Fractures and dislocations Flashcards
What is the definition of a fracture?
Break in continuity of a bone, as a result of a force applied to that bone which exceeds tensile or compressive strength of the bone
What is an open vs closed fracture?
open: penetrates the skin over the site
closed: doe not break the skin
What is a comminuted vs non-comminuted fracture?
comminuted: > 3 fragments
non-comminuted: < 3 fragments
What is a complete vs incomplete fracture?
complete: into 2 pieces
incomplete: not into 2 pieces,; remain attached (bent or buckled)
What is an avulsion fracture?
- tearing away of bone from forceful muscular / ligament pulling
- corner / chip fracture
What is an impacted fracture?
- impaction into another, giving shortening
- seldom visualized, white line
- depression fracture or compression fracture
What is a depression fracture?
- type of impacted fracture
- inner bulging of outer bone surface
- tibial plateau
- frontal bone
What is a compression fracture?
- type of impacted fracture in the spine only
- trabecular telescoping
- following forceful hyperflexion injury
What is a compound fracture?
other name for open fracture
What is a simple fracture?
other name for closed fracture
What is a torus fracture?
- type of incomplete fracture
- long axis forces make buckling of the cortex
- in metaphysis
- very painful
- FOOSH
What is a greenstick fracture?
- type of incomplete fracture
- perpendicular forces make bending
- disruption of cortex on one side
- paediatrics under age 10
What is a stable fracture?
does not move during healing
Where can an unstable fracture occur?
C1 broken in 3 parts
What forces cause spiral fracture?
torsional + compression + angulation
What is a stress fracture?
- repetitive stress causes gradual formation of micro fractures at greater rate than reparative process
- often starts as occult fracture
What is an occult fracture?
- clinically evident but not radiologically until 10 days post
- ex. scaphoid, ribs
What is an insufficient fracture?
stress fracture in diseased bone
What is the definition of a pathological fracture?
normal force acting on a weekend bone and breaking it
What is fracture alignment?
- position of distal fragment in relation to proximal fragment
- good alignment = no perceptible angulation
What is fracture apposition?
- closeness of bony contact at the fracture site
- good = complete surface contact
- partial = partial contact
- separation = distraction
What is fracture rotation?
- rotational deformity
* rotational malposition
What are the 3 phases of fracture repair?
1) circulatory / inflammatory phase
2) reparative / metabolic phase
3) remodelling / mechanical phase
List the events that occur during fracture repair
- bleeding from bone ends
- haematoma (day 1)
- necrosis of adjacent bone
- inflammatory reaction -debris removed by osteoclasts and macrophages
- granulation tissue invades fracture
- haematoma gets organized
- osteoblasts form provisional fracture callus (1-4 weeks)
- Formation of definitive fracture callus (4-12 weeks)
- remodelling of bone (3-12 months)
What are the immediate complications of a fracture?
- Arterial injury
- Neural injury
- Compartment syndromes
- Gas Gangrene
- Fat embolism
- Thromboembolism
What are the intermediate complications of a fracture?
- osteomyelitis
- failure of hardware
- reflex sympathetic dystrophy syndrome
- post-traumaticosteolysis
- re-fracture
- myositis ossificans
- synostosis
- delayed union
What are the delayed complications of a fracture?
- osteonecrosis
- DJD
- lead arthropathy and toxicity
- localized osteoporosis
- non-union
- mal-union
What is Volkmann’s contracture?
- immediate complication of fracture
* compartment syndrome in anterior forearm
What is Sudeck’s atrophy?
- immediate complication of fracture
- reflex sympathetic dystrophy syndrome
- severe and painful regional osteoporosis following relative trivial injury
What is synostosis?
bony fusion of 2 bones or across interosseous membrane
How do we diagnose fractures?
- how the injury occurred
- history of trauma
- pain
- no previous symptomatology
- guarding posture
- distressed patient
- swollen, red, guarded
- discontinuity on palpation, haematoma, tenderness, heat, crepitus, spasm
- note neuromuscular status
What are the definitions of dislocation and subluxation?
Dislocation: loss of articulation between bony ends within the joint capsule with disruption of supporting ligaments
Subluxation: partial loss with still partial contact
What are the aetiologies of dislocations and subluxations?
- trauma
- congenital
- pathological
What is the pathology of dislocations and subluxations?
results in muscular imbalance, joint instability, interference with ability of bones to be in right position
What are the clinical features of dislocations and subluxations?
- pain
- deformity
- loss of function
- swelling
- maybe recurrent
- if recurrent, pain becomes minimal
What are the complications of dislocations?
- damages to nerves, blood vessels, capsule, ligaments
* ischaemia, muscle weakness, sensory changes
Which direction does the shoulder and hip usually dislocate?
shoulder: anterior
hip: rarely, but posteriorly
