few days following injury
Closed Reduction
Obtained by means of gentle manipulation
Direct manual force
Usually under regional/local anesthetic
Skeletal or skin traction may be necessary to reduce overriding fractures with much shortening
Immobilization and Maintenance of Reduction
External non-invasive
-molded paster cast
Maintenance Traction
Internal Fixation
- pins, wires, rods, crews etc.
External Fixation
- used for fractures accompanied by large soft tissue wounds and multiple injuries
- ease of visualization and care of wounds
Early restoration of function
Immobilization may be maintained anywhere from 1 to 8 weeks depending on location, type and severity of the fracture
Weight bearing on a fracture
Weight bearing on plaster may begin as early as 10 days following injury
As a general rule, weight bearing through a reduced, immobilized fracture site promotes healing
Stages of healing
Initial Response
• Inflammatory response and formation of fracture haematoma is followed by initiation of callus production after three to four days
Clinical union
• Achieved through ossification of callus tissue
o Over a period of 2 to 3 months
• Fracture clinically united when no movement or pain can be produced at the fracture site
Consolidation and remodeling
• Radiographic union usually achieved 4 to 5 months post-injury
Factors that affect healing
o Age
• E.g. femoral fracture will unite in 3 to 4 weeks in an infant and 20 weeks in an adult
o Extent, type and location of fracture
o Area of contact and accuracy of reduction of the fragments (10)
o Interruption of availability of blood supply determines healing time
o Cancellous bone, having greater blood supply, heals more rapidly than cortical bone
Complications
o Delayed union or non-union
o Infection
o Vascular compromise
o Misalignment
Objective of orthotic management
Successful union of fracture through early graded function in fracture orthosis capable of responding to volume changes
NEVER used in initial treatment on a fractured limb, only after acute symptoms of pain and edema are resolved
Contrainidications to orthotic management of fractures
Excessive wound drainage
Spastic disorders
Anaesthetic limbs
Severe soft tissue damage
Benefits of Orthosis
Controlled movement of fracture fragments within fracture orthosis promotes healing (union of the fracture) and aids in the early recovery of the patient while maintaining
- range of motion
- muscle tone
- reducing edema
Load taken through the fracture site increases progressively as the fracture stabilizes through callus formation
Hydraulics
Enclosed in fracture orthosis, viscoelastic soft tissues surrounding fracture bone behave mechanically as fluids
- Exerting lateral and oblique forces that offset the vertical loads of ambulation
- According to Law of Pascal
- 80% of forces are absorbed by the soft tissues within the brace
- Adjustability of fracture orthosis critical in maintaining even compression of soft tissues in response to edema and muscle atrophy within the injured limb
Orthotic Management of Ankle Fractures
Early weight bearing and exercise with a fracture orthosis facilitates
• Union of the fracture
• Restoration of the mortise integrity
• Normal ankle ROM
Clinically, maximum dorsiflexion is not required to preserve mortise integrity and neutral ankle position (90 degrees) will allow healing with adequate mortise width
Lauge Hansen ankle fracture classification (4)
First part of hyphenated classification describes position of the foot at the time of injury
Second part describes the direction of the injuring force
Classifications • Supination-eversion • Supination-adduction • Pronation-eversion • Pronation-abduction
Most common injury is one of supination-eversion
Orthotic Management of Tibial Fractures
Following acute care of closed tibial fracture
• Limb is immobilized in a groin to toes cast
• Almost complete extension at the knee with foot plantargrade to facilitate early weight bearing which may take place within the first few days after injury
- 1 to 3 weeks after injury, when pain and swelling have subsided and there is acceptable alignment of the fracture
- Fracture orthosis may be applied
- Partial weight bearing encouraged
• Within 6 weeks post injury, patient able to walk without external aids
