fractures Flashcards
what is the most common bone lesion
fracture
what is a fx
a few ways it can be classified
• Most common bone lesion
• Break in continuity of bone–A fracture does not need to involve a break across the entire bone. (he drew what look like little cracks)
• Many classifications—too many for us
o Cause, location, pattern, type
what is a simple fx
Simple (closed)—dividing the fx into simple or compound is simple step. The closed or open refers to whether the integument is broken or not. Skin is closed still
what is compound fx
• Compound (open)—where the skin is broken
terms we learned for classifying by type of fx
greenstick
pathologic
comminuted
fractures by pattern
oblique
longitudinal
names for fractures by appearance
burst
chip
displaced
pt gets fx due to bone disorder like osteopososis what kind of fx is this
pathologic (way of classifying by type)
what kind of fx occurs in kids only. why in kids
how do you desribe this
Greenstick—this is a fx that is encountered in kids only
• 1 broken and 1 bent surface
• In children (why?) –in kids bone is still forming and is pliable and flexible, it is less likely to break. The bone in the kid is like a green stick that isn’t dry
comminuted fx
which other type can be used to describe this
Comminuted
• multiple breaks at primary site—at the point of break the bone splits into multiple pieces. 1 of difficulties with htis is that other terminology is used for this type
burst
oblique fx
- break at approx 45 degrees—
- D/T twisting force– (this is also called a spiral break)
- –this is the least informative type. There must be additional info added to this
longitudinal fx
Longitudinal
• Longitudinal break line—up and down along length of bone
burst fx
where does this occur
Burst—same as a comminuted fx
• Bone breaks into multiple pieces
• Usually at end of bone
where does chip fx usually occur
Chip
• Small fragment near joint—at end of bone
displaced fx
Displaced
• Bone separates at fracture line—the pieces move apart but are still aligned. He drew another pic in which the fx pieces were displaced laterally
the following types are from a figure 57.1
decribe a segmented fx
impacted fx…where does this usually occur
Segmented there are two break lines with a piece of broken bone in between two fx bone (3 pcs total).
Impacted fx is v serious the head of the femur (in example) the head of femur has dislocated from acetabulum and the force has been so strong that it has pushed the head of the femur into the opposing bone…this can happen anywhere but more often in joint.
colles fx how does this gen occur and where
Colles fracture is fx of wris distal part of wristt (more than one of them would most liley break) often occurs when they fall forwards or backwards and catch themselves. Needs to be reduced surgically.
potts fx
compression fx
Pott’s fracture is in distal fibula at ankle
Compression fx of vertebra occurs when pt falls and lands on butt
et and patho of fx
• Force overload on bone
-• 1=more force than it can withstand
• 2=that additional force that is applied is applied in direction that bone cant withstand
-where stress is applied to bone in the direction that force should be applied o the bone the bone is stronger than concrete. More imp is application of force to bone in direction in which it cant be applied.
mnfts of fx
- Pain—quite severe and is major issue
- Deformity—in arthritis the subchondral bone deforms (which is normal). In fx this deformity is not physiologic.
- Loss of function
- Hemorrhage-
- Soft tissue injury—this may be diff to detect.
is there always hemorrhage with fx
is this good or bad
Bone is considered to be hard tissue (like cartilage). The soft tissue adjoining the bon is likely to be damaged. The hemmorgahe that you see is likely to be soft tissue. But when a bone breaks there will always be hemmorhaging. Bone is richly vascularised…the severed blood vessels may be lg or sm.
The hemorrhage that occurs with fx is imp requirement of healing process. Just because youd ont see it doesn’t mean there isn’t any hem. Just means that soft tissue isn’t damaged. Particularly if there is closed fx.
tx of fx
- Reduction (re align bones)
- Immobilization (healing)—usually involves a cast. Youll have atrophy of the muscle. The atrophy should reverse once cast is off.
- Preserve and restore function—you are NOT healing the fx youre simply putting in place steps to help facilitate healing
now stages of healing fx
titles of 4 stages
hematoma
soft callus stage
bony callus stage
remodelling
what is a hematoma
how long does hematoma stage last (although the stages are overlapping)
Hematoma is a blood clot. The initial clot happens within minutes This stage requires 48-72 hrs
2 functions of hematoma…where is it
1=Hematoma prevents further misalignment. (iti is a gel surrounding the whole fx)
2=provides medium for cellular activity/cellular interaction through molecular signalling of WBC, RBC, platelet etc. This process continues throughout (the cell signalling)
what occurs in hematoma and sevred area
There are cap buds appearing at the point of where the vessel is severed. This will give rise to blood vessels (angiogenesis) angiogenesis doesn’t begin at this stage but the mech are put in place for it
The fibrin serves several imp purposes
• It tends to seal the fx site (with the mesh)
• It is source of inflm cells (inflm is part of healing process)
• It is framework/medium for dev of new vessels
is the bone wt bearing in soft callus stage
what occurs
not yet wt bearing
During this stage the hematoma is replaced by cartilage (fibroblasts deposit fibrocartilage at site of break. )
There is now angiogenesis (from cap buds). In order for this to occur you need granulation tissue.
During this time the bone isn’t wt bearing (the glue hasn’t hardened yet)
There is broken blood vesselischemianecrosis. If there is necrotic bone you need to remove it and form new bone
what ocurs in bony callus stage
where bone begins to form
there are proliferating osteogeneic cells (osteoblasts) and trabeculae of forming bone
ossification is occurring. The bone that forms here is SPONGY…in ossificationt he bone turns to spongy before compact bone.
what occurs in remodelling stage
the spongy bone now becomes compact bone (like in ossification)
the break is now completely repaired. This bone now becomes wt bearing
there was necrosis of bone in preceding stages which cant remain, there was multitude of healing cells/inflm cells and need to leave or be removed. The remodelling speaks of reshshaping the bone and the break back to what it was. Youre removing extraneous material
with any fx it is rare to achieve the reg shape of the bone. In majority of cases the bone will work as before, but, if healing inappropriate and its not aligned then youll see deformity
