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Lecture Notes- Orthopaedics and Fractures > Fractures and Healing > Flashcards

Fractures and Healing Flashcards

1
Q

What is a comminuted fracture

A

A fracture with more than 2 fragments

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2
Q

What usually causes a transverse fracture

A

when a force is applied directly to the site at which the fracture occurs

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3
Q

What can cause a spiral or oblique fracture

A

a twisting force applied distant from the site of fracture (e.g. each end of a long bone such as a tibia)

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4
Q

Who do greenstick fractures occur in

A

children whose bones are soft and yielding

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5
Q

Describe the appearance of a greenstick fracture on x ray

A

the bone bends without fracturing across completely - the cortex on the concave side usually remains intact

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6
Q

What causes a crush fracture

A

compression force

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7
Q

where do burst fractures occur and how

A

short bones e.g. vertebra

strong direct pressure, usually occurs as a result of impacting of the discs

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8
Q

What causes an avulsion fracture

A

traction

a bony fragment is torn off by a tendon or ligament

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9
Q

What is a fracture dislocation or subluxation

A

a fracture which involves a joint and results in malalignment

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10
Q

What is an open fracture

A

a surface wound that communicates with a fracture

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11
Q

Why do open fractures need urgent treatment

A

They can become infected

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12
Q

When is a fracture termed complicated

A

wen there is involvement of important soft-tissue damage e.g. nerves, vessels or internal organs

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13
Q

When is a fracture impacted

A

when the fragments are driven into one another

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14
Q

Are impacted fractures stable or unstable

A

Stable

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15
Q

What is an unstable fracture

A

a fracture which is displaced or has the potential to displace

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16
Q

What is an intra-articular fracture

A

one in which the fracture involves the joint surfaces

17
Q

What classification is used for epiphyseal injuries

A

Salter and Harris (I-V)

18
Q

What is the commonest type of epiphyseal fracture

A

Type 2 - the fracture line runs across the epiphyseal line and the obliquely shearing off a small triangle of metaphysis

19
Q

What types of epiphyseal fractures have a good prognosisi

A

The first 3 types

20
Q

What might a type 3 epiphyseal fracture require and who does it occur most commonly in

A

Open reduction and pinning

older children and adolescents

21
Q

What is the commonest symptom of a fracture

A

Pain

22
Q

What are the 6 clinical signs you need to look for in a suspected fracture

A 
Tenderness
Deformity 
Swelling 
Local temperature increase
Abnormal mobility or crepitus 
Loss of function
23
Q

Why does swelling in a fracture occur

A

Gross swelling - due to vascular rupture

Small - due to haematoma, and due to inflammatory exudation

24
Q

How many planes should X rays be taken in

A

at least 2 - at right angles

25
Q

What are the benefits of using an Xray for fractures

A

It localises it and determines the number of fragments
Indicates the degree and direction of displacement
Provides evidence of pre-existing disease of the bone
May show foreign body
May who unsuspected fracture
May show air in the tissues - Penetrating injury

26
Q

What is the ultimate aim of fracture healing

A

Cortex-cortex union

27
Q

How are many fractures joined initially

A

By a cuff of provisional woven bone known as a callus

28
Q

What is responsible for the slow growth of new bone across the fracture gap

A

Late medullary callus

29
Q

What might inhibit late medullary callus

A

intramedullary internal fixation

30
Q

Describe the appearance of the callus if a fracture is fixed rigidly

A

almost none is seen

31
Q

Why do man fixation devices allow some movement to occur

A

Due tot he potential for rigid fixation to delay union

32
Q

How long does clinical union of a long bone normally take in an adult

A

3-4 months

33
Q

What happens after clinical union

A

Remodelling to produce cancellous and cortical bone with normal trabecular orientation

34
Q

Describe how fractures heal

A

Ina similar way to soft tissue but the migrating cells have osteogenic potential and sometimes cartilage is laid down as an intermediate step

35
Q

Describe the changes to a fracture site from onset - 12 months

A

Onset - break in periosteum and clot forms between 2 fragments
1 week - Clot retracts and active osteoblasts move in
3 weeks - cartilage and osteoid are laid down
6-12 weeks - Callus is formed
6 months - Callus size reduces and looks more normal
12 months - complete radiological union and cortex to cortex union

Lecture Notes- Orthopaedics and Fractures (23 decks)

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