Fractures- Ayers Flashcards
Discuss difference between Non-articular vs. Intra-articular fractures
Non-articular fractures do not involve the joint surface.
Intra-articular fx involve the joint surface (articular surface) and can lead to post-traumatic arthritis.
Name the different fracture (fx) patterns.
- Spiral
- Oblique
- Transverse
Name different types of Diaphyseal Fractures
Type A:
-Simple fracture with 2 fragments
Type B:
-Butterfly fracture with a free wedge of bone
Type C:
- Comminuted fracture
- Complex
- Contact lost between the bone fragments.
Fracture healing, Infection and amputation rate are a function of what?
Degree of Soft tissue injury
Note: We must also evaluate degree of Periosteal stripping in the OR.
Describe Type I Open Fracture
- Inside out injury (fractured bone penetrating through skin).
- Minimal soft tissue damage
- Periosteum is minimally damaged
Describe Type II Open fracture
- Inside out or Outside in mechanism
- Moderate soft tissue damage
- Some necrotic muscle
- Some Periosteal stripping
Describe a Type IIIA Open Fracture
- Outside in injury
- Extensive muscle devitalization
- Bone coverage with existing soft tissue is not a problem.
Describe a Type IIIB Open fracture
- Outside in injury
- Extensive muscle devitalization
- Requires a local or free flap for bone coverage and soft tissue closure.
- Periosteal stripping
Describe a Type IIIC Open fracture
- High energy
- Major vascular injury requiring repair
- High risk for infection and/or amputation
What is Comminution?
The amount of bone fragments from the fracture.
Will most fractures heal without intervention?
Yes.
Exceptions: (Confirm this)
- Ribs and Clavicles
- Nonunion model difficult to create.
Note: Intervention is aimed at putting bone is best realignment to achieve the best functional outcome.
Fractures that heal non-operatively occur via what?
Callus:
-Which is highly vascularized bone growth that appears around the fracture site.
Name the 2 factors required for bone healing.
- Good blood supply
- Good mechanical stability
Name the 3 blood supplies of Long bones
- Nutrient artery (intermedullary)
- Periosteal vessels
- Metaphyseal vessels
Name 2 mechanisms of Bone formation
- Endochondral
2. Direct bone formation (Cutting Cones)
What are the 6 Stages of Fracture healing?
- Impact
- Induction (Hematoma formation leading to inflammatory cells)
- Inflammation
- Soft Callus (Chondroid matrix)
- Ossification (Woven bone formation)
- Remodeling (Lamellar bone formation)
What is Endochondral bone formation?
- Process by which Long bones grow in length.
- Cartilage laid out. Chondrocytes then hypertrophy, degenerate, and ossify.
- Vascular invasion occurs followed by ossification
What is Endochondral (indirect) bone formation?
- Mechanism for healing fractures that are not rigidly fixed.
- Most common
- Bridging periosteal soft callus comes into communication with medullary hard callus
- Ossification takes place
- Rapid process (weeks)
What is Direct bone healing? Timing?
-Method of bone healing when the fracture is rigidly fixed with no internal movement.
- Fracture callus is not formed. Lamellar bone laid down instead.
- Osteoblasts originate from endothelial and perivascular cells.
-Slow process (months to years).
Describe mechanism of Direct bone healing
- Cutting cone formed that crosses fracture site.
- Osteoclasts at tip of cone that chisel path
- Osteoblasts at tail of cone that lay down Lamellar bone. - Fracture site is gradually healed by formation of Secondary osteons.
Note: Very slow process (months to years).
What is Contact Healing?
- Direct Bone Healing
- Direct contact between the fracture ends allow healing to be with Lamellar bone immediately.
Note: There is no cartilage or soft callus intermediate.
What is Gap Healing?
-Gaps less than 200-500microns are initially filled with Woven bone that is remodeled into Lamellar bone over time.
- Larger gaps are healed by Indirect Bone healing.
- Therefore, filled with a fibrous tissue that is ossified over time (Secondary Ossification).
What is BMP2?
- Bone morphogenic protein 2.
- Available to surgeons to stimulate bone formation in patients.
Are most fractures Closed or open?
-Closed (76.5% of them)
