Fractures Flashcards
What is a fracture?
A soft tissue injury where there is also a break in the continuity, surface, substructure of bone
What are the most common sites of fracture?
Fibula
Radius + Ulna
Humerus
Tibia
What is the difference between adult and paediatric bone?
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
When do children’s bones grow until?
Girls: until 2yrs after they start menstruation
Boys: until about age 16
What is a physis? Describe it.
A growth plate
Cartilage cells that create solid bone in time, with growth
What is the:
- epiphysis
- metaphysis
- diaphysis?
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
What is the periosteum?
Thick nutrient layer that wraps around the bones
Why do children get more fractures than adults?
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
What is a plastic deformation fracture?
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
What is a buckle fracture? And what’s another name for one.
Torus fracture
Compression failure of a bone
Usually at the junction between the metaphysis and the diaphysis
What is a greenstick fracture?
Bone is bent and the convex side of the bone breaks
Not all the way through though
How do you treat a buckle fracture?
Immobilisation, should heal in 3 weeks
How do you treat a greenstick fracture?
Immobilisation
Sometimes you need to break the other side of the bone to restore alignment
What types of complete fractures can you get?
Transverse: break straight across
Oblique: break diagonally
Spiral: occur by rotational force
What are physeal fractures?
What causes them?
Fractures to the growth plate
Caused by:
- crushing
- vascular compromise of physis
What’s the problem with physeal fractures?
Damage to the growth plate can result in progressive angular deformity
Also leg length mismatch
What is the Salter Harris Classification?
Defines types of breaks in paediatric fractures
What Salter Harris Classification do most fractures belong to?
Type II
Explain what a type II Salter Harris fracture is like?
Fracture through a portion of the physis that extends through the metaphyses
What is an Alder Hey splint?
A gentle support for mild problems
How do you treat displaced fractures?
A well moulded cast
That applies pressure either side to maintain alignment
What are K wires?
Surgical wires used to hold bone in a corrected position
They remain inside the bone for 4 weeks
K wires are easy to remove, why?
They are left sticking out of the skin so can be removed easily in a clinic
What is an intramedullary rod?
A metal rod that is passed up inside bone to stabilise the joint
Do intramedullary rods remain within the joint permanently?
Sometimes yes
At what age can children start using crutches?
Age 7
Briefly describe the process of bone repair? And give timescales for each.
Haematoma (hours)
Inflammation (days)
Repair (weeks)
Remodelling (months-years)
What is a haematoma?
Bleeding leads to a blood clot being formed at the site
Blood brings nutrients needed to heal fracture
What occurs during the inflammation phase of fracture healing?
Fibrin clot organisation
Neovascularisation
Cellular invasion:
- stem cells
- haemopoietic cells
What happens during the repair phase?
Formation of a callus: bony healing tissue - fibroblasts - Chondroblasts - osteoblasts These help repair
Matrix remineralisation
High vascularity
What is a callus?
Bony healing tissue
That contains fibroblasts, Chondroblasts, osteoblasts
What happens during the remodelling phase of fracture repair?
The temporary bone is replaced by lamellar bone
Increased bone strength
Vascularity returns to normal
