Fractures

Question 1

What is a fracture?

Answer 1

A soft tissue injury where there is also a break in the continuity, surface, substructure of bone

Question 2

What are the most common sites of fracture?

Answer 2

Fibula
Radius + Ulna
Humerus
Tibia

Question 3

What is the difference between adult and paediatric bone?

Answer 3

Paediatric bone:
- less dense

• more porous
• lower mineral content
• penetrated throughout with capillaries
• extremely thick periosteum
• presence of physis (growth plates)
• soft tissue attachments are strong

Question 4

When do children’s bones grow until?

Answer 4

Girls: until 2yrs after they start menstruation

Boys: until about age 16

Question 5

What is a physis? Describe it.

Answer 5

A growth plate

Cartilage cells that create solid bone in time, with growth

Question 6

What is the:

• epiphysis
• metaphysis
• diaphysis?

Answer 6

Epiphysis: the head of the bone, associated with joint cartilage

Metaphysis: area below the physis and near the diaphysis

Diaphysis: the long shaft of the bone

Question 7

What is the periosteum?

Answer 7

Thick nutrient layer that wraps around the bones

Question 8

Why do children get more fractures than adults?

Answer 8

Less careful

Children’s ligaments are stronger, so forces are more likely to be transmitted to the bone and cause a fracture in a child

Question 9

What is a plastic deformation fracture?

Answer 9

A force produces a microscopic failure on one side of a bone causing that side to become convex

No actual fracture, the bone is bent

Question 10

What is a buckle fracture? And what’s another name for one.

Answer 10

Torus fracture

Compression failure of a bone
Usually at the junction between the metaphysis and the diaphysis

Question 11

What is a greenstick fracture?

Answer 11

Bone is bent and the convex side of the bone breaks

Not all the way through though

Question 12

How do you treat a buckle fracture?

Answer 12

Immobilisation, should heal in 3 weeks

Question 13

How do you treat a greenstick fracture?

Answer 13

Immobilisation

Sometimes you need to break the other side of the bone to restore alignment

Question 14

What types of complete fractures can you get?

Answer 14

Transverse: break straight across

Oblique: break diagonally

Spiral: occur by rotational force

Question 15

What are physeal fractures?

What causes them?

Answer 15

Fractures to the growth plate

Caused by:

• crushing
• vascular compromise of physis

Question 16

What’s the problem with physeal fractures?

Answer 16

Damage to the growth plate can result in progressive angular deformity

Also leg length mismatch

Question 17

What is the Salter Harris Classification?

Answer 17

Defines types of breaks in paediatric fractures

Question 18

What Salter Harris Classification do most fractures belong to?

Answer 18

Type II

Question 19

Explain what a type II Salter Harris fracture is like?

Answer 19

Fracture through a portion of the physis that extends through the metaphyses

Question 20

What is an Alder Hey splint?

Answer 20

A gentle support for mild problems

Question 21

How do you treat displaced fractures?

Answer 21

A well moulded cast

That applies pressure either side to maintain alignment

Question 22

What are K wires?

Answer 22

Surgical wires used to hold bone in a corrected position

They remain inside the bone for 4 weeks

Question 23

K wires are easy to remove, why?

Answer 23

They are left sticking out of the skin so can be removed easily in a clinic

Question 24

What is an intramedullary rod?

Answer 24

A metal rod that is passed up inside bone to stabilise the joint

Question 25

Do intramedullary rods remain within the joint permanently?

Answer 25

Sometimes yes

Question 26

At what age can children start using crutches?

Answer 26

Age 7

Question 27

Briefly describe the process of bone repair? And give timescales for each.

Answer 27

Haematoma (hours)

Inflammation (days)

Repair (weeks)

Remodelling (months-years)

Question 28

What is a haematoma?

Answer 28

Bleeding leads to a blood clot being formed at the site

Blood brings nutrients needed to heal fracture

Question 29

What occurs during the inflammation phase of fracture healing?

Answer 29

Fibrin clot organisation

Neovascularisation

Cellular invasion:

• stem cells
• haemopoietic cells

Question 30

What happens during the repair phase?

Answer 30

Formation of a callus: bony healing tissue
- fibroblasts
- Chondroblasts
- osteoblasts
These help repair

Matrix remineralisation

High vascularity

Question 31

What is a callus?

Answer 31

Bony healing tissue

That contains fibroblasts, Chondroblasts, osteoblasts

Question 32

What happens during the remodelling phase of fracture repair?

Answer 32

The temporary bone is replaced by lamellar bone

Increased bone strength

Vascularity returns to normal