Fractures and bone healing Flashcards
What is the difference between a closed and open fracture?
Closed: bone fragments do not pierce the skin
Open: bone fragments pierce through the skin
What are the difference types of fractures? (beside closed and open)
- transverse
- oblique
- spiral
- comminuted
- segmental
- avulsion
- impacted
- torus
- greenstick
How can fractures be differentiated by direction of force?
can have:
- tension
- compression
- bending (usually children)
- shear
- torsion
- combined loading
What is a transverse fracture, and how is it caused?
Fracture that is at a right angle to the bone’s long axis
Caused by directly applied force to the fracture site
What is a spiral/oblique fracture, and how is it caused?
Spiral: where at least one part of the bone has twisted
Oblique: fracture is diagonal to bone’s long axis (by at least 30 degrees)
Caused by violence transmitted though limb from a distance
What is a crush/compression fracture, and how does it occur?
fracture usually in cancellous bone, usually affecting the thoracic and lumbar vertebrae (weight bearing-regions)
usually occurs between 30-80 years of age and in people with osteoarthritis
What is a burst fracture, and how does it occur? Why is this type of fracture so severe
Fracture that usually occurs in short bones (i.e. vertebra) and is usually the result of high-energy trauma such as RTA, falling from a great height with speed)
Incredibly severe as the bone fragments can go into the vertebral canal and compress the spinal cord or cauda equina
What is an avulsion fracture?
Where a fragment of bone is separated from the main mass
- might come off with a piece of tendon or ligament
What is an impacted fracture?
bone fragments are driven into each other
usually quite a stable fracture and sometimes can be difficult to see on imaging (MRI will provide a clear image)
What is a comminuted fracture, and how does it usually occur?
When the bone fragments splinter into smaller pieces
- dangerous as it can interrupt blood supply
Usually the result of high energy trauma (RTA)
What is a stress fracture, how does it occur?
Small crack in bone or severe bruising
Occurs either by:
1. abnormal stress on normal bone (fatigue fracture caused by over/repeated use)
2. normal stress on abnormal bone (insufficiency fracture)
*look for periosteal reactions or a little bump on bone in imaging
What is a torus fracture, why does it occur?
incomplete fractures of a long bone, characterised by bulging of the cortex (AKA buckle fracture)
usually seen in children when there is axial loading causing trabecular compression
this occurs as children have softer bones
What is a greenstick fracture, and how does it occur?
when the bone bends and breaks, but the breakage is incomplete
occurs in children (soft bone) due to bending forces - often a result of non-accidental injury, can also result from accidental injury
Describe the different types of fractures that can occur to the epiphyseal growth plate.
Type I: complete physeal fracture with/without displacement
Type II: physeal fracture that extends through the metaphysis, producing a chip fracture of the metaphysis
Type III: physeal fracture that extends through the epiphysis
Type IV: physeal fracture and epiphyseal and metaphyseal fracture
Type V: compression fracture of growth plate
(look at images in notes)
Describe the first stage of bone healing.
Fracture haematoma:
- blood from broken vessels forms a clot
- characterised by hypoxia and low pH
- occurs 6-8 hours after injury
- haematoma contains pro- and anti-inflammatory cytokines + other inflammatory cells (neutrophils, then macrophages, then lymphocytes
- swelling and inflammation at fracture site
