Fractures Flashcards
What is the most common type of fx in adults above 65?
hip
What is the most common types of fx’s in its under 65?
arm and leg
What are the signs/symptoms of a fracture?
Visible or palpable deformity (except in case of stress fx)
Marked pain or local tenderness
ecchymosis or visible bruising
Functional impairment
What is the etiology of the fx?
How it happened (trauma, stress, pathological etc)
What is a stress fx?
Fx 2ndary to abnormal or repetitive forces on normal bone
When do stres fx’s start to show up on X-rays?
not until the 2nd or 3rd week
What is a pathological fx?
When a normal force on an abnormal or weakened bone causes a fx.
What are pathological fx’s usually 2ndary to?
Cancer/metastasis, osteoporosis, Paget’s disease
What are some common sites for pathological fxs?
Vertebrae
proximal femur
ribs
wrist
What is a closed fx? Open fx?
closed-no communication external to body
Open-Connumication with fractures site and surface of skin
What are the concerns with an open fx?
Infection
What are you given if you have an open fx?
Antibiotics and prophylaxis for teatnus
What is the pattern of fx?
Classification of how the bone broke (transverse, oblique, Avulsion)
What is a complete fx?
The bone is broken completely (Transverse, oblique, Avulsion), spiral, comminuted
What is an incomplete fx?
Bone doesn’t completely brake (greenstick, compression)
Where do you most often see greenstick fx’s?
IN children due to lack of strength of bone
What type of injury are spiral fx’s usually 2ndary to?
Twisting injuries
Are spiral fx’s stable or unstable?
Very unstable-needs fixation
What does a spiral fx look like?
Looks like a corkscrew on the long axis
How many planes is the spiral fx in?
Multiple planes
How many planes is the oblique fx in?
One plane
Are oblique fx’s stable or unstable?
Often unstable, needs fixation
What is a comminuted fx?
Serious fx where the bone is broken into many pieces, usually 2ndary to significant trauma
What is an avulsion fx caused by?
Caused by an excessive pull by a tendon or ligament
What is the most proximal fx of the 5th metatarsal?
Avulsion fx due to excessive pull of the peronius brevis. This is the MOST common
What is a fx in the middle portion of the 5th metatarsal?
A jones fx, at the diaphyseal-metaphyseal junction
What is the most distal fx of the 5th metatarsal?
A stress fx
What is a greenstick fx?
Incomplete fx of a long bone with cortical disruption on ONE side. Creates a bowing effect
How do you classify epiphyseal injuries?
The Harris and Salter classification which consists of a I-V rating scale
What is a Type I epiphyseal fx?
Epiphyseal slip only
Requires casting and sometimes pinning
What is the outcome for a Type I epiphyseal fx?
Usually good unless the blood supply is damaged
What is a Type II epiphyseal fx?
Fx through epiphyseal plate with part of shaft attached
Usually needs fixation but has good results
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| Ih a Type II fx, is the articular surface intact or damaged?</p>
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| Intact</p>
What is the most common type of epiphyseal fx?
Type II
What is a type III epiphyseal fx?
A rare fx through the epiphysis extending into the plate
What is the outlook for a type III epiphyseal fx?
Outlook is good only if the blood supply is intact and it is not displaced
What is a Type IV epiphyseal fx?
Fx of epiphysis, metaphysics and through the growth plate
What do you need for a Type IV epiphyseal fx to heal?
Surgical stabilization and joint realignment
What is a Type V epiphyseal fx?
The growth plate is crushed usually at the ankle or knee
IN which types of fx’s is premature fusion likely to occur?
Types III and IV
In which types of fx’s is late deformity likely to occur?
Types III-V
What are some examples of late deformity in epiphyseal injuries?
Limb shortening
abnormal joint alignment
What is radiological union?
When there is a visible callus on a radiograph (soft and hard)
There will also be bridging, or continuity of bone trabeculae across the fx site
When is there clinical union?
Absence of mobility between fx fragments
Absence of tenderness over site on palpation
Absence of pain with angulation stress
When is a callus visible in the UE? LE?
UE- 2-3 weeks
LE- 2-3 weeks
When is clinical union in the UE? LE?
UE- 4-6 weeks
LE 8-12 weeks
When does consolidation happen in the UE? LE?
UE- 6-8 weeks
LE- 12-16 weeks
Why does union take longer in the LE than the UE?
larger bones in the LE
What affect does age have on bone healing?
The younger you are the quicker it takes for your bone to heal
What is the difference in healing times for different types of bone (cortical/cancellous)?
Cortical bone heals more slowly than cancellous bone
What effect does blood supply after trauma have on rate of union?
If the blood supply is impacted after trauma this may severely slow healing or stop it altogether (avascular necrosis)
How does the normal blood supply affect union?
If an area does not have a good blood supply, like the proximal scaphoid and distal shaft of tibia/fibula, you will have increased healing times
What does the apposition of bone fragments affect healing time?
How far the fragments are and how aligned they are will affect the rate and quality of healing
What affect does movement of bone fragments have on healing?
Movement disrupts healing so requires fixation
What is reduction?
The realignment of the fx fragments into as close to a normal position as possible
What is a closed reduction?
Non-surgical, casted or in a boot
What is an open reduction?
Surgical and fixed with some device (ORIF)
What is the purpose of immobilization?
Prevents displacement or angulation of fragments
Prevents movement
Relieves pain
What are some methods of immobilization?
Cast/sling/splint Continuous traction (bucks traction, skeletal traction)
What is the purpose of a dynamic/compression screw in a hip fx?
Gives a little when weight is put through it so it does not get rammed through the acetabulum
Where are tension bands used?
Used where muscles will tend to pull fragments apart (olecranon and patella fxs)
What type of fixation is Percutaneous pinning and what is it?
External fixation where pins are put through the skin temporary and pulled out when fx is healed
When do you use and external fixator device?
When there are numerous fragments or you cannot get a good fixation internally
What is an Arthoplasty and when do you use it?
Joint replacement. Used when there are too many fragments or the bone stock is too poor to use fixation devices
What is a Total joint arthoplasty?
Both joint partners are replaced
What is a Hemi-arthoplasty?
Only one joint partner is replaced
What is the biggest complication with a fx? What are some other complications that can happen?
Infection is a huge complication. Can also have:
Nonunion, delayed union or mal union
Avascualr necrosis
Injuries to other structures
What is avascular necrosis?
Loss of bone due to loss of blood supply
What is post traumatic osteomyelitis?
Infection of bone and marrow
What is delayed union?
Takes longer than expected for age, site and type of fx, BUT NO EVIDENCE OF NON-UNION
What is mal-union?
Heals with a deformity (e.g. shortening)
What is non union?
NO evidence of healing on 3 CONSECUTIVE RADIOGRAPHS
Often in the presence of abnormal changes at the fx site
What is atrophic non-union?
No bone growth at fx site
What is hypertrophic non-union?
There is bone growth but no union
What is pseudoarthroses?
There is movement, need to re-break and reset
What type of device can you use for a non-union fracture?
Bone Growth Stimulator
Where are common sites of avascular necrosis?
Femoral head
Proximal scaphoid
Body of talus
What is Charcot’s joint?
Joint injury when there is no sensation of kinesthesia. See in DM neuropathy
What is FES?
Fat embolism Syndrome, a rare but potentially fatal complication of long bone or pelvic fx involving pulmonary, cerebral and cutaneous manifestations
When does FES usually present?
24-48 hrs “post-injury”
