Fractures And Fracture Healing Flashcards
First stage of healing
Haematoma
Bleeding from lacerated medullary vessels-> coagulates
Osteophytes near the # surface a deprived of nutrients -> necrosis -> acute inflam response -> granulation tissue
Second stage of healing
Organisation
Capillary and fibroblast proliferation-> fibrovascular granulation tissue
Osteoproginstor cells differentiate into osteoblasts and migrate into granulation tissue
2 weeks
Third stage of healing
Callus formation
Osteoblasts synthesises osteoid -> calcified to form callus off woven bone
3-6w
Fourth stage of healing
Modelling
Osteoblasts and osteoclasts activity-> woven bone is replaced by lamellar bone
1-2y
Fifth stage of healing
Remodelling or completion
Under load the bone is strengthen under lines of stress
1-2y
risk fractures
Age Females BMI PH FH osteoporosis Smoking RA Alcohol Corticosteroids Osteomalacia
Fracture classification
1) open/closed
2) type
3) location
4) displacement
5) angulation
6) anything else
Fracture types
Transfers Oblique Spiral Commuinuted >2 parts Bowing Buckle-> # on the concave surface Green stick-> # on the convex surface
Fracture location
Diaphysis-> shaft
Metaphysis -> by growth plate
Epiphysis-> end of bone
Articular-> involves joint
Open fracture management
Take photos and cover with sterile dressing Antibiotics and tetanus Stabilise Analgesia Check neurovascular status X Ray
Early fracture complications
Skin damage Nerve compression/damage -numeral shaft-> radial nerve -supra condylar humeral-> ant. Interosseous/median nerve -distal radius-> median -posterior acetabulum-> sciatic Blood vessel injury -loss -ischaemia Infection Compartment syndrome Thromboembolism Fat embolus
Compartment syndrome clinical features
Muscle swelling with a facial compartment-> occluded capillaries-> ischaemia
Unusually bad untreatable pain
Increased pain on passive stretching
No pulses and parasthesia-> late signs
Tibial shaft or forearm
Remove any compression -> 15 mins -> decompress
BP/compartment pressure >30
Late complications
Delayed/non Union 5%
Mal Union-> inadequate reduction/stabilisation
Post traumatic osteoarthritis
A vascular necrosis -> femoral neck, scaphoid, tallus
Complex regional pain syndrome
Risk factors for non Union
Smoking Alcohol Age Steroids DM Chronic renal failure High enters # Open # Infection Bone loss Fixation failure
Complex regional pain syndrome clinical features
Burning/ crushing pain Usually upper limb, foot or ankle Red, swollen and shiney Excessive joint stiffness Idiopathic
CBT
Physio
Analgesia
