fractures Flashcards
precipitations for a fragility, vertebral, stress, high energy and pathological #
fragility=fall from standing height or less vertebral=bending, lifting and falling stress=running high energy=major trauma pathological=spontaneous minimal trauma
diseases that cause pathological #
malignancy
paget
osteomalacia
investigation for a fracture main points
- order x-rays in 2 projections at right angles
- request MRI if # cant be seen
management of a #
analgesia immobilisation reduction -cast -splint -internal fixation ie ex fix vs in fix -dvt phx
that often need surgical management
- watershed areas
- long bone #
- peri articular#
what is the most common cause of compartment syndrome
trauma
who does non-union usually affect
- high energy or open# with extensive damage to nv supply
- or smoking, infection
what is avascular necrosis
where blood supply to one of the major fragments crosses the plane of fracture so gets disrupted
definition of a fracture, dislocation and sublaxation and comminuted
#=disruption in bone continuity dislocation=complete loss of continuity of 2 bones forming a joint sublaxation: partial loss of continuity of 2 bones forming a joint comminuted= break into more than 2 fragments
ways of describing #
displacement -translation -angulated -rotated -shortened (impaction or bayonetting)
shapes of fractures
simple:
- transverse
- linear
- oblique
- spiral
complex: more than 2
green stick
impaction
bayonetting
what is a green stick #
one side is fractured and the other one is bent
what are buckle fractures and who gets them
all compresses either side of fracture to buckle
in children
also called torus
difference between impaction and bayonetting
both shorten but the proximal fragment goes past the fracture site
what causes a #
1.injury mechanism that exceeds the max force a bone can withstand
normal bone abnormal force
2.abnormal bone norm force if have tumours, degenerative or congenital ostoegenesis imperfecta
3. co-morbidities that increase the risk of trauma eg balance, visual impair, alcohol
physical signs of a #
abnormal movement crepitus deformity bruising tenderness pain on stressing limb impaired function swelling
primary # healing requirenements
- direct healing
- needs end of bones to be touching
- WITHOUT a callus
- therefore needs an operation probably to align with plates first
mechanism of primary # healing
- gaps are invaded with blood vessels and cells that differentiate into osteoblast that lay down woven and lamella bone
- osteoclast act as cutting cones and pass directly across the fracture site leaving channel for the blood vessels and osteoblast to follow
- remodelling then occurs
stages of secondary bone healing
- inflamamtion get a haematoma formed and inflamamtory cells, granulation tissue for 2 weeks
- soft callus in 2-6 weeks
- soft callus calcified by chondroblast to form a hard callus 12-26 weeks
- 1-2 years of bone remodelling to form lamellar bone and osteoclast remove woven bone
what is a callus
deposition of collagen and fibrocartilage tissue
fracture healing timeframe in children, adult humerus, distal radius, femur, ankle and tibia
children=2-4 weeks humerus=6-12 weeks radius=5-6 weeks femur=24 weeks ankle=6 weeks tibia=12 weeks
factors affecting # healing
- patient related eg smoke and dm
- energy related so high and blood supply, soft tissue
- fixation related: is it adequate, infection
how delayed does healing have to be to be considered delayed healing
3-6 months
at what point is non-union defined
at minimum of 9 months and # shown no sign of healing for 3 months
conservative vs non conservative managent depending on the # considerations
- is the position acceptable ie consider soft tissue and NV risk, salter harris
- is it stable or unstable
- will it slip
- risk of not operating ie prolonged bed rest in eldery, bed sores, independence
- do they work as takes longer secondary healing
options for non-op
splint
braces
elevate
casting
when should someone seek attention if they had non-op
- increasing pain
- numbness
- pins and needles
pros and cons of non-op
-cheap
-easy
-reduce op risk
cons
-stiffness
-doesnt fully control if unstable
-pressure issues
-comfort
-bed rest
-morbidity risk
surgical pros and cons
pros -less immobilisation -earlier rehab and pain control -anatomical reduction reduce risk of further disability cons -expensive -slow healing -risk of complication
cons of surgical ext fix
- pin site infection
- osteomyelitis risk
- NV injury
- over distraction causing non-union
cons of surgical internal fix risk
-infection
NV injury
-non-union
-implant failure and subsequent # through a bony defect removal
absolute indication for op management
- displaced intra-articular#
- open #
- pathological #
- polytrauma
- # of long bones
- NV damage
relative indication for op management of #
- failure of conservative management
- # with high risk complication
- morbidity of conservative manage
- elderly patients intolerant to prolonged bed rest
indications for external fixation
- open # with sif soft tissue damage
- highly comminuted
- life saving splintage procedure in pelvic#
- initial stabilising surgery
- salvage option of union problems
- definitive treatment of periarticular# eg pilon
3 main methods of external fixation
- pin and rods
- ring fixators
- circulator fixators for definitive fracture fixation
