Fractures Flashcards
How should fractures be treated generally?
return to anatomic position and immobilize
What are the types of fracture?
- closed (simple)
- open (compound)
- displaced (pulled out of normal alignment)
- pathologic
- spiral
What is a closed (simple) fracture?
fracture in which the bone does not pierce the overlying skin
What is a open (compound) fracture?
the bone is exposed to the environment through the wound (infection risk).
Procedural washout and antibiotics should be used in treatment of these fractures
Compression fractures?
common in the vertebrae due to collapse of the anterior portion of a process (commonly due to osteoporosis)
What is a comminuted fracture?
fracture has broken the bone into a number of pieces (high impact, gunshot wounds)
What is an impacted fracture?
when bone fragments are driven into each other
What is a spiral fracture?
fracture from torque
Something to always consider with a spiral fracture?
child abuse because they may indicate child abuse (twisting arm or leg)
What type of spiral fracture in children suggests a LOW suspicion of child abuse?
spiral fracture of the distal tibia (toddler’s fracture)- can occur normally
Complete vs. incomplete fracture
complete- bone fragments completely separated
What is a stress (hairline) fracture?
caused by stress or repeated stress (commonly in weight bearing bones) that may require CT span to ID (x-ray may not pick up).
What is a scaphoid fracture?
often secondary to a fall on an outstretched hand
How does a scaphoid fracture present typically?
patients will have snuffbox pain but usually an x-ray is unremarkable. Patients still should be splinted or the proximal scaphoid may undergo avascular necrosis
What is a Baslar skull fracture?
usually secondary to trauma and may present as:
- periorbital ecchymoses (raccoon eyes)
- mastoid ecchymoses (Battle sign)
- CSF leakage through the ear (otorrhea) or nose (rhinorrhea with salt, metallic taste)
Notes on femoral head fractures?
common in elderly and have a high mortality (10-15% die in a year)
Types of femoral head fractures?
- intracapsular (prone to avascular necrosis)
- extracapsular
treatment is variable to patient, usually arthroplasty
Series of events following fracture
1) hematoma fills fracture gap and surrounding area of injury allowing platelets and inflammatory cells to enter
2) end of week 1- tissue is primed for new matrix synthesis
3) Weeks 2-3- early callus formation (cannot support weight)
4) Around 6 weeks- bony callus mineralized to the point to where controlled weight bearing can be tolerated
What is compartment syndrome?
occurs when fracture disrupts vascular supply to the extremity. The legs and forearm are the areas most often affected
How does compartment syndrome present?
patients will experience severe pain and exam will reveal a tense, wedlock compartment
Diagnosis of compartment syndrome?
measuring the intra-compartmental pressure
How is compartment syndrome treated?
fasciotomy (release tension via fascia incision)
HandP five P’s of compartment syndrome
Pain Pallor Pulselessness Paralysis Parastesias
