Fractures Flashcards
What occurs in inflammatory phase of bone healing?
1-2 weeks
increased vascularity and formation of fracture hematoma
cellular response: infiltration of neutrophils, macrophages, phagocytes, osteoclasts
What happens in reparative phase of bone healing?
months
cell differentiation: bone callous formed by chondroblasts and fibroblasts, osteoblasts mineralize the soft callous
radiographic evidence of fracture line diminishes, but bone is immature and at risk fro delayed union/non-union
What happens in remodeling phase of bone healing
months to years
reformation of medullary canal
delayed remodeling with compromised blood flow, periosteal stripping, highly comminuted fractures, extensive associated soft tissue injury
What is function like in inflammatory phase?
total restriction: NWB, immobilization
What is function like in reparative phase?
early: PWB, PROM/limited AROM
late: WBAT, increasing AROM
What is function like in remodeling phase?
near normal: FWB, full AROM/RROM
What factors go into bone healing?
1) Age: remodeling is fast in kids, relatively constant after early adulthood
2) Location and configuration: fractures around muscle heal faster, cancellous bone heals faster than cortical bone, long oblique and spiral fractures heal faster than transverse
3) Extent of initial displacement: non displaced fractures with intact periosteal sleeve heal twice as fast as displaced, greater initial displacement=more extensive periosteal sleeve disruption=prolonged healing time
4) Blood supply: if all fractures have blood supply=excellent prognosis for healing, if only some fragments have supply rigid immobilization allows vascularized fragments to serve as hosts, if both fragments are avascular union will not occur until there is revascularization even with rigid immobilization
What are initial fracture complications>?
local injuries: skin, vascular, neurologic, muscular, visceral
What are early fracture complications?
Local: infection, gangrene, septic arthritis, compartment syndrome, osteomyelitis, avascular necrosis
Remote: thrombus/embolus formation, pneumonia, tetanus
What are late fracture complications?
Joint: persistent pain or stiffness, post traumatic DJD
Bony: abnormal healing, growth disturbance, persistent osteomyelitis, osteoporosis, CRPS
Muscular: myositis ossificans, tendon rupture
True or False: compartment syndrome is a emergency situation?
TRUE
What is acute compartment syndrome?
increased pressure within fascial compartment (especially anterior lower leg) due to edema or hematoma within closed space
What are symptoms of acute compartment syndrome?
painful
edematous, tight
absent or significantly diminished pulse (biggest factor because you can lose blood supply and cause ischemia leading to loss of limb)
What is chronic compartment syndrome?
due to muscular expansion or decreased size of anatomical compartment
What is heterotropic ossification?
soft tissue ossification, usually periarticular
most commonly involves hip or knee
unknown etiology
What are risk factors for heterotropic ossification?
neurologic involvement open wounds/burns sepsis prolonged critical illness aggressive ROM
How are fractures described?
described by: anatomic location fracture location (proximal, mid, distal) direction (transverse, oblique, etc) alignment (varus, displaced, etc) articular involvement open/closed
What is oblique fracture caused from?
usually results from a sharp angled blow
Cause of spiral fracture?
also called torsion fracture
commonly due to sports injury or child abuse
What is longitudinal fracture?
fracture down long axis of bone
What is comminuted fracture?
pieces of bones, often open fractures commonly associated with trauma or aging (due to fragile bones)
What is depressed fracture usually associated with?
blunt force head trauma
What is avulsion fracture?
bone isn’t fully formed and tendons are pulling on it with too much force. the growth plate can’t tolerate it so it fractures
more common in children especially at growth plates
What are the 8 fracture types talked about in the powerpoint?
transverse, oblique, spiral, longitudinal, comminuted, depressed, impacted, avulsion
What are fracture mechanics of cortical bone?
tolerant to compression and shear force
fractures represent tension forces (bending, twisting, pulling)
more flexible in children; angulatory tension may cause green stick fracture
What are fracture mechanics of cancellous bone?
susceptible to compression forces
What is used to classify growth plate injuries?
Salter-Harris classifcation
What is a Type 1 salter harris and what is treatment and prognosis?
Runs directly along growth plate. Vital portions of growth plate remain attached to the epiphysis.
Tx: rarely need reduction, immobilization until fully healed
Px: excellent if blood supply intact
What is Type 2 salter harris and what is tx and px?
most common, runs along growth plate and includes triangular metaphyseal fragment
Tx: reduction and immobilization
Px: good prognosis
What is type 3 slater harris and what is tx and px?
run along part of growth plate and turn perpendiculary into joint
tx: surgery to restore joint surface
px: good if blood supply to separated portion is intact
What is type 4 slater harris and what is tx and px?
run from epiphysis, across growth plate, and into metaphysis
tx: surgery to restore joint surface and align growth plate
px: may cause permanent focal fusion and joint deformity
What is type 5 slater harris and what is px?
compression of growth plate results in growth disturbance
often not recognized at time of injury
px: poor
What is type 6 slater harris?
injury to perichondrial ring may cause physis to tether to bone, hindering growth
What are types of reduction?
Closed or open
What are types of fracture immobilization?
casting
splinting
external fixation
internal fixation: pins, screws, prosthetics, IM rods
What is Ilizarov procedure?
type of external fixation used to lengthen the limb
What must PTs consider for interventions with fractures?
consider: MOI, patient’s age, functional needs and demands, type of immobilization and orthopedic plan of care
What are possible interventions for fractures?
preserve/improve ROM (proximal and distal to injury site)
increase mobility (to decrease risk for DVT, ulcers, pneumonia, UTI)
ADL training
education
wound care
