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Musculoskeletal > Fractures > Flashcards

Fractures Flashcards

1
Q

Bone Function

A
  • Stability
  • Mobility
  • Hematopoiesis
  • Protection of vital organs
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2
Q

Bone Layers

A 
Cortex
- Hard, outer layer
- Covered by the periosteum
    > Thick
    > Contains vessels, nerve endings, & cells
    > Repairs fractures

Cancellous bone

  • Soft, inner layer
  • Covered by the endosteum
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3
Q

Physis

A

Regions of long bone growth

  • Highly vascular
  • Prone to infections & fractures
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4
Q

Metaphysis

A
  • Largely consists of spongy, cancellous bone

- Most susceptible region to compression fractures

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5
Q

Diaphysis

A
  • Thick cortical bone

- Provides most of the structural support

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6
Q

Fracture

A

A disruption in the continuity or structural integrity of bone

  • Occurs when stress applied to the bone is greater than the bone’s intrinsic strength
  • Bone withstands high compressive force (BUT, susceptible to breaks from tension/torsion)
  • Fractures involve the bone & surrounding soft tissue (e.g. periosteum, muscles, & vessels)
    • open fractures = skin involvement*
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7
Q

Fracture Classifications

A
  • Location
  • Orientation
  • Extent of fracture lines
  • Amount of displacement
  • Skin integrity
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8
Q

Clinical Sxs of Fractures

A
  • Pain
    ` Worsened by movement
    ` May limit weight-bearing capacity
  • Swelling
  • Decreased function
  • Visible deformity w/ displaced fractures
  • Numbness/tingling w/ injury to nerves or vessels
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9
Q

Open vs. Closed Fracture

A

Closed
- Skin over & near fx is intact

Open
- Skin over & near fx is lacerated or abraded by the injury

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10
Q

Types of Fracture Displacement

A 
Non-displaced
  *Fragments in anatomic alignment
Displaced
  *Fragments NOT in usual alignment
Angulated
  *Fragments are malaligned
  *Displaced from midline
Bayonetted ("shortened")
  *Distal fragment overlaps proximal fragment
Distracted
  *Gap b/t distal & proximal fragments
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11
Q

Orientation of Fracture Lines

A
  • Transverse
  • Comminuted
  • Oblique
  • Segmental
  • Spiral
  • Intra-articular
  • Torus
  • Greenstick
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12
Q

Transverse Fx

A

A fracture that is perpendicular to the shaft of the bone

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13
Q

Comminuted Fx

A

A fracture in which there are more than 2 fracture fragments

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14
Q

Oblique Fx

A

An angulated fx line

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15
Q

Segmental Fx

A

A type of comminuted fx in which a completely separate segment of bone is bordered by fx lines

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16
Q

Spiral Fx

A

A multiplanar & complex fx line

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17
Q

Intra-articular Fx

A

The fx line crosses the articular cartilage & enters the joint

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18
Q

Torus Fx

A

An incomplete buckle fx of one cortex, often seen in children

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19
Q

Greenstick Fx

A

An incomplete fx w/ angular deformity, often seen in children

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20
Q

Types of Fractures

A
  • Impaction
  • Compression
  • Depression
  • Stress (Fatigue)
  • Stress (Insufficiency)
  • Pathologic
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21
Q

Impaction Fx

A

A fracture that occurs when 1 bone hits or impacts an adjacent bone

22
Q

Compression Fx

A

A type of impaction fx that occurs in the vertebrae, resulting in depression of the end plates

23
Q

Depression Fx

A

A type of impaction fx that occurs in the knee when the femoral condyle strikes the softer tibial plateau

24
Q

Stress (Fatigue) Fx

A

A fracture in normal bone that has been subjected to repeated or cyclical loads that alone are not sufficient to cause a fx

25
Q

Stress (Insufficiency) Fx

A

A fx in weakened bone that has been subjected to a load insufficient to fx normal bone

26
Q

Pathologic Fx

A

A fx through bone weakened by tumor, metabolic bone disease, or osteoporosis

27
Q

Physical Exam Findings: Fracture

A
  • Swelling
    ` extreme may –> compartment syndrome
  • Ecchymosis
  • Deformity
  • Skin lacerations/abrasions
  • Palpation (+/- tenderness, crepitus, or compartment tightness)
28
Q

Diagnostic Testing: Fracture

A

X-Ray
- initial test for suspected fx
- minimun, AP & lateral projections
- always includes joints above/below injury
CT
- indicated for evaluation of bony anatomy
- suspected joint involvement or bone loss
- MC used w/ spine, scapula, foot & hand
MRI
- indicated w/ soft tissue injury
- necessary for non-displaced or stress fx

29
Q

Complications of Fractures

A
  • Delayed union, non-union, or malunion (fx that heals w/ poor alignment -> poor functioning)
  • Joint fx -> stiffness or contractures
  • Osteonecrosis d/t compromised blood supply (MC in bones w/ tenuous blood supply, e.g. talus, scaphoid, & femoral head)
  • Open fx -> soft tissue loss, infection, or osteomyelitis
  • Compartment syndrome (pain w/ passive stretching of involved muscle & significant swelling)
30
Q

Fracture Treatment

A
  • 1st: manipulation, reduction, & urgent stabilization
  • Immobilization
    Cast, splint, or sling (extremities) Bed rest (axial fx-hip, pelvis, spine)
  • Surgery (displaced/unstable fx)
  • Open Fx: copious irrigation & dressing, splinting, IV antibiotics, tetanus prophylaxis, & urgen surgery
  • Following healing –> rehabilitation d/t muscle atrophy & joint stiffness
31
Q

Factors that Improve Stability or Prognosis of Fractures

A
  • Skeletal immaturity: thick periosteum, potential for remodeling, faster healing
  • Non-displaced fx
  • Single bone fx of forearm (radius/ulna) or lower leg (tibia/fibula)
  • Thoracic spine fractures (support of rib cage provides added stability)
32
Q

Factors that Worsen Stability or Prognosis of Fractures

A
  • Skeletal maturity: little remodeling ability, thin periosteum, slower healing
  • Marked displacement or segmental (indicates soft-tissue stripping)
  • Intra-articular fractures
  • Nerve or vascular injury
  • Compartment syndrome
  • Osteonecrosis
  • Oblique fracture pattern
33
Q

Fracture Healing

A

Structural regeneration

  • Complex biologic cascade mediated by a variety of cells & proteins
  • Clinical evidence = absence of tenderness & motion at the fracture site
  • Radiographic evidence = union–amount of bridging callus or obliteration of the fracture line
34
Q

Risk Factors for Impaired Fracture Healing

A 
Smoking
Indolent infection
Inadequate immobilization
Malnutrition
NSAID use
Significant soft tissue injury
35
Q

Phases of Fracture Healing

A

Three overlapping phases

1: inflammation
- hematoma forms
2: repair
- fibrocartilaginous callus forms
- bony callus forms
3: remodeling
- bone remodeling occurs

36
Q

Fracture Healing: Phase 1

A
  • begins w/ bleeding from fracture site & surrounding soft tissue
  • peaks after several days
  • formation of granulation tissue
37
Q

Fracture Healing: Phase 2

A
  • formation of new blood vessels
  • removal of necrotic tissue & debris by phagocytes
  • production of new collagen by fibroblasts
  • soft cartilaginous callus produced -> mineralized -> converted to woven (immature) bone
38
Q

Fracture Healing: Phase 3

A
  • overlaps w/ repair phase (occurs at 6-10 wks)
  • can continue for several months
  • woven bone replaced w/ mature lamellar bone
39
Q

Primary Fracture Healing Pattern

A

Direct re-establishment of bony cortex

  • requires very small gaps
  • occurs almost exclusively w/ surgical anatomic restoration w/ rigid internal fixation
  • osteoclasts on 1 fragment show a tunneling resorptive response
  • no intermediate callus forms
40
Q

Secondary Fracture Healing Pattern

A

Indirect bone healing through a cartilaginous callus intermediate

  • does not require absolute stability (allows for relative stability–controlled fracture motion)
  • immobilized by splints, casts, or certain intramedullary fixation devices
  • periosteum provides progenitor cells, which differentiate into healing cells
41
Q

Malunion

A

= An inadequately aligned union of a fracture

  • MCC’s-inadequate fx reduction, immobilization, or surgical error in alignment
  • May result in loss of function or poor cosmesis
42
Q

Delayed Union

A

= Prolongation time to union (beyond 16-20 weeks)

43
Q

Non-Union

A

= Failure of normal fracture healing

(1) fx unhealed after 6 months of tx
(2) fx w/o healing process on x-rays for 3 consecutive months

Tx: bone grafting

44
Q

Delayed Union & Non-Union Presentation

A
  • Persistent pain
  • Etiology: compromised biologic environment, infection, insufficient immobilization, inadequate reduction, or extensive surgical disruption of the surrounding vascular supply
45
Q

Hypertrophic Nonunion

A

Cause: inadequate stability
Tx: revision to more stable fixation

46
Q

Atrophic Nonunion

A

Cause: inadequate biologic conditions
Tx: bone grafting

47
Q

Fibrous Nonunion

A 
Cause:
- inadequate reduction
- inadequate biologic conditions
- inadequate stability
Tx:
- debridement
- bone grafting
48
Q

Oligotrophic Nonunion

A

Cause: inadequate reduction
Tx: revision of reduction

49
Q

Septic Nonunion

A

Cause: infection
Tx: debridement, antibiotics

50
Q

Nonsurgical Tx of Fractures

A

Indicated w/ stable fracture patterns that can be immobilized w/ a splint or cast

  • require follow-up radiographs
  • loss of reduction or a lack of healing may require surgical interventions
  • electrical & ultrasound stimulation may enhance healing in fractures prone to impaired healing
51
Q

Surgical Tx of Fractures

A

Indicated for unstable fractures & fractures that fail to respond to nonsurgical tx

  • open fx: debridement to reduce infection
  • intraarticular fx: reduce articular cartilage & minimize future posttraumatic arthritis
  • malunion: osteotomy, or bone cuts
  • nonunion: debridement & bone grafting

Musculoskeletal (9 decks)

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