Fractures Flashcards
Fractures in hip occur in which population? Arms/Legs?
Hip fractures-> age 65 & older
Arms/Legs-> Under 65
Name 4 signs/symptoms of a fracture
1) Visible or palpable deformity
2) Marked pain or local tenderness
3) Ecchymosis or visible bruising
4) Marked functional impairment
Name 3 way fracture classifications
1) Etiology
2) Open vs. closed
3) Pattern of the fracture
Name 3 fracture etiology
1) Trauma
- Direct or indirect force
2) Stress or fatigue fracture
- Secondary abnormal or reptitive forces on normal bone
3) Pathological fracture
- Normal force on an abnormal or weakened bone, secondary to CA, osteoporosis, Paget’s disease, etc.
Describe the difference between closed vs open fractures
1) Closed
- No communication external to body
2) Open
- Communication with fracture site and surface of skin
- Concern re: infection - need antibiotics
- Prophylaxis for tetanus
Classification by pattern of fracture: Name the 2 large categories and all the subcategories within
A) Complete
1) Transverse
2) Oblique
3) Avulsion
4) Spiral
5) Comminuted
B) Incomplete
1) Greenstick
2) Compression
Describe a transverse fracture. It’s usually secondary to direct trauma
- Fracture is at right angle to a long portion of the bone
- Usually secondary to direct trauma
Spiral fracture-Secondary to what?
twisting injury
Spiral fracture-Stable or unstable? What does it need?
- Very unstable
- needs fixation
Oblique fracture-Common or rare? Confined to how many planes? Stable or unstable (needs this)
- Rarer than the other types
- Confined to one plane
- Often unstable-needs fixation
Comminuted fracture-Usually secondary to what?
Significant trauma
Comminuted fracture-Has many or few parts? Stable or unstable?
Has many parts so unstable and requires fixation
Describe avulsion fracture
Fracture caused by excessive pull by a tendon or ligament
Name the 3 types of fractures of 5th metatarsal
1) Stress fracture
2) Jones fracture
3) Avulsion fracture
Where does the stress fracture occur?
Most distal of the three 5th toe fracture
Where does the Jones fracture occur?
At the diaphyseal-metaphyseal junction
Where does the Avulsion fracture occur?
At the base of the 5th metatarsal by excessive pull of the peroneus brevis
Which type of 5th metatarsal fracture is most common?
Avulsion fracture
Describe a greenstick fracture in children
Incomplete fracture of a long bone with cortical disruption on one side – creates a bowing effect
What system is used to classify epiphyseal injuries? How many degrees are there/
- Harris and Salter classification
- 1 through 5
Salter-Harris Type I-What happeens? What does it require? How are the results for healing?
- Epiphyseal slip only
- Requires casting and sometimes pinning
- Usually good result unless there is daage to the blood supply
Salter-Harris Type II-What happens? What does it require? How are the results for healing?
- Fracture through epiphyseal plate with part of shaft attached
- Usually needs fixation
- Good result for healing
Which Salter-Harris type is most common?
Salter-Harris Type II
Salter-Harris Type III-What happens? How are the results for healing?
- Fracture through the epiphysis extending into the plate
- Outlook good only if blood supply is intact and it is not displaced
Salter-Harris III-What can occur prematurely? Why does it occur?
-Could get premature fusion and late deformity because it affects the growth place AND is intraarticular
How common is the Salter-Harris Type III fracture?
Rare fracture
WHat happens in a Salter-Harris Type IV fracture?
Fracture of the epiphysis and the shaft which crosses the epiphyseal plate
What is likely to happen in a salter-harris Type IV fracture?
Likely to have growth deformities because it is an intra articular fracture
Salter-harris Type V fracture-What happens?
Damage to the epiphyseal plate, growth plate is crushed
Salter-harris Type V fracture-Where does it usually occur?
Usually at the knee or ankle
Salter-harris Type V fracture-What is likely too occur?
Deformity likely
Premature fusion occurs in which Salter-Harris types?
3 & 4
Late deformity occurs in which Salter-Harris types?
Types 3-5
Define radiological union
healing at the fracture site
When there is radiological union, Name 3 things that occur
Visble callus on radiograph
1) Soft
2) Hard &
- Continuity of bone trabeculae across site (bridging)
Name the 3 things absent in clinical union
1) Absence of mobility between fracture fragments
2) Absence of tenderness over site on palpation
3) Absence of pain with angulation stress
List the average rates of union for UE for callus visible, clinical union, consolidation
1) 2-3 wks
2) 4-6 wks
3) 6-8 wks
List the average rates of union for LE for callus visible, clinical union, consolidation
1) 2-3 wks
2) 8-12 wks
3) 12-16 wks
Name 6 factors affecting rates of union
1) Age - younger usually heals faster - more bone turnover
2) Type of bone - cortical heals more slowly than cancellous
3) Site - UE often heals faster than LE - bones tend to be smaller
4) Blood supply
5) Apoosition of bone fragments (How close the bone fragments are and how good is the alignment?)
6) Movement between bone fragments (disrupts healing - need good fixation)
Name two specific bones that have poor blood supply that have increased healing times
1) Proximal scaphoid
2) distal shaft of tibia/fibula
Name 3 categories for principles of fracture management
1) Reduction
2) Immbolization
3) Preservation of function
Fracture management-Reduction-Define
Realignment of the fracture fragments into as close to a normal position as possible
Name 2 types of reduction for fracture mangement
1) Closed - non-surgical, casted, or in sling/boot, etc.
2) Open - surgical and fixed with some device, e.g. ORIF open reduction with internal fixation
Name 3 purposes of immobilization after a fracture
1) Prevent displacement or angulation of fragments
2) Prevent movement
3) Relieve pain
Name 2 methods of immobilization
1) Cast/Splint/Sling (Passive or active (walking cast)
2) Continuous traction
- Bucks traction
- Skeletal traction
Name 3 types of internal fixation devices
1) Plates and Screws
2) Intermedullary nails or rods
3) Circumferential wires or bands
- Tension bands - used where muscles will tend pull fragments apart - e.g. olecranon and patella fractures
Name 2 types of external fixation
1) Percutaneous pinning - pins through the skin that are temporary and pulled out when fracture is healed
2) External fixator device - usually when there are numerous fragments or cannot get good fixation internally
Define Arthroplasty
Replacement of body part
Name two reasons when arthroplasty is used
1) Too deformed or too many pieces to fix
2) Bone stock too poor to use fixation devices
Name 2 types of arthroplasty
1) Total joint arthroplasty - both joint partners are replaced
2) Hemi-arthroplasty - only one joint partner is replaced
Name 4 fracture complications
1) Infection! Huge!
2) Non union, delayed union, or mal union
3) Avascular necrosis
4) Injuries to other structures
Name a specific type of infection that an occur with a fracture
Post traumatic osteomyelitis
Acute -> tends to occur with children
Chronic -> more with adults, can occur within weeks to months within an injury
Name the 3 problems with union
1) Delayed Union
2) Mal-union
3) Non-union
Explain what delayed union is
Longer than expeected for age, site and type of fracture, but no evidence of non-union
Explain what mal-union is
Heals with deformity - e.g. shortening
Explain what non-union is
- no evidence of healing on 3 CONSECUTIVE RADIOGRAPHS
- often in the presence of abnormal changes at the fracture site - atrophic, hypertrophic, pseudoarthroses
What type of fraction will a bone growth stimulator help?
Non-union fracture
With a fracture, name 3 other structures that can be injured
1) Major blood vessels
2) Neurological injury
3) Viscera
WIth injury to major blood vessels, name 2 things that can occur
1) Ischemia - can lead to bone and other tissue death
2) Avascular necrosis - death of the bone secondary to lack of blood supply
Name 3 common sites of avascular necrosis when dealing with fractures
1) Femoral head
2) Proximal scaphoid
3) Body of talus
In neurological injuries, name 2 things that can occur with the nerves
1) Torn/crushed peripheral nerves e.g. radial nerve in humeral spiral groove with humeral shaft fracture
2) Nerve to joints -> Charcot joint (joint injury when there is no sensation or kinsthesia)
- Also seen in severe diabetic neuropathy
Name 2 viscera that can become injured with a fracture
1) Pelvic organs s/p pelvic fracture
2) Lungs s/p rib fractures
Define Fat Embolism Syndrome
Fat Embolism Syndrome (FES) is a rare but potentially fatal complication of long bone or pelvic fracture. The classic syndrome involves pulmonary, cerebral and cutaneous manifestations and presents 24 hrs to 48 hrs post-injury.
What are the incidence rates for FES? Name the % and fracture site
1) 1-3.5% of tibia or fibula
2) 5-11% bilateral/multiple fracture
Name 3 signs/symptoms of FES (generally)
1) Pulmonary
2) Cerebral
3) Cutaneous
Name the pulmonary signs/symptoms of FES
Dyspna, basilar crackles - 2-3 days post injuy
Name the cerebral signs/symptoms of FES
acute confusional state, can have other focal deficits
Name the cutaneous signs/symptoms of FES
petechiae (pinpoint, round spots that appear on the skin as a result of bleeding under the skin) rash - conjuctiva, skinfolds
Name 2 categories of joint injuries
1) Acute
2) Chronic
WIth an acute injury of the joint, what are 2 things that can occur?
1) Hemarthrosis - blood in joint
2) Poor alignment if fracture through joint
With a chronic injury of the joint, what is one thing that can occur?
Potential for post-traumatic degenerative joint disease (DJD) - long term effect
Name 3 implications of complications for PT and rehab in fractures
1) Monitor and screen for vascular and neurological definicits
2) Longer healing times may require slower rehab progress
3) Consider possiblity of abnormal healing that will affect ultimate recovery
