fractures and osteomyelitis

Question 1

fracture

Answer 1

any break in continuity of bone that occurs when more stress is placed on bone than it can absorb

Question 2

causes of fx

Answer 2

traumatic (direct/indirect)
fatigue
pathologic (weak, high risk elderly)

Question 3

how do you describe a fx

Answer 3

name of bone
location
orientation of fx (spiral)
alignment of fx (displaced or aligned)
condition of overlying tissue (open vs. closed)

Question 4

what is another name for a open fx

Answer 4

compound

bone penetrates skin

Question 5

what is another name for a closed fx?

Answer 5

simple

does not break skin

Question 6

types of fx orientation

Answer 6

transverse ( straight across)
spiral (twist)
longitudinal (longways)
oblique (side)
impacted (overlapping)
greenstick (kids, not complete)
stress (elderly)
avulsion (bone pulled away from tendon)

Question 7

what does P.E.D stand for with fx

Answer 7

P- pain
E- edema
D- deformity (loss of function, abnormal mobility)

Question 8

complication of delayed union

Answer 8

bone pain and tenderness increase

Question 9

complication of malunion

Answer 9

improper alignment

Question 10

complication of nonunion

Answer 10

no healing 4-6 months post fx

causing poor blood supply, repetitive stress

Question 11

what types of injuries is compartment syndrome seen with?

Answer 11

crush injuries
cast
long bone injuries
severe thermal burns
animal bites

Question 12

what causes compartment syndrome?

Answer 12

increased pressure within limited anatomic space
causes a tourniquet effect
puts intense pressure on soft tissue
can lead to tissue hypoxia of muscles and nerves

Question 13

what is the cycle of compartment syndrome?

Answer 13

initial injury
tissue swelling
increased compartment pressure
decreased perfusion pressure
local hypoxia
cell membrane damage

Question 14

what is fat embolism syndrome

Answer 14

fat molecules in the lung following a long bone fx, major trauma
typically occurs 24-48 hrs after injury

Question 15

where do fat embolisms come from?

Answer 15

fat molecules from bone marrow or traumatized tissues

released into blood stream and travels to lungs

Question 16

traid of manifestations of fat embolisms

Answer 16

hypoxemia
altered LOC
petechiae

Question 17

osteomylitis

Answer 17

an acute or chronic pyogenic (pus producing) infection of the bone
usually caused by bacteria (s. aureus)

Question 18

risk factors for osteomylitis

Answer 18

recent trauma
DIABETES
hemodialysis
IV drug abuse
splenectomy
PVD

Question 19

types of direct route of contamination in osteomyelitis

Answer 19

open wound
open fx
gunshot 
puncture
surgery
insertion of metal plates or screws

Question 20

types of hematogenous (indirect) routes of contamination in osteomylitis

Answer 20

most common type
from blood stream
bacteremia
hands, feet, femur, humerus, fibula

Question 21

hematogenous route pathogenesis

Answer 21

arterial blood flow brings bacteria to bone
infection results (inflammation, bone destruction, pus and edema)
pressure increases
ischemia/necrosis
osteoblasts lay new bone around old bone
infection is isolated

Question 22

what happens when the pressure inside the bone is the same as arterial flow?

Answer 22

local arteries collapse

meaning no oxygen, nutrition, immune cells, ANTIBIOTICS

Question 23

what happens when local arteries collapse due to bone pressure?

Answer 23

impaired healing

Question 24

clinical manifestations of local osteomylitis

Answer 24

local tenderness, redness
wound drainage
restricted movement
spontaneous fractures

Question 25

clinical manifestations of systemic osteomylitis

Answer 25

spiking fevers
positive blood culture
leukocytosis

Question 26

empiric therapy of osteomylitis

Answer 26

nafcillin
cefazolin
vancomycin
*bacteria specific

Question 27

osteomyelitis complications

Answer 27

chronic osteomyelitis
local spread of infection
reduced limb or joint function