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Musculoskeletal I > Fractures > Flashcards

Fractures Flashcards

1
Q

Classification of Spinal Fractures & Stability

A

Stability = refers to the risk of spinal cord & spinal nerve root injury

  1. Type I = stable
    - involving 1 column; ligaments intact & no sign. displacement
    - i.e. compression, traumatic disc herniations, unilateral facet dislocations
  2. Type II = unstable
    - slight displacement & ligamentous damage
  3. Type III = very unstable
    - involving all 3 columns (if 2 involved, determine if stable or unstable by middle column)
    - significant displacement (or potential of)
    - i.e. fracture-dislocations, bilateral facet dislocations
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2
Q

Most Vulnerable Sites for Injury of Vertebral Column

-cervical, thoracic & lumbar

A

Cervical = lower portion, & c-t junction

  • -> can be occipital-cervical OR subaxial (C3-C7)
  • -> usually traumatic

Thoracic = c-t junction & T1-T4, t-l junction & T9-12 are highly susceptible, but most common is T12 & L1

  • -> usually flexion force
  • -> compression, burst, flexion-distraction, or dislocations

Lumbar = T11-L2 region highly susceptible, but T12 &L1 most common
–> usually hyperflexion & associated w/ hindfoot or burst fractures

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3
Q

Acute Interventions for Spine Patient

A

Post surgical = immobilization

Goal is to get patient upright and functional ASAP to prevent secondary conditions such as pneumonia, UTI…

Bed mobility: log rolling
Education & ADL’s: avoid flexion & rotation
Assistive Device: use if needed to promote early ambulation

Prognosis may change based on extent of injury & if spinal cord injury is involved

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4
Q

Bone Healing & Functional Limitations

A 
Inflammatory Phase (1-2 weeks): increased vascularity & formation of hematoma
- NWB & immobilization

Proliferative Phase (months): cell differentiation

  • early: PWB, PROM/limited AROM
  • late: WBAT, increased AROM
Remodeling Phase (months to years): reformation of medullary cavity
- FWB, full AROM/RROM
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5
Q

Factors that affect Fracture Healing (4)

A
  1. Age:
    the younger you are the quicker you heal
  2. Location & Configuration:
    faster if: surrounded by muscle, cancellous > cortical, & long oblique & spiral > transverse
  3. Extent of initial displacement:
    non-displaced w/ intact periosteal sleeve 2x faster (greater initial displacement = prolonged healing time)
  4. Blood supply: excellent prognosis if all fragments have adequate supply
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6
Q

Compartment Syndrome

A

Emergency Complication - EARLY in fractures healing process

increased pressure w/n fascial compartment due to edema or hematome –> compresses blood vessels –> ischemia

Symptoms: painful, edematous & tight, shiny, hair loss, absent or diminished pulse

*Acute is emergency, chronic is not (aka shin splints)

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7
Q

Heterotropic Ossification

A

Late complication of a fracture –> specifically dealing w/ myositis ossificans

DEFN: bone formation at an abnormal anatomical site; usually in soft tissues (^^muscle)

Risk factors: SC injury, open wounds/burns, sepsis, prolonged critical illness, & aggressive ROM

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8
Q

Transverse Fracture

A

fracture line perpendicular to the axis of the joint

MOI - trauma

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9
Q

Oblique Fracture

A

fracture line that runs obliquely to the axis

MOI - sharp, angled blow

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10
Q

Spiral (torsion) Fracture

A

fracture line that spirals around axis of bone

MOI - sports, child abuse

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11
Q

Longitudinal Fracture

A

through the long axis of the bone

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12
Q

Comminuted Fracture

A

multiple fragments, often open

MOI - trauma or aging

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13
Q

Impacted Fracture

A

Pressure fracture; common in hip & shoulder

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14
Q

Depressed Fracture

A

common in the skull

MOI - blunt force trauma head injury

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15
Q

Avulsion Fracture

A

small fragment of bone is pulled away from the larger (main) bone
-usually seen in children before complete development of the bone; cannot withstand the strain from tendons

MOI - kids at growth plates

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16
Q

Susceptibility of cortical & cancellous bone

A

Cortical bone is the outer, tougher part of bone; more susceptible to tension force (bending, twisting, pulling)

Cancellous (spongy) bone is the inner portion of the bone; more susceptible to compression forces

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17
Q

Greenstick Fractures

A

Seen in children b/c the cortical bone is more flexible; doesn’t fracture completely & periosteal sleeve remains intact

MOI - bending force (fall or direct blow)

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18
Q

Growth Plate Injuries (Type I-VI)

-defn & prognosis

A

Based on Salter-Harris Classification

Type I - fracture along the plate, but unaffected & intact to epiphysis; Excellent
Type II - MOST COMMON - fracture along the plate & across metaphysis, including triangular part of meta; Good
Type III - fracture along part of plate & continues perpendicular through GP and epiphysis; Good if adequate blood supply
Type IV - fracture completely through meta, GP and epiphysis; Fair, may cause premature focal fusion & deformity
Type V - compression fracture of GP –> can lead to type VI which is when GP tethers to bone; Poor b/c often not recognized at time of injury

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19
Q

Intracapsular vs. Extracapsular Hip Fractures

A

Intracapsular - involve femoral head or neck; higher rate of non-union and AVN
–> usually treated w/ hemiarthroplasty or THA

Extracapsular - involve trochanteric region
–> usually treated w/ ORIF

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20
Q

Surgical Approaches for Hip Fractures

A
  1. ORIF
    - bone conserving; good for younger, highly active patients OR older and less stable
    - lower mortality rate BUT higher failure rate
  2. Hemiarthroplasty
    - hip replacement w/o acetabular component
    - lower failure rate BUT can have deterioration of function after 3-5 years
  3. Total Hip Arthroplasty
    - hip replacement containing acetabular component
    - better outcomes than HA beyond 3 years BUT increased risk of dislocation
    - often used to revise ORIF or HA
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21
Q

Post-Surgical Hip Precautions

A

Posterior - more functionally limitation!!
–> NO flexion >90, adduction, or IR

Anterior
–> NO extension, abduction or ER

22
Q

Delirium

A

Single best predictor of post-operative mortality

DEFN: state of mental confusion & excitement, disorientation, illusions & hallicunations

  • delirium is transient
  • occurs 30-50% of time
  • should be resolved by POD7 at the latest
  • very poor prognosis
23
Q

PT Interventions for Hip Fractures

A

Early mobilization is crucial!!
-delayed leads to delirium, pneumonia, inc. length of stay, greater 6month mortality rate, poorer 2month functional performance

Acute stage - general ROM, UPRIGHT in chair, by day 7 should be ambulatory (w/ precautions & ass. device if necessary)

Subacute/Chronic stage - more aggressive strength training, ROM & mobility

EDUCATION is key b/c 90% of hip fractures are due to falls

24
Q

Mallet Finger

A

DEFN - extensor tendon disrupted & often associated w/ an avulsion fracture
MOI - forced flexion of extended DIP

25
Q

Scaphoid Fracture

A

MOI - FOOSH + radial deviation

often associated w/ non-union and AVN

26
Q

Perilunate Fracture/Dislocation

A

DEFN - axial loading into hyperextension & UD that causes the carpals to be dislocated to the lunate w/ the lunate stays in line w/ the radius

MOI - high energy impact, typically young adults

Often missed!

27
Q

Boxer’s Fracture

A

DEFN - fracture of the distal portion of 4th or 5th metacarpal

MOI - blow w/ a clinched fist

28
Q

Bennett’s Fracture

A

DEFN - fracture/dislocation of the base of the 1st metacarpal
- radial notch appearance at base b/c pulled by APL

MOI - axial loading of the partially flexed thumb

29
Q

Colles’ Fracture

A

DEFN - fracture of the distal radius w/ a dorsal displacement
-dinner fork deformity

MOI - FOOSH
- more common in women

30
Q

Smith’s Fracture

A

DEFN - fracture of the distal radius w/ a palmar displacement

MOI - fall onto flexed wrist
-more common in men

31
Q

Monteggia Fracture

A

DEFN - fracture of proximal or mid 1/3 of ulna w/ radial head dislocation

MOI - FOOSH or direct blow (MVA)

32
Q

Galeazzi Fracture

A

DEFN - fracture of the distal 1/3 of radius w/ distal radiaoulnar disruption

MOI - FOOSH or direct blow (MVA)

33
Q

Radial Head Fracture

A

DEFN - valgus force impaction of capitellum onto radial head causing a fracture

MOI - axial loading on a pronated & partially flexed or outstretched arm

34
Q

Humeral Fractures

A

Usually diaphyseal (distal) in children & proximal in adults

MOI - FOOSH, fall onto elbow, or direct blow

35
Q

Clavicle Fracture

A

DEFN - typically middle 1/3 of clavicle

MOI - fall onto or direct blow to shoulder

36
Q

Femoral Shaft Fracture

A

DEFN - usually related to OP, metatsttic disease or TKA

MOI - ^^ and high energy trauma (MVA)

37
Q

Tibial Plateau Fracture

A

DEFN - fracture along the joint line; critical load bearing area
- often associated w/ meniscal and/or ligamentous damage

MOI - valgus force w/ axial loading

38
Q

Tibial Shaft Fracture

A

MOST COMMON fractured long bone

MOI - high energy trauma

39
Q

Talus & Calcaneal Fracture

A

Talus - intra-articular; prone to AVN

MOI - fall from height or trauma (>3feet is associated w/ lumbar spine burst or compression fractures)

40
Q

Garden Staging System for Hip Fracture

A

Stage 1 - incomplete, may be impacted
Stage 2 - complete, non-displaced
Stage 3 - complete, slight displacement
Stage 4 - complete, fully displaced

41
Q

Occipital-Cervical Fracture

A

fracture of occipital condyle on base of skull

RARE

Treatment -
type I = arthosis
type II = halo
type III = orthosis or halo +/- PSF

42
Q

Atlanto-Occipital Dislocation (AOD)

A

Internal decapitation
–>severe spinal cord involvement

Treatment - immobilization, reduction w/ PSF & halo

43
Q

Atlas Fracture

A

Jefferson or “burst” fracture
1/2 associated w/ dens fracture

Rare neurological compromise b/c burst away from spinal cord

MOI = axial loading/compression on top of head

Treatment -
2 w/ other fracture = traction & halo
Unstable = AA fusion

44
Q

C2 Odontoid Fracture

A

fracture of the dens (can be 3 different places)

Young risk takers or elderly are at risk

High non-union rates

Treatment -
Type I = orthosis
Type II & III = halo (5mm)

45
Q

C2 Axis Fracture

A

Handman’s Fracture

MOI = traumatic hyperextension causing bilateral pars interarticularis fractures
–>distraction (not fracture) causes neurological compromise

Treatment -
Type I = orthosis
Type II = halo
Type III = ORIF or PSF

46
Q

Distraction-Flexion Cervical Injury

A

Whiplash injury w/ “bowtie” sign - C5/6 & C6/7 most susceptible

MOI = distraction load on a flexed neck

PSF needed only if disc is herneated

47
Q

Vertical Compression Cervical Injury

A

Compress & shortens anterior & middle columns - C5/6/7 most susceptible

MOI = MVA, diving

Treatment =
If stable & no kyphosis = orthosis
Unstable w/ kyphosis ACDF or PSF w/ rigid orthosis or halo

48
Q

Compression-Flexion Cervical Injury

A

“teardrop” fracture

Facet dislocation, compromised stability, ligament rupture & disc tearing

Treatment -
ACDF +/- PSF & cervical orthosis

49
Q

Lateral Flexion Injury

A

MOI = MVA or blow to head

Rarely involves ligamentous injury & rarely needs surgery

50
Q

Thoracic Spine Fractures (4 common types)

A

T12-L1 most susceptible; usually FLEXION force

  1. Compression - failure of anterior column
  2. Flexion distraction - “seatbelt” fracture; transverse fracture line
  3. Burst - axial loading (neurological compromise)
  4. Dislocation - unstable; involving all 3 columns; can be conservative or PSF or ACDF
51
Q

Lumbar Spine Fracture

-common MOI & types of fractures (2)

A

T12 & L1 most susceptible

MOI = hyperflexion w/ or w/o shear force, rotation, or axial compression
Can be due to jumping from height >3feet

Types of fractures it is associated w/:

  1. Hindfoot
  2. Burst

Treatment - based on amount of kyphosis of lumbar spine

52
Q

When is surgery indicated for a patient w/ scoliosis vs. conservative treatment?

A

If the curve is >40-50 degrees then surgery is indicated

Can be idiopathic or neuropathic

Musculoskeletal I (11 decks)

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