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Musculoskeletal Pathophysiology > Fractures > Flashcards

Fractures Flashcards

1
Q

What is the most common type of fx in adults above 65?

A

hip

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2
Q

What is the most common types of fx’s in its under 65?

A

arm and leg

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3
Q

What are the signs/symptoms of a fracture?

A

Visible or palpable deformity (except in case of stress fx)
Marked pain or local tenderness
ecchymosis or visible bruising
Functional impairment

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4
Q

What is the etiology of the fx?

A

How it happened (trauma, stress, pathological etc)

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5
Q

What is a stress fx?

A

Fx 2ndary to abnormal or repetitive forces on normal bone

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6
Q

When do stres fx’s start to show up on X-rays?

A

not until the 2nd or 3rd week

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7
Q

What is a pathological fx?

A

When a normal force on an abnormal or weakened bone causes a fx.

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8
Q

What are pathological fx’s usually 2ndary to?

A

Cancer/metastasis, osteoporosis, Paget’s disease

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9
Q

What are some common sites for pathological fxs?

A

Vertebrae
proximal femur
ribs
wrist

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10
Q

What is a closed fx? Open fx?

A

closed-no communication external to body

Open-Connumication with fractures site and surface of skin

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11
Q

What are the concerns with an open fx?

A

Infection

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12
Q

What are you given if you have an open fx?

A

Antibiotics and prophylaxis for teatnus

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13
Q

What is the pattern of fx?

A

Classification of how the bone broke (transverse, oblique, Avulsion)

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14
Q

What is a complete fx?

A

The bone is broken completely (Transverse, oblique, Avulsion), spiral, comminuted

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15
Q

What is an incomplete fx?

A

Bone doesn’t completely brake (greenstick, compression)

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16
Q

Where do you most often see greenstick fx’s?

A

IN children due to lack of strength of bone

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17
Q

What type of injury are spiral fx’s usually 2ndary to?

A

Twisting injuries

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18
Q

Are spiral fx’s stable or unstable?

A

Very unstable-needs fixation

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19
Q

What does a spiral fx look like?

A

Looks like a corkscrew on the long axis

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20
Q

How many planes is the spiral fx in?

A

Multiple planes

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21
Q

How many planes is the oblique fx in?

A

One plane

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22
Q

Are oblique fx’s stable or unstable?

A

Often unstable, needs fixation

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23
Q

What is a comminuted fx?

A

Serious fx where the bone is broken into many pieces, usually 2ndary to significant trauma

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24
Q

What is an avulsion fx caused by?

A

Caused by an excessive pull by a tendon or ligament

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25
Q

What is the most proximal fx of the 5th metatarsal?

A

Avulsion fx due to excessive pull of the peronius brevis. This is the MOST common

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26
Q

What is a fx in the middle portion of the 5th metatarsal?

A

A jones fx, at the diaphyseal-metaphyseal junction

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27
Q

What is the most distal fx of the 5th metatarsal?

A

A stress fx

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28
Q

What is a greenstick fx?

A

Incomplete fx of a long bone with cortical disruption on ONE side. Creates a bowing effect

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29
Q

How do you classify epiphyseal injuries?

A

The Harris and Salter classification which consists of a I-V rating scale

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30
Q

What is a Type I epiphyseal fx?

A

Epiphyseal slip only

Requires casting and sometimes pinning

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31
Q

What is the outcome for a Type I epiphyseal fx?

A

Usually good unless the blood supply is damaged

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32
Q

What is a Type II epiphyseal fx?

A

Fx through epiphyseal plate with part of shaft attached

Usually needs fixation but has good results

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33
Q

<p>

| Ih a Type II fx, is the articular surface intact or damaged?</p>

A

<p>

| Intact</p>

34
Q

What is the most common type of epiphyseal fx?

A

Type II

35
Q

What is a type III epiphyseal fx?

A

A rare fx through the epiphysis extending into the plate

36
Q

What is the outlook for a type III epiphyseal fx?

A

Outlook is good only if the blood supply is intact and it is not displaced

37
Q

What is a Type IV epiphyseal fx?

A

Fx of epiphysis, metaphysics and through the growth plate

38
Q

What do you need for a Type IV epiphyseal fx to heal?

A

Surgical stabilization and joint realignment

39
Q

What is a Type V epiphyseal fx?

A

The growth plate is crushed usually at the ankle or knee

40
Q

IN which types of fx’s is premature fusion likely to occur?

A

Types III and IV

41
Q

In which types of fx’s is late deformity likely to occur?

A

Types III-V

42
Q

What are some examples of late deformity in epiphyseal injuries?

A

Limb shortening

abnormal joint alignment

43
Q

What is radiological union?

A

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

44
Q

When is there clinical union?

A

Absence of mobility between fx fragments
Absence of tenderness over site on palpation
Absence of pain with angulation stress

45
Q

When is a callus visible in the UE? LE?

A

UE- 2-3 weeks

LE- 2-3 weeks

46
Q

When is clinical union in the UE? LE?

A

UE- 4-6 weeks

LE 8-12 weeks

47
Q

When does consolidation happen in the UE? LE?

A

UE- 6-8 weeks

LE- 12-16 weeks

48
Q

Why does union take longer in the LE than the UE?

A

larger bones in the LE

49
Q

What affect does age have on bone healing?

A

The younger you are the quicker it takes for your bone to heal

50
Q

What is the difference in healing times for different types of bone (cortical/cancellous)?

A

Cortical bone heals more slowly than cancellous bone

51
Q

What effect does blood supply after trauma have on rate of union?

A

If the blood supply is impacted after trauma this may severely slow healing or stop it altogether (avascular necrosis)

52
Q

How does the normal blood supply affect union?

A

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

53
Q

What does the apposition of bone fragments affect healing time?

A

How far the fragments are and how aligned they are will affect the rate and quality of healing

54
Q

What affect does movement of bone fragments have on healing?

A

Movement disrupts healing so requires fixation

55
Q

What is reduction?

A

The realignment of the fx fragments into as close to a normal position as possible

56
Q

What is a closed reduction?

A

Non-surgical, casted or in a boot

57
Q

What is an open reduction?

A

Surgical and fixed with some device (ORIF)

58
Q

What is the purpose of immobilization?

A

Prevents displacement or angulation of fragments
Prevents movement
Relieves pain

59
Q

What are some methods of immobilization?

A 
Cast/sling/splint
Continuous traction (bucks traction, skeletal traction)
60
Q

What is the purpose of a dynamic/compression screw in a hip fx?

A

Gives a little when weight is put through it so it does not get rammed through the acetabulum

61
Q

Where are tension bands used?

A

Used where muscles will tend to pull fragments apart (olecranon and patella fxs)

62
Q

What type of fixation is Percutaneous pinning and what is it?

A

External fixation where pins are put through the skin temporary and pulled out when fx is healed

63
Q

When do you use and external fixator device?

A

When there are numerous fragments or you cannot get a good fixation internally

64
Q

What is an Arthoplasty and when do you use it?

A

Joint replacement. Used when there are too many fragments or the bone stock is too poor to use fixation devices

65
Q

What is a Total joint arthoplasty?

A

Both joint partners are replaced

66
Q

What is a Hemi-arthoplasty?

A

Only one joint partner is replaced

67
Q

What is the biggest complication with a fx? What are some other complications that can happen?

A

Infection is a huge complication. Can also have:
Nonunion, delayed union or mal union
Avascualr necrosis
Injuries to other structures

68
Q

What is avascular necrosis?

A

Loss of bone due to loss of blood supply

69
Q

What is post traumatic osteomyelitis?

A

Infection of bone and marrow

70
Q

What is delayed union?

A

Takes longer than expected for age, site and type of fx, BUT NO EVIDENCE OF NON-UNION

71
Q

What is mal-union?

A

Heals with a deformity (e.g. shortening)

72
Q

What is non union?

A

NO evidence of healing on 3 CONSECUTIVE RADIOGRAPHS

Often in the presence of abnormal changes at the fx site

73
Q

What is atrophic non-union?

A

No bone growth at fx site

74
Q

What is hypertrophic non-union?

A

There is bone growth but no union

75
Q

What is pseudoarthroses?

A

There is movement, need to re-break and reset

76
Q

What type of device can you use for a non-union fracture?

A

Bone Growth Stimulator

77
Q

Where are common sites of avascular necrosis?

A

Femoral head
Proximal scaphoid
Body of talus

78
Q

What is Charcot’s joint?

A

Joint injury when there is no sensation of kinesthesia. See in DM neuropathy

79
Q

What is FES?

A

Fat embolism Syndrome, a rare but potentially fatal complication of long bone or pelvic fx involving pulmonary, cerebral and cutaneous manifestations

80
Q

When does FES usually present?

A

24-48 hrs “post-injury”

Musculoskeletal Pathophysiology (14 decks)

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