Fractures

Question 1

How is a fracture defined?

Answer 1

Musculoskeletal disease state that involved formation of a hematoma and surrounding zone of tissue necrosis (involving bone, neuromuscular, subQ tissues, skin, muscles)

Question 2

Comminution

Answer 2

break into several pieces (esp if high energy mechanism of injury)

Question 3

3 Phases of Bone Repair

Answer 3

1- Initial - inflammatory (macrophages and degranulating platelets –> chemokines/cytokines –> attract stem cells)

2- Reparative - neo vascularization and creation of osteoblasts

3- Remodeling

Question 4

3 Cells Involved in Bone Repair

Answer 4

• Osteoblasts - lay down bone matrix
• Osteoclasts - resorb bone matrix
• Osteocytes - embedded in matrix; homeostasis

Question 5

3 Bone Growth Processes

Answer 5

• Endochondrial - formation of cartilage template then osteoblasts deposit mineral and collagen; seen as callus formation
• Intramembranous - form bones by spicules w/o cartilage intermediary
• Appositional - healing by remodeling; cutting cones of osteoclasts resorb a tunnel of bone followed by osteoblasts

**Usually a combo of endochondrial and interosseous then remodeling w/ appositional

Question 6

General Tx

Answer 6

• Acute - stabilize w/ splint 1st for elasticity (swelling)
• Then place cast once swelling diminishes
• Fixation and tension

Question 7

When is a fracture considered an emergency?

Answer 7

• open fracture (bone exposed), skin or neuromuscular compromise, suspect compartment syndrome, femoral neck fractures in non-elderly, native hip dislocations