Fractures and dislocations Flashcards

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1
Q

What is the definition of a fracture?

A

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

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2
Q

What is an open vs closed fracture?

A

open: penetrates the skin over the site
closed: doe not break the skin

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3
Q

What is a comminuted vs non-comminuted fracture?

A

comminuted: > 3 fragments

non-comminuted: < 3 fragments

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4
Q

What is a complete vs incomplete fracture?

A

complete: into 2 pieces
incomplete: not into 2 pieces,; remain attached (bent or buckled)

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5
Q

What is an avulsion fracture?

A
  • tearing away of bone from forceful muscular / ligament pulling
  • corner / chip fracture
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6
Q

What is an impacted fracture?

A
  • impaction into another, giving shortening
  • seldom visualized, white line
  • depression fracture or compression fracture
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7
Q

What is a depression fracture?

A
  • type of impacted fracture
  • inner bulging of outer bone surface
  • tibial plateau
  • frontal bone
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8
Q

What is a compression fracture?

A
  • type of impacted fracture in the spine only
  • trabecular telescoping
  • following forceful hyperflexion injury
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9
Q

What is a compound fracture?

A

other name for open fracture

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10
Q

What is a simple fracture?

A

other name for closed fracture

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11
Q

What is a torus fracture?

A
  • type of incomplete fracture
  • long axis forces make buckling of the cortex
  • in metaphysis
  • very painful
  • FOOSH
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12
Q

What is a greenstick fracture?

A
  • type of incomplete fracture
  • perpendicular forces make bending
  • disruption of cortex on one side
  • paediatrics under age 10
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13
Q

What is a stable fracture?

A

does not move during healing

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14
Q

Where can an unstable fracture occur?

A

C1 broken in 3 parts

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15
Q

What forces cause spiral fracture?

A

torsional + compression + angulation

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16
Q

What is a stress fracture?

A
  • repetitive stress causes gradual formation of micro fractures at greater rate than reparative process
  • often starts as occult fracture
17
Q

What is an occult fracture?

A
  • clinically evident but not radiologically until 10 days post
  • ex. scaphoid, ribs
18
Q

What is an insufficient fracture?

A

stress fracture in diseased bone

19
Q

What is the definition of a pathological fracture?

A

normal force acting on a weekend bone and breaking it

20
Q

What is fracture alignment?

A
  • position of distal fragment in relation to proximal fragment
  • good alignment = no perceptible angulation
21
Q

What is fracture apposition?

A
  • closeness of bony contact at the fracture site
  • good = complete surface contact
  • partial = partial contact
  • separation = distraction
22
Q

What is fracture rotation?

A
  • rotational deformity

* rotational malposition

23
Q

What are the 3 phases of fracture repair?

A

1) circulatory / inflammatory phase
2) reparative / metabolic phase
3) remodelling / mechanical phase

24
Q

List the events that occur during fracture repair

A
  • 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)
25
Q

What are the immediate complications of a fracture?

A
  • Arterial injury
  • Neural injury
  • Compartment syndromes
  • Gas Gangrene
  • Fat embolism
  • Thromboembolism
26
Q

What are the intermediate complications of a fracture?

A
  • osteomyelitis
  • failure of hardware
  • reflex sympathetic dystrophy syndrome
  • post-traumaticosteolysis
  • re-fracture
  • myositis ossificans
  • synostosis
  • delayed union
27
Q

What are the delayed complications of a fracture?

A
  • osteonecrosis
  • DJD
  • lead arthropathy and toxicity
  • localized osteoporosis
  • non-union
  • mal-union
28
Q

What is Volkmann’s contracture?

A
  • immediate complication of fracture

* compartment syndrome in anterior forearm

29
Q

What is Sudeck’s atrophy?

A
  • immediate complication of fracture
  • reflex sympathetic dystrophy syndrome
  • severe and painful regional osteoporosis following relative trivial injury
30
Q

What is synostosis?

A

bony fusion of 2 bones or across interosseous membrane

31
Q

How do we diagnose fractures?

A
  • 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
32
Q

What are the definitions of dislocation and subluxation?

A

Dislocation: loss of articulation between bony ends within the joint capsule with disruption of supporting ligaments

Subluxation: partial loss with still partial contact

33
Q

What are the aetiologies of dislocations and subluxations?

A
  • trauma
  • congenital
  • pathological
34
Q

What is the pathology of dislocations and subluxations?

A

results in muscular imbalance, joint instability, interference with ability of bones to be in right position

35
Q

What are the clinical features of dislocations and subluxations?

A
  • pain
  • deformity
  • loss of function
  • swelling
  • maybe recurrent
  • if recurrent, pain becomes minimal
36
Q

What are the complications of dislocations?

A
  • damages to nerves, blood vessels, capsule, ligaments

* ischaemia, muscle weakness, sensory changes

37
Q

Which direction does the shoulder and hip usually dislocate?

A

shoulder: anterior
hip: rarely, but posteriorly