Fractures Flashcards
Fracture?
Disrupted continuity of the bone
Does the bone have to be broken in order to have a fracture?
No, it can be a small chip or break down he side fo the bone
List the classifications.
- cause
- appearance
- location (not where in the skeleton but where on the bone)
- pattern
- type
Name 2 type of fractures.
- simple (closed) fracture
- compound (open) fracture
Simple (closed) fracture?
closed = integument intact
Compound (open) fracture?
open = integument is broken (bone may be protruding out)
Types of fractures?
- greenstick fracture
- comminuted fracture
- pathologic fracture
- segmental
- butterfly
- impacted
greenstick fracture?
“greenstick” referring to a freshly fallen tree branch/ twig that is difficult to snap because it is flexible. An older twig would be dry and snap very easily. in younger children because the bone is still developing and is very pliable
Comminuted fracture?
bone breaks into multiple pieces under excessive force . Multiple breaks at one site; difficult to treat -> pt will most likely need surgery.
Segmental fracture?
large bone fragments separate from the main body of the bone
Butterfly fracture?
2 oblique fracture lines meeting to create a large triangular or wedge-shaped fragment that resembles a butterfly
Impacted fracture?
parts of the broken bone are driven toward or into each other by force (eg. head of the femur driven into the acetabulum on extreme impact)
Pathologic fracture?
d/t bone disorder eg. osteoporosis , bone cancer etc (simple things like standing or walking may break the bone)
List the patterns.
based on the direction of the fracture line:
- longitudinal
- oblique
- spiral
- transverse/horizontal
Oblique?
usually d/t a twisting force; breaks at 45 degrees.
List the appearances.
- Burst
- chip
- displaced
Burst?
multiple bone pieces @ break (same as comminuted fracture, but that is the type and burst is the appearance). usually at the end of the bone.
Chip?
small fragment of the bone is chipped away near the joint
Displaced?
bone separated at fracture line
Etiology/patho?
- more force is applied to the bone than it can withstand = force overload
- bone is extremely strong and can handle a great amount of force provided that the force is applied in the same direction that the bone is equipped to handle
- 3 categories:
1. trauma
2. fatigue/stress
3. pathologic
example of a fatigue/stress fracture?
someone running a marathon is persistently applying force, the bone previously would have been able to handle this but now that is fatigued it will break
Manifestations of fractures?
- pain
- soft tissue injury d/t inflammation
- hemorrhage
- deformity
- loss of function
Dx?
- hx, px
- xray
Treatment?
- reduce (ensure that the bone is aligned so that it heals properly)
- stabilize (immobile the affected bone to allow the body to do the healing)
- healing will take a long time
- restore function (PT+OT)
How long does healing of a fracture take?
Complex and lengthy process that takes 3-6 months but can take longer, up to 2 yrs depending on pt and underlying cause
Name the 4 stages that occurring in healing of a fracture.
- Hematoma and cell proliferation
- Soft callus formation
- bony callus formation stage
- remodelling stage
Hematoma?
blood clot; gel-like material that retain bones in proximity to each other
Hematoma and cell proliferation stage?
bone is richly vascularized; when you break bone -> vessels are severed and you will have bleeding. -> hematoma (forms bc blood is clotting) and forms within 48-72 hrs. Cellular activity occurs within the hematoma mediated by molecular signalling. Hematoma facilitates the formation of a fibrin mesh that seals off the fracture site an serves as a framework for the influx of inflammatory cells, ingrowth of fibroblasts and development of capillary buds (angiogenesis). Inflammation occurs -> to defend against any microbes entering the break in the skin/bone integrity. Bone necrosis begins d/t ischemia from the severed vessels -> necrotic bone tissue must be removed.
What does optimal healing require?
Blood/oxygen/nutrient supply and the ability to remove waste products
Soft callus formation?
(appearance of fibrocartilage) New capillaries/vessels forming (angiogenesis) -> forms into granulation tissue. Fibroblasts from the periosteum, endosperm and red bone marrow proliferate and invade the granulation tissues -> produce fibrocartilaginous CT -> cartilage must form before new bone can -> necrotic bone becomes visible in this stage -> bone is still not weight-bearing
Bony Callus Formation Stage?
osteogenic cells develop into osteoblasts once new vessels are present in tissue -> form thin projections of spongy bone (referred to as trabeculae). Fibrocartilaginous callus is converted into bony callus (bone is initially deposited on the outer surface of the bone and progresses towards the fracture site until a new bony sheath cover the fibrocartilaginous callus. 3-4 weeks after injury, the bony callus calcifies and is replaced by mature bone
How does the remodelling stage differ from the physiologic process of bone remodelling?
The physiologic process of bone remodelling occurs continuously, while this process refers to reshaping the bone and finalizing its form.
Remodelling stage?
Osteoclasts remove inessential material, including any remaining necrotic bone and excess material on the outside of the bone shaft and within the medullar cavity. Compact bone replaces spongy bone around the periphery of the fracture. Bone begins to resemble original bone prior to the break. At the end of this stage, the bone will have healed completely.
In which stages is the bone weight-bearing?
Only in the remodelling stage
