Fractures

Question 1

What is a pathology?

Answer 1

The study of disease and injury

Question 2

What are some reasons/mechanisms for fractures?
(3)

Answer 2

Stress

Pathologies

Trauma (direct or indirect)

Question 4

Who is most likely to have fractures due to stress?
Why?

Answer 4

Athletes

Because they perform repetitive movement

Question 5

How can pathologies cause fractures?

Answer 5

When the bone is weakened by an underlying disease or condition, making it more susceptible to fracture even with minimal force

Question 6

How can stress cause fractures?

Answer 6

Repetitive movement, overuse

Question 7

How can trauma cause fractures?

Answer 7

Ir can result from a sudden force or impact applied to the bone, exceeding its strength

Question 8

What are the types of force?

Answer 8

(Unloaded is no force)

(Torsion is like a Chinese burn)

Question 9

When is combined loading likely to happen?

Answer 9

In a road traffic accident (RTC)

Question 10

What are the main types of fractures?
(4)

Answer 10

Open

Closed

Displaced

Non-displaced

Question 11

Are displaced and non-displaced an open or closed fracture?

Answer 11

They can be either, but displaced is more likely to be open

Question 12

What is an incomplete fracture?

Answer 12

Where the bone doesn’t fully break

Question 13

What are examples of incomplete fractures?

Answer 13

Fissure

Green stick

Bowing

Torus/buckle

Question 14

What is a fissure?

Answer 14

It results from minor injury, incomplete cortical break without bending

Question 15

Which types of fractures are most common in paediatrics?
(3)

Answer 15

Green stick

Bowing

Torus

Question 16

What is a green stick fracture?

Answer 16

Similar to a fissure, but the bone is bent- compression and bending

Question 17

What is a bowing fracture?

Answer 17

Bending without visible break- bending

Question 18

What is a torus/buckle fracture?

Answer 18

Bending with compression and outward bulging of the cortex- compression

Question 19

What are examples of complete fractures?
(5)

Answer 19

Transverse

Oblique

Spiral

Comminuted

Avulsion

Question 20

What is a transverse fracture?

Answer 20

Straight across the bone- tension

Question 21

What is an oblique fracture?

Answer 21

At an angle to the bone-compression

Question 22

What is a spiral fracture?

Answer 22

A corkscrew shaped fracture around the bone- torsion

Question 23

What is an Avulsion fracture?

Answer 23

Avulsion of a fragment of bone away from the main body of the bone

Question 24

Which type of fractures are these?

Answer 24

Question 25

What types of incomplete fractures are these?

Answer 25

Question 26

What types of complete fractures are these?

Answer 26

Question 27

What is a comminuted fracture?

Answer 27

The bone has been shattered into multiple pieces- high energy forces

Question 28

Where is a comminuted fracture likely to occur?

Answer 28

A road traffic collision (RTC)

Question 29

What is an example of a paediatric fracture?

Answer 29

Physeal/growth plate fracture

Question 30

What are the types of physeal/growth plate fractures? (5)

Answer 30

Type 1 Type 2 Type 3 Type 4 Type 5

Question 31

What type of physeal/growth plate fractures are these?

Answer 31

Question 32

What happens if there’s movement at the fracture site? (2)

Answer 32

Relative stability Secondary/indirect healing

Question 33

What happens if there’s no movement at the fracture site? (2)

Answer 33

Absolute stability and compression Primary/direct healing

Question 34

What happens following movement at the fracture site? (2)

Answer 34

Non-operative fracture treatment Operative treatments happen only where some motion occurs at the fracture site, such as external fixation or internal fixation of comminuted fractures

Question 35

When does no movement at the fracture site tend to occur? (2)

Answer 35

No movement doesn’t usually occur naturally, but rather following open reduction and internal fixation surgery There’s no callus formation

Question 36

What are the stages of indirect bone healing? (4)

Answer 36

Haematoma/inflammation Soft callus Bony callus Bone remodelling

Question 37

What happens during the haematoma/inflammation stage in indirect bone healing? (3)

Answer 37

Blood vessels rupture and produce a haematoma that fills the fracture gap The clotted blood creates a fibrin scaffold that guides the influx of inflammatory cells and the ingrowth of fibroblasts and new capillaries This activates osteoprogenitor (osteogenic) cells in the periosteum, medullary cavity and surrounding soft tissues and stimulation. Of osteoclastic and osteoblastic activity

Question 38

What happens during the soft callus stage in indirect bone healing?

Answer 38

A mass of predominantly uncalcified tissue, soft callus, bridges the ends of the fractured bones

Question 40

What happens during the bony callus stage of indirect bone healing? (2)

Answer 40

There’s a deposition of woven/fibrous bone by osteoblasts In some cases, the activated osteogenic cells in the soft tissues and bone surrounding the fracture line also differentiate into chondrocytes (cartilage cells) to make fibrocartilage and hyaline cartilage

Question 41

What happens in the bone remodelling stage of indirect bone healing? (2)

Answer 41

Te cartilage undergoes ossification As the callus matures and is subject to weight-bearing forces, portions that are not physically stressed and resorbed. This remodelling reduces the size of the callus until the shape and outline of the fractured bone are re-established