Fractures Flashcards
What are some reasons why fractures are missed?
Failure to order radiography
Failure to recognize fractures on the radiograph
Subtle fractures that may not be evident on initial radiographs
Presence of multiple injuries
Inadequate patient history
Primary bone healing:
some form of compression intervention performed (ORIF, fusion, etc)
Secondary bone healing:
Three stages
Inflammatory
Reparative
Remodeling
Inflammatory phase
Hematoma forms
Inflammatory cells become present
Osteoclastic reaction begins
Typically lasts several weeks and carries over into second stage
Reparative phase
Chondroblasts and fibroblasts enter the hematoma and form a callus matrix
Osteoblasts enter the callus matrix and form bony callus
Delayed and non-union result from errors in this stage
Remodeling phase
Bony matrix becomes more organized
Reabsorbs the less organized callous as the organized structure is laid down
Callous is reabsorbed and the fx is usually no longer visible
Process takes months to years
Stress fractures are best picked up by which radiography?
Most common areas:
MRI
Sacral Pubis Femoral neck Tibia Calcaneal Navicular Metatarsals Sesamoid
What are 6 things that look like Fx, but are not?
- Accessory bone 2. Epiphysis 3. Juxta-articular calcification 4. Multipartite conditions 5. Nutrient Foramina 6. Sesamoids
What factors affect healing of bone?
Degree of Fx - Age - Nutrition -Systemic Factors - Hormones -AVN -Intra-articular injury -NSAIDs -Cipro -XRT -Smoking
When is non-union of Femoral neck?
> 3 months
When is non-union in shaft of long bones?
> 6 months
What do you see at both ends of non-union Fx?
Sclerosis
5 kinds of non-union:
- Hypertrophic 2. Atrophic 3. Fibrous 4. Pseudoarthrosis 5. Septic
8 common sites for Stress Fx’s:
STP FCN M S -Sacral -Tibia -Pubis -Femoral neck -Calcaneal -Navicular -Metatarsals -Sesamoid
When will Stress Fx appear on PF?
2-4 weeks
