Fractures and Sprains Flashcards
Classifications of bones?
Compact (cortical), spongy bone (trabecular)
Why do we use casts? Should you be immobilized?
Casts are for maintaining position, you should bear weight/ move as soon as possible to allow for bone rebuilding
Regulation of bone remodelling and resorption - factors
RANK, RANK L (binds to RANK triggers the clasts, OPG (blocks RNAK L protects bone) PTH - triggers clasts if calcium is low
Estrogen (stimulates apoptosis of clasts), Vit D (activates blasts), Ca++, corticosteroids (increase clast lifespan), bisphosphonates (block clasts)
Stages of secondary bone healing?
- Inflammatory (1-5) - hematoma forms and release of cytokines, can put local into the hematoma
- Fibrocartilage callus formation (5-11), angiogenesis, rejoins fracture
- Bony callus formation (11-28) - RANK L stimulated bone formation
- Bone remodelling (18 onwards) - woven bone replaced by laminar bone
NSAIDs good vs bad in the bone healing process
Not great, decrease cytokines the inflammatory phase. But still used all the time.
What is primary bone healing?
Only happens if fixed - less than 1mm apart only with surgical plating. Reestablishes cortex without a callus.
Adverse factors effecting healing?
Infection, poor blood supply, malnutrition, obesity, Immuno suppression, age, smoking, drugs, diabetes
Types of fracture
Traumatic , pathologic, stress, Salter-Harris
Stable vs Unstable spinal #
Stable - anterior column, no NVS symptoms, not moving around
Unstable - mid/posterior columns, NVS, moving around on palpation
Triad of fat emboli sx?
Petechial rash, decreased LOC and SOB, more common in femoral fracture, not to do with BMI, supportive management
Guidelines for BMD?
<50 - medications put at risk
50-64 - pre-existing conditions
All adults over 65 - 5-10 years if low risk
Cancer Mets to bone? Locations?
Breast, kidney, lung, prostate , most common to spine and pelvis
Ankle fracture vs sprain?
Is the pain right on the tip of the malleolus or is it more posterior, not on the bone
If sprain not on bone, give crutch and wrap
Waking boot for #
Describing a fracture?
Say the anatomic location, whether closed or open fracture, simple or compound, complete or incomplete, direction and degree of angulation, stable or unstable,
vascular and neurological impairment of an injury for documentation or referral purposes
Comminuted fractures vs segmental
Comminuted - multiple fragments per fractured part
Segmental - one fragment per complete fractured part
Risk factors for osteoporosis?
Smoking, poor diet, low body weight, Fhx
Female, post-menopausal, inactivity, drug use (steroids)
Osteoporosis BMD criteria?
> 2.5 SD from mean, usually female and over 50
How do you measure BMD?
Dexascan
Can use screening tools FRAX and CAROC for fracture risk
Tx of low risk (of #) osteoporosis?
Calcium (1000-1200) and vitamin D - 5-10 years BMD
Tx of high risk osteoporosis?
( or already had a fracture)
Initiate on bisphosphonates or prolia, BMD ever 1-3 years
Bisphosphonates (alendronate) - 1st line in males
Denosumab - 1st line in females (if poor renal function can use zoledronic acid)
Raloxifene - for post-menopausal (estrogen agonist)
Canadian C-spine rule?
If greater than 65, dangerous mechanism (fall from heights, axial load, MVC (high speed)) or parasthesias need CT
Possible scaphoid fracture?
Tenderness over the anatomical snuffbox, FOOSH, may not see initially on X-ray
Put in a thumb spica, for 4 weeks check on every weeks operate if displaced.
Ottawa ankle rules
Bone tenderness at the post tip of the lateral or medial malleolus inability to bear weight
Indications for ORIF
Non-union Open fracture Neurovascular compromise Displaced Inara articular Salter Harris (3-5) Poly trauma
Pulled elbow or nursemaids elbow?
Seen in children - yanked up by elbow
Salter-Harris Fracture?
Paediatric fracture of the growth plate
Stage 1 - just a plate separation Stage 2 - + transverse fracture Stage 3 - through the epiphysis and growth plate separation Stage 4 - + transverse fracture Stage 5 - crush injury
Colles fracture?
Fracture of the ulna with radial displacement - FOOSH
Most commonly sprained ankle ligament?
ATF
Boxer’s fracture?
From punching something, 5th metacarpal
What is a greenstick fracture?
Disruption of the cortex and the periosteum on the side of tension but it is intact on the other side - involves angulation
In kids because their bones are still flexible
Maisonneuve fracture
Separation of the ankle mortise, fracture of the fibular and ligamenous injury
