Fractures Flashcards
Which age groups have the most fractures and why? Which bones are most common?
- Young people (15-24) – Bones not fully developed. Fracture usually second to trauma. Tibia, clavicle, lower humerus.
- Old people (>65) – Usually secondary to OP. Upper femur, upper humerus, vertebrae, pelvis.
What is a pathologic fracture? Discuss.
- When a small/moderate force acts on a weakened or diseased bone, causing fracture. May be caused by:
o Focal bone lesions (neoplasms, cysts, infections)
o Metabolic disorders – Lead to poor mineral absorption and hormonal changes that decrease bone calcification
o Disuse – Muscle atrophy and osteopenia
Discuss the classification of fractures.
- Aetiology – Physiological (strong force, normal bone)/pathological (weak force, weak bone)
- Location of force on bone – Direct (fracture at point of trauma)/indirect (bone breaks at distant site)
- Visual characteristics of fracture – Spiral, transverse, oblique, chip, impacted, linear, depressed
- Type of bone damage – Compression, comminuted (splintered/fragmented), avulsion (pull from joint capsule, ligament, tendon or muscle), greenstick (incomplete fracture involving one side of periosteum), complete (disruption of both sides of periosteum)
- Skin trauma – Closed/simple, open/compound
- named after a person
colle’s, potts, monteggia’s
List and describe the events occurring during the healing of fractures. Discuss the approximate times necessary for each stage.
F# occurs
- Haematoma formation
a. Intense/acute activation and migration of inflammatory cells
b. Activation and proliferation of local connective tissue cells (3 BLASTS – osteo, fibro, chondro) - Procallus formation – Organisation of haematoma into granulation tissue
a. Phagocytes remove debris and kill bacteria
b. Formation of woven bone (osteoblasts), collagen (fibroblasts) and cartilage (chondroblasts)
c. Angiogenesis
3. Fibro-cartilaginous callus formation
a. Rapid formation of collagen (fibroblasts) and cartilage (chondroblasts) cause fibrocartilaginous callus composition – Requires limited O2
b. Osteoblastic activity limited by low O2, however new blood vessels continue to invade callus (angiogenesis)
- Bony callus formation
a. Blood vessels have invaded deepest part of callus, forming a rich network (increased O2) – increased osteoblastic & osteoclastic activity
b. Destruction of fibrocartilage (osteoclasts) and increased woven bone formation (osteoblasts). - Remodelling of bony callus
a. Osteoclast activity > osteoblast activity
b. Woven bone destroyed (osteoclasts) and replaced by compact bone (osteoblasts)
c. Internal and external calluses reabsorbed
List the signs and symptoms that could indicate the presence of a fracture
General Ssx
- Shock
- Ssx of secondary damage sustained by CNS or viscera
- Ssx of underlying disease
Local Ssx
- Observation – Deformity, oedema, bruising, loss of function
- Palpation – Pulselessness (BVs compromised), paraesthesia (nerves compromised), tenderness
- Movement – Abnormal movement, local muscle spasm, crepitation
B SLIP DUCT
Bruising
Swelling
Loss of movement
Irregularities
Pain
Deformity
Unnatural movement
Crepitus
Tenderness
Local and systemic causes of delayed healing
Local:
- Malalignment
- Excessive movement
- Communition
- Bone disease
- Severe soft tissue injury
- Infection
- Ischaemia
- Soft-tissue interposition
Systemic:
- Mineral deficiency
- Vitamin deficiency
- Systemic infections
- Ischaemia (eg atherosclerosis)
- Endocrine disease (eg hyperparathyroidism, hyperthyroidism etc)
- Medications
- Poor general health
- Advanced age
Briefly define the following terms
a. Delayed union – Prolonged healing time
b. Non-union – Bone ends fail to unite
c. Malunion – Union of bone in non-anatomical position
d. Psudoarthrosis – Non-union in which a fluid filled space forms between fractured ends of a bone
List the complications of a fracture
- Delayed healing
- Bone necrosis
- Shock
- Infection (open/compound F#s)
- Deformity
- Fat embolism
- Compartment syndrome
