Fractures

Question 1

What is a fracture?

Answer 1

a break in the continuity of a bone

Question 2

What is a simple fracture?

Answer 2

aka. closed.

- bone is broken without an external wound; the skin is intact

Question 3

What is a compound fracture?

Answer 3

aka open

• bone is broken and there is an external wound leading to the site of the fractured bone, or fragments of bone protrude through the skin;
• ends of the bone have broken through the skin or into one of the body cavities;
• more prone to infection

Question 4

what is a complicated fracture?

Answer 4

bone is broken and has injured some internal organ. ie. rib pierces lung

Question 5

What is a comminuted fracture?

Answer 5

bone is splintered into pieces

Question 6

what is an impacted fracture?

Answer 6

bone is broken and one end of the fractured bone segment is wedged into the interior of the other bone

Question 7

What is a complete fracture?

Answer 7

the bone is broken into 2 or more pieces (ie. transverse, oblique spiral, comminuted, avulsion and osteochondral)

Question 8

What is an incomplete fracture?

Answer 8

• the line of fracture does not include the whole cross section of bone
• bone is bent or cracked and the periosteum remains intact (ie. compression, greenstick, perforation and stress fractures)

Question 9

What is a greenstick fracture?

Answer 9

the bone is partially bent and partially broken. occurs usually in children especially those with rickets

Question 10

What is a depressed fracture?

Answer 10

a piece of skull is broken and driven inwards

Question 11

What is an epiphyseal separation?

Answer 11

separation between shaft and bone and epiphysis (growing end).
-occurs in young patients

Question 12

What are Salter Harris classifictions?

Answer 12

• classification system used to describe fractures affecting the epiphyseal plate or growth plate
• only applies while bone is still growing
• Five types

Question 13

What is a type I salter harris classification?

Answer 13

transverse fracture through the growth plate

Question 14

What is a type II salter harris classification?

Answer 14

fracture through the growth plate and metaphysis

Question 15

What is a type III salter harris classification?

Answer 15

fracture through the growth plate and the epiphysis

Question 16

What is a type IV salter harris classification?

Answer 16

fracture through the growth plate, epiphysis and metaphysis

Question 17

What is a type V salter harris classification?

Answer 17

compression fracture through the growth plate

Question 18

What are the complete fractures?

Answer 18

transverse, comminuted, avulsion, osteochondral

Question 19

What are the incomplete fractures?

Answer 19

compression, greenstick, perforation, and stress fractures

Question 20

What is a Colles fracture?

Answer 20

• wrist fracture
• transverse fracture of the radius proximal to the wrist allows the fragment to rotate and displace dorasally
• “dinner fork” deformity
• most common fracture in elderly
• FOOSH

Question 21

What are some complications of a Colles fracture?

Answer 21

malunion and RSD/CRPS (complex regional pain syndrome) or shoulder-hand syndrome (edmea and capsular tightening affect the wrist and shoulder); CTS

Question 22

What is a Galeazzi fracture?

Answer 22

• break of the radial shaft and a dislocation of the inferior radioulnar joint (rotational break)
• FOOSH with some rotational component
• casting approx 6 weeks
• ulnar nerve lesion may occur with this injury
• “scooping ice cream”

Question 23

What is a Pott’s fracture?

Answer 23

• ankle fracture affects 1 or both malleoli
• distal fibula breaks close to the lateral malleolus
• deltoid ligament may also rupture or avulse the medial malleolus

Question 24

What is a Dupuytren’s fracture?

Answer 24

• fibula fractures higher up, the medial malleolus avulses and the talus is pushed superiorly between the tibia and fibula
• MOI=eversion with some external rotation
• leg is casted for 6-12 weeks
• malunion and joint stiffness are possible complications

Question 25

What are causes of Dupuytren’s fracture?

Answer 25

• direct violence
• indirect violence
• muscular contraction
• overuse
• pathologies

Question 26

What pathologies can cause fractures?

Answer 26

osteoporosis, tumors, local infections or bone cysts which can cause a brittleness or weakness of the bone.

Question 27

What does indirect force mean in terms of a fracture?

Answer 27

the bone is fractured by a force applied at a distance from the site of fracture and transmitted to the fractured bone; torquing or twisting force causes a spiral fracture, often with little soft tissue damage. ie. fracture of the clavicle.

Question 28

A patellar fracture secondary to a massive quadriceps contraction is an example of what?

Answer 28

A fracture caused by a muscular contraction.

Question 29

What are some complications of fractures?

Answer 29

• can develop early or late

- client may note increase in pain levels, edema, bruising, paresthesia or temperature local to the fracture

Question 30

What are the early complications of fractures?

Answer 30

torn muscles and tendons, ligament damage, compartment syndromes, nerve injuries, vascular injuries, joint hemarthrosis, bone and soft tissue infections, DVT’s and problems caused by poorly fitting casts.

Question 31

What are the late complications of fractures?

Answer 31

delayed union and non-union, malunion, myositis ossificans, nerve compression, nerve entrapment, bone necrosis, Volkmann’s ischemic contracture, joint stiffness and disuse atrophy

Question 32

What is the symptom picture for fracture?

Answer 32

• immediately after the fracture and before reduction, unnatural mobility and deformity are present at the fracture site
• shock
• pain with acute/severe tenderness over fracture site
• bleeding
• inflammation
• edema, both local (early) and diffuse (follows)
• local erythema, followed by bruising, both local and/or diffuse
• muscle spasm/splinting
• loss of motion/function (active and passive)
• possible local, unnatural, hypermobility, often with crepitus (end of bone rubbing together)
• possible deformity, as in shortening of limb or trunk segment
• fatigue, generalized weakness.