Fractures

Question 1

Definition

Answer 1

An interruption in continuity of bone and/or cartilageUsually painful, not alwaysUsually accompanied by varying degrees of soft tissue injury

Question 2

Fracture Dislocation

Answer 2

Fracture through or near a jointAccompanied by dislocation of that joint

Question 3

Pathological Fracture

Answer 3

Occurs through weak bone or abnormal compositionResults from normal use or mild injury to area weakened by underlying disorderso Osteogenesis imperfectao Spina bifidao Ricketso Polioo Tumor, cyst, infection etc.

Question 4

Stress or Fatigue Fracture

Answer 4

• Produced by repeated overuse of a body part yet unaccustomed to the stress to which it is being subjected• Commonly seen in new or very active participants in sports• Exampleso Undisplaced crack such as “march” fracture of the metatarsalo Avulsion such as occurs with tibial tubercle in Osgood-Schlatter’s disease

Question 5

Simple Fracture

Answer 5

AKA ClosedFracture where there is no open skin wound

Question 6

Compound

Answer 6

AKA OpenFracture that has an accompanying open skin wound at the fracture site

Question 7

Complete

Answer 7

One which the fractured bone is separated into two discrete fragments

Question 8

Incomplete

Answer 8

One in which some contact or continuity is maintained between the bony fragments

Question 9

Types of Incomplete Fractures

Answer 9

Hairline or crackGreenstickBuckle or Torus (usually metaphyseal fractures and do not actually produce fragments)BowingPermanent deformation of bone in young children

Question 10

Undisplaced

Answer 10

No shift in normal alignment of the two or more bony fragments

Question 11

Displaced

Answer 11

Two or more bony fragments become shifted out of their normal alignmenti. Lateral Translationii. Rotationiii. Angulationiv. Overidingv. Compressionvi. Distraction

Question 12

Importance of periosteum in reduction and healing

Answer 12

Fracture of largely intact periosteal sleeve or hinge will o Heal more quicklyo Be easier to reduceo Be more stable thereafter

Question 13

Reduction

Answer 13

Correction of displacement of fracture fragmentsProduces most successful results when performed within a few days following injury

Question 14

Closed Reduction

Answer 14

Obtained by means of gentle manipulationDirect manual forceUsually under regional/local anestheticSkeletal or skin traction may be necessary to reduce overriding fractures with much shortening

Question 15

Immobilization and Maintenance of Reduction

Answer 15

External non-invasive-molded paster castMaintenance TractionInternal Fixation- pins, wires, rods, crews etc.External Fixation-used for fractures accompanied by large soft tissue wounds and multiple injuries-ease of visualization and care of wounds

Question 16

Early restoration of function

Answer 16

Immobilization may be maintained anywhere from 1 to 8 weeks depending on location, type and severity of the fracture

Question 17

Weight bearing on a fracture

Answer 17

Weight bearing on plaster may begin as early as 10 days following injuryAs a general rule, weight bearing through a reduced, immobilized fracture site promotes healing

Question 18

Stages of healing

Answer 18

Initial Response• Inflammatory response and formation of fracture haematoma is followed by initiation of callus production after three to four daysClinical union• Achieved through ossification of callus tissueo Over a period of 2 to 3 months• Fracture clinically united when no movement or pain can be produced at the fracture siteConsolidation and remodeling• Radiographic union usually achieved 4 to 5 months post-injury

Question 19

Factors that affect healing

Answer 19

o Age• E.g. femoral fracture will unite in 3 to 4 weeks in an infant and 20 weeks in an adulto Extent, type and location of fractureo Area of contact and accuracy of reduction of the fragments (10)o Interruption of availability of blood supply determines healing timeo Cancellous bone, having greater blood supply, heals more rapidly than cortical bone

Question 20

Complications

Answer 20

o Delayed union or non-uniono Infectiono Vascular compromiseo Misalignment

Question 21

Objective of orthotic management

Answer 21

Successful union of fracture through early graded function in fracture orthosis capable of responding to volume changesNEVER used in initial treatment on a fractured limb, only after acute symptoms of pain and edema are resolved

Question 22

Contrainidications to orthotic management of fractures

Answer 22

Excessive wound drainageSpastic disordersAnaesthetic limbsSevere soft tissue damage

Question 23

Benefits of Orthosis

Answer 23

Controlled movement of fracture fragments within fracture orthosis promotes healing (union of the fracture) and aids in the early recovery of the patient while maintaining• range of motion• muscle tone• reducing edemaLoad taken through the fracture site increases progressively as the fracture stabilizes through callus formation

Question 24

Hydraulics

Answer 24

Enclosed in fracture orthosis, viscoelastic soft tissues surrounding fracture bone behave mechanically as fluids• Exerting lateral and oblique forces that offset the vertical loads of ambulation• According to Law of Pascal• 80% of forces are absorbed by the soft tissues within the brace• Adjustability of fracture orthosis critical in maintaining even compression of soft tissues in response to edema and muscle atrophy within the injured limb

Question 25

Orthotic Management of Ankle Fractures

Answer 25

Early weight bearing and exercise with a fracture orthosis facilitates • Union of the fracture• Restoration of the mortise integrity• Normal ankle ROMClinically, maximum dorsiflexion is not required to preserve mortise integrity and neutral ankle position (90 degrees) will allow healing with adequate mortise width

Question 26

Lauge Hansen ankle fracture classification (4)

Answer 26

First part of hyphenated classification describes position of the foot at the time of injurySecond part describes the direction of the injuring forceClassifications• Supination-eversion• Supination-adduction• Pronation-eversion• Pronation-abductionMost common injury is one of supination-eversion

Question 27

Orthotic Management of Tibial Fractures

Answer 27

Following acute care of closed tibial fracture• Limb is immobilized in a groin to toes cast• Almost complete extension at the knee with foot plantargrade to facilitate early weight bearing which may take place within the first few days after injury• 1 to 3 weeks after injury, when pain and swelling have subsided and there is acceptable alignment of the fracture• Fracture orthosis may be applied• Partial weight bearing encouraged• Within 6 weeks post injury, patient able to walk without external aids