Fractures and bone healing Flashcards
what are the most common areas that is fractured
- extremities are the most common as they stick out
in under 45s who are fractures most common in
men as they have more risk behaviours
in over 45s who are fractures most common in
- women due to hormone changes
before 75 years old what fracture is most common
Colles and colles like
in over 75 years old what fracture is most common
hip fractures
What is the difference between a colles and a colles like fracture
Colles’ = this is fracture of the distal radius
Colles’ like = this is fracture of the distal radius and ulna
What is a closed fracture
when Bone fragments do not pierce skin
what is an open/compound fracture
- bone fragments pierce the skin
name different types of fractures
- tension
- compression
- bending
- shear
- torsion
- combined
- avulsion
- spiral
- transverse
what does the type of fracture depend on
- Depends on magnitude and direction of force
what is a transverse fracture usually caused by
- caused by directly applied force to the fracture site
What two views on an X ray should you use
- lateral view to see if the bone is displaced
- as well as the normal view looking down on it
if a scaphoid fracture is difficult to see what do you do
- treat it conservatively
- tell a person to come back and see if there is any farceur healing going on
what is a spiral or oblique fracture caused by
- caused by violence transmitted through limb from a distance specifically a twisting movement
What is a crush or compression fracture
- This is a fracture in cancellous bone result of compression
what is the osteoporotic curve
- the osteoporotic curve increases thoracic kyphosis
what vertebra are the most affected in a compression fracture
thoracic
lumbar
- these carry more weight
describe what happens between 30-80 years with - elasticity - strength - toughness of the bone in curls fractures
Elasticity of trabecular bone decreases by 64%
Strength decreases by 68%
Toughness decreases by 70%
why do compression fractures occur
Due to trabecular network
what do burst fractures occur in
- Occur in short bones such as vertebra from strong direct pressure such as impaction of a disc
Where are burst fractures most common
thoracic/lumbar junction
what is the problem with a burst vertebra
- when a vertebra bursts it goes anterior and posterior
- posteriorly section goes into the vertebral canal and compresses the spinal cord which can be the problem
what can cause a burst fracture
- A burst fracture can be caused by when someone lands on their feet and the force is transmitted up the vertebral column
what causes an avulsion fracture
- Caused by traction
what is an avulsion fracture
- Bony fragment usually torn off by a tendon or ligament
where is an avulsion fracture usually
- lesser tronchater - this is the attachment point for illopsoas and therefore it can be pulled away from the femur
- achilles tendon can pull part of the calcareous off
- the medial epicondyle can be pulled of by the forearm flexors of the wrists and digits
what is a fracture dislocation/subluxation
this is when the fracture involves a joint and this results in malalignment of joint surfaces
- therefore you have to get the joint realigned
What is an impacted fracture
- this is when bone fragments are impacted and forced, pushed into each other
What is a comminuted fracture
- this is a high impact trauma where two or more bone pieces
- for example he middle part of the bone might be completely detached and thus completed detached from the blood supply
What is a stress fracture
- abnormal stress on a normal bone (fatigue fracture)
- normal stress on abnormal bone (insufficiency fracture)
what are the majority of stress fractures
- abnormal stress on a normal bone (fatigue fracture)
how do you see a stress fracture in an X ray
- see a stress fracture when the periosteum get larger as you have an increase in the number of osteoblast as they start to proliferate
what does a periosteal reaction look like
- looks larger
-
what does a periosteal reaction look like on bone scintigraphy
- becomes positive at the same time or sooner than plain films
- low false positive
What is bone scintigraphy
Skeletal scintigraphy is a special type of nuclear medicine procedure that uses small amounts of radioactive material to diagnose and assess the severity of a variety of bone diseases and conditions, including fractures, infection, and cancer.
Name the fractures that are specific to children
Torus fracutre
Greenstick fracture
fractures of the epiphyseal growth plate
Describe what happens in a torus fracture
- common injuries to children
softer bones and compression applied to them - axial loading causing trabecular compression
- one side of the bone may buckle
- bulging of the cortex
these heal quickly
What is a greenstick fracture
- Bones soft and bend without fracturing completely
- the woven bone will allow the bones to bend fracturing them completely
what happens when there are fractures of the epiphyseal growth plate
can get a fracture to the epiphyseal growth plate and this can affect the growth of bones
When does an epiphyseal growth plate become a problem
- the epiphyseal growth plate becomes a problem if you have two bones that are parallel to each other for example the radius and ulna and tibia and tibia
- the fracture can cause the epiphyseal growth plate to close immaturely and this can cause the ulna to continue to grow at both ends and you end up with deformity
How long on average do bones take to heal
8 weeks
name the stages of bone healing
Fracture haematoma (6-8 hours)
fibrocartilaginous callus (lasts about 3 weeks)
bony callus (after 3 weeks and lasts abut 3-4 months)
bone remodelling
describe the fracture haemotoma part of bone healing
- blood clot forms via the broken blood vessels
- 6-8 hours after the initial injury
- hypoxia is caused due to a lack of blood vessels as they are broken this lowers the pH and allows pro inflammatory neutrophils, lymphocytes and macrophages to move in and to take away necrotic bone cells, blood vessels and any dead cells to make the site nice and clean
- there is swelling and inflammation to dead bone cells at fracture site
What happens in the fibrocartilangeous callus stage of bone healing
- lasts about 3 weeks
- new capillaries organise fracture haematoma into granulation tissue - procallus
- fibroblasts and osteogenic cells invade the procalllus
- make collagen fibres which connect ends together
- chondroblast begin to produce fibrocartilage
- Fibroblasts enter and differentiate as chondrocytes
- chondrocytes produce collagen that bridges fracture site cartilage and trabecular bone is laid down
describe the bony callus stage of bone healing
- bony callus forms as the bone starts to be made
- osteoblasts make the woven bone which replaces the fibrocartilage
describe the bone remodelling stage of bone healing
- Osteoclasts remodel woven bone into compact (lamellar) bone and trabecular bone
- often there is no trace of fracture line on Xray
what heals first the upper or lower limb
Upper limb usually heals a weak or two weeks quicker than the lower limb as it has a better blood supply
what happens if the bone is not set
- a bony callus forms and gradually becomes remodelled
- takes up to a year or two to heal properly
