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Diagnostic Imaging > Fractures/ Fracture Healing > Flashcards

Fractures/ Fracture Healing Flashcards

1
Q

What are 2 types of excessive loading that cause fractures?

A
  • One time events

- Repetitive loading cycles

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2
Q

What are 8 sets of descriptive terms for fractures?

A
  • If skin is broken
  • Anatomic site/ extent of fracture
  • Complete/ Incomplete
  • Fracture segment alignment
  • Direction of the fracture line
  • Special features
  • Associated abnormalities
  • Special types of fractures
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3
Q

What are the terms for skin broken or not broken fractures?

A

Open vs Closed.

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4
Q

What are risks of open fractures?

A
  • Osteomyelitis

- Infection

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5
Q

What are 2 examples of fracture sites with specific names?

A
  • Intertrochanteric

- Supracondylar

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6
Q

How are shafts of long bones divided in terms of naming the fracture?

A
  • Proximal/ middle/ distal thirds
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7
Q

What are the descriptions of fractures near joints?

A
  • Intra-articular (inside joint)

- Extra-articular (Near joint on proximal or distal bone)

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8
Q

What type of fracture can be splinted or casted?

A

An incomplete fracture in which the cortex is partiall intact.

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9
Q

What is a complete fracture?

A

All cortices are disrupted around the circumference of the bone.

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10
Q

How are complete fractures stabilized?

A
  • Fixators
  • Screws
  • Plates
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11
Q

If there are more than 2 complete fractures, how is it described?

A

Comminuted.

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12
Q

How are fracture segment alignments described?

A
  • Distal relative to proximal
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13
Q

What are 5 types of displacement?

A
  • Medial/ lateral
  • Anterior/ posterior
  • Superior/ inferior
  • Rotated
  • Overriding/ distracted
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14
Q

What are terms used to describe the amount of displacement?

A
  • % of shaft, cortex

- Fully

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15
Q

How is angulation described?

A
  • Direction of distal segment.
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16
Q

How is an apex described?

A
  • The point of the two segments of the fracture.
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17
Q

How is the direction of the fracture line described?

A
  • In reference to the long axis of the bone.

Ex) transverse, oblique, longitudinal, spiral

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18
Q

What type of force may cause a transverse fracture?

A
  • Bending
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19
Q

How are transverse and longitudinal fractures aligned to the long axis of the bone?

A
  • Parallel (longitudinal)

- Perpendicular (transverse)

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20
Q

What type of force can cause an oblique fracture?

A
  • Compression on bending and torsion.
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21
Q

What type of force causes a spiral fracture?

A
  • Torsion
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22
Q

What differentiates a spiral fracture from an oblique fracture?

A
  • Sharp edges around vertical segment
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23
Q

What type of force causes an impaction fracture?

A
  • Compressive
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24
Q

What type of bone tends to heal quickly from impaction fractures?

A
  • Cancellous bone

ex) vertebral body, metaphysis

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25
Q

How well do impaction fractures tend to heal generally?

A
  • Quickly

relatively stable fractures

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26
Q

What is a Hill-sachs lesion?

A

Humerus dislocated and impacted on glenoid causing deformation in the humeral head.

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27
Q

What causes an avulsion fracture?

A
  • Tensile loads from ligaments and tendons fracture bone at the site of the attachment.
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28
Q

How are avulsion fractures described?

A
  • Location, and fracture line.
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29
Q

What are 3 common sites of avulsion fractures?

A
  • Deltoid ligament/ malleolus
  • Rectus femoris/ AIIS
  • Achilles/ Calcaneus
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30
Q

What are associated abnormalities with fractures?

A
  • Subluxations

- Dislocations

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31
Q

How longs does it take for a stress fracture to become visible on plain film, and what is visible?

A
  • 2 weeks for bony callus to become visible./
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32
Q

What is a pathologic fracture?

A
  • Fracture due to weakened bony architecture.
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33
Q

What cause periprosthetic fractures?

A
  • Bony adaptations around joint replacements
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34
Q

What can cause a bone graft fracture?

A

Bone grafts.

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35
Q

Why are fractures different in children?

A
  • Bones are more pliable,and structures are incomplete

- Growth plates

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36
Q

What is an incomplete fracture extremely common in children?

A

Greenstick

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37
Q

What is a torus fracture?

A

A common incomplete fracture in children, where one side of a bone buckles in on itself.

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38
Q

What is a plastic bowing fracture?

A
  • Common incomplete fracture in children with a failure at the microscopic level leading to plastic deformation.
  • No distinct fracture line
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39
Q

What type of fracturesare plastic bowing fractures often coupled with?

A
  • Greenstick
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40
Q

What is a type I Salter-Harris (SH) fracture?

A

Fracture transversely through cartilage.

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41
Q

What is a type II SH fracture?

A

Fracture through cartilage and towards into metaphysis.

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42
Q

What is a type III SH fracture?

A

Fracture through cartilage and into epiphysis.

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43
Q

What is another name for a type III SH fracture?

A

Secondary Ossification Fracture.

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44
Q

What is a type IV SH fracture?

A

Through cartilage, and into the metaphysis and epiphysis.

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45
Q

What is a type V SH fracture?

A
  • Compression/ Crush fracture.
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46
Q

What is a type VI SH fracture?

A

Crush on one side of bone/ cartilage.

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47
Q

What is a type VII SH fracture?

A
  • Epiphyseal fracture only.

- Secondary ossification center

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48
Q

What is another name for a type VII SH fracture?

A

Intra-articular fracture.

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49
Q

What is a type VIII SH fracture?

A

Through metaphysis only.

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50
Q

What is a type IX SH fracture?

A

Periosteum tears/ rips.

No other fractures/ crush.

51
Q

How do SH fractures affect angulation deformities in different age groups?

A

According to skeletal maturity/ activity of growth plates.

Very young: High potential
Children: Moderate potential
Adolescence: Lower potential
Adult: No chance.

52
Q

Where do growth deformities due SH fractures usually occur?

A

In under-developed countries.

53
Q

What does the amount of reduction of a fracture depend upon?

A
  • Skeletal age.
54
Q

What type of fractures result in relatively risk free reduction?

55
Q

What are 4 indications for reduction of an open fracture?

A
  • Closed won’t work
  • Intra-articular fracture
  • Blood or nerve compromise
  • Desire early mobility (other joints)
56
Q

What are 4 indications for the use of fixation?

A
  • Avoidance of further injury
  • Maintenance of bone length
  • Maintenance of alignment
  • Allows for calcification of callus
57
Q

What are 3 types of external fixation?

A
  • Casts
  • Splints
  • Fixators
58
Q

What are 3 types of internal fixation?

A
  • Rods
  • Plate nails
  • Screws
59
Q

What is a non-union?

A

When a fracture fails to heal.

60
Q

How is fixation related to nonunion?

A
  • If the fixator bears too much force, then the bone is not sufficiently stimulated to grow/ increase density.
  • Sometimes the bone may undergo significant degradation.
61
Q

What is a malunion?

A
  • Fracture fails to heal properly.
62
Q

What is the treatment for a malunion?

A

Rebreak the bone, and hope it heals correctly.

63
Q

What is a pseudoarthrosis?

A
  • Joint formed at fracture site due to motion./
64
Q

When can it be determined that a pseudoarthrosis has in fact been formed?

A

8 - 12 weeks with no healing.

65
Q

What type of motion is especially detrimental to the healing process?

66
Q

How does the periosteum differ throughout aging?

A
  • Thicker in children

- Thinner and more firmly attached in older persons

67
Q

What are the 3 key roles of the periosteum in fracture healing?

A
  • Reducing and aligning the fracture
  • Maintaining (stabilizing) the fracture
  • Serving as an osteogenic sleeve. (chondroblast and osteocyte supplier)
68
Q

What tissue plays a large role in the rate and success of healing of fractures?

A

Periosteum.

69
Q

If a fracture is suspected during a clinical exam, what are the next steps?

A
  • Take thorough history to determine if there
  • Splint/ cast fracture
  • Send to orthopod
  • Confirm with radiograph
70
Q

In whom are fractures always noticed? Who may miss them?

A
  • The patients without sensory deficits always know

- Radiographs may deliver a false negative

71
Q

In acute trauma situations, what is the fracture of secondary importance to?

A
  • Circulatory concerns

- Neural concerns

72
Q

What is unique about bone healing?

A

It heals with bone instead of scar tissue.

73
Q

When does primary bone healing occur?

A
  • When both ends of the fracture are compressed together and held rigidly by an internal or external fixation.
74
Q

What is the mechanism of primary bony healing?

A

No callus is formed. Cortices heal directly into one another.

75
Q

Is secondary or primary bone healing a faster process?

76
Q

What is the 7 step process of secondary bony healing?

A
  • Hemmorage of ruptured blood vessels in haversian system, periosteum, and endosteum
  • Clot formation
  • Proliferation of osteogenic cells from periosteum and endosteum (lining haversian canals) near and distant from the fracture site
  • Pro-callus/ fibrous union formed by the entrance of dense fibrous tissue into the clot
  • External callus formed from osteogenic cells in periosteum, and internal callus formed from cells in endosteum
  • Cartilagenous callus gradually replaced by woven bone (high O2 tension), or by endochondral ossification (low O2 tension); both can happen in same fracture
  • Lamellar bone forms over woven bone, and excess bone is resorbed
77
Q

In an external callus, which portion has woven bone, and which portion is cartilaginous; why?

A

Edges: Woven due to high O2 tension (periosteum)
Center: Cartilaginous due to low O2 tension

78
Q

Why is the internal callus created directly from woven bone?

A

Many blood vessels in haversian canal lead to high O2 tension.

79
Q

How are the internal and external callus united?

A

By woven bone bridges, and endochondral replacement within cartilaginous callus.

80
Q

How long does it take for excess bone in callus to be partially or completely resorbed?

A

1 - 5 years.

81
Q

In what types of bones does spongy bone healing occur?

A
  • Metaphyses or cuboidal bones
82
Q

What is the 4 step process of spongy bone healing?

A
  • Osteogenic cells from endosteum of trabeculae invade hematoma and laydown woven bone
  • Healing begins at points of direct contact, and then spreads to bridge gaps
  • Woven bone is replaced by lamellar bone
  • Trabecular patterns according to the time average force patterns of Wolf’s law.
83
Q

How much distraction leads to a probability of 50 % fracture healing?

A

Gap of 1/2 bone diameter.

84
Q

What amount of distraction has a less than 5% probability of healing?

A

Exceeds bone diameter.

85
Q

How much distraction leads to a greater than 98 % change of fracture healing?

A

Direct contact.

86
Q

What healing processes are interrupted by distraction?

A

Osteogenic cells from periosetum and endoosteum do not invade the clot causing a procallus.

87
Q

What amount of linear displacement leads to a >98 % chance of fracture healing?

A

Any amount of lateral displacement up to only 20% overlap.

88
Q

How much does the fracture healing probability drop by when 20 % contact is lost due to linear displacement?

A

50 % chance of healing (48 % drop)

89
Q

What is the probabilty of fracture healing when the total displacement has exceeded the total linear displacement by 20%?

90
Q

What degree of angular displacement leads to a delay in the union of bone?

A

45 degrees.

91
Q

What is the delay in healing at 45 degrees of angular displacement due to?

A

Motion between the fragments.

92
Q

What is the most common factor that prevents healing?

A

Shear motion.

93
Q

What factor determines the amount of shear required to disrupt healing?

A

The closer the fracture edges are approximated, the less amount of shear is required to damage healing.

94
Q

Does shear refer only to side-to-side shear?

A

No; it also refers to torsional shear.

95
Q

What amount of flexion must occur to slow healing?

A

Over around 20-30 degrees of flexion.

96
Q

Flexure is not a huge factor on healing; what surprising effect does it have on some patients? Why does this occur?

A

Flexure strains can actually help to build a strong callus due to bioelectrical input/ Wolf’s law.

97
Q

What steps of healing can flexure interrupt?

A

The replacement of calluses with woven bone.

98
Q

What steps of the healing process does pistoning interrupt?

A
  • Clot formation
  • Osteogenic cell infiltration
  • Forming a fibrous callus
99
Q

What 4 factors affect the duration of fracture healing?

A
  • Age of the patient
  • Site and configuration of the fracture
  • Initial displacement of the fracture
  • Blood supply to fracture fragments
100
Q

What heals faster: bones surrounded by muscle, or subcutaneous bone?

A

Bone surrounded by muscle.

101
Q

At what site does bone heal very slowly?

A

In joints.

102
Q

Does cancellous or cortical bone heal faster?

A

Cancellous.

103
Q

Do metaphyseal or epiphyseal fractures heal faster?

A

Epiphyseal.

104
Q

Do long oblique/spiral or transverse fractures heal faster?

A

Long oblique/ spiral.

105
Q

Why does initial displacement of a fracture affect healing?

A

There is a greater tear of the periosteal tissues.

106
Q

What occurs if one of two or more fractures lose its blood supply during healing?

A

The dead bone acts as a framework for new bone due to osteogenic cells from the vascularized segment.

107
Q

What is required to assist in the healing process if one of the bones is devascularized?

A
  • Rigid immobilization

- Prolonged period of time

108
Q

What may occur if both fragments lose their blood supply? How is this treated?

A
  • Bone may die and become resorbed into the body before it can heal.
  • Prosthetic bone required.
109
Q

When is a bony callus visible on x-ray generally?

A

2 - 3 weeks.

110
Q

When do unions form in the UE, and LE? What activity is indicated?

A

UE: 4 - 6 weeks
LE: 8 - 12 weeks
Functional/ non-sport use

111
Q

When does consolidation occur in the UE and LE? What does this indicate?

A

UE: 6 - 8 weeks
LE: 12 - 16 weeks
Bone is secure.

112
Q

If there are symptoms of a fracture, but they do not appear on radiographs, how do you treat the patient?

A

As though they have a fracture.

Re-eval with radiographs in 1 - 2 weeks.

113
Q

What are the PT’s responsibilities immediately post-fracture?

A
  • Provide first aid, ICB, splinting

- Get to ER, or orthopod depending on severity

114
Q

What is not the PT’s responsibility in an acute fracture?

A

DO NOT REDUCE THE FRACTURE.

115
Q

What should a patient bring to the PT post acute care?

A
  • Referral
  • Letters from MD
  • Radiographs and radiologist’s reports
  • Exercise/ instructions of MD
116
Q

What 4 factors should be considered by a PT in post-acute care of fractures?

A
  • History
  • Present activity allowed
  • Physical exam
  • Treatment
117
Q

What should be included in the history related to the fracture?

A
  • When
  • Where
  • How
  • Immediate treatment taken for fracture
118
Q

If present activity allowed is not consistent with normal time frames for fractures, what should be done?

A

Contact MD.

119
Q

What other situations would lead to contact of the MD related to present activities allowed?

A

WB, motion not included on referral.

120
Q

What should a physical exam of a fracture include?

A
  • Active, passive, resistive and neurological tests above and below fracture site
  • Posture/ gait screening
  • Adaptive equipment considerations
  • May test for union, but very carefully
121
Q

What does treatment of a fracture consist of?

A
  • Findings of physical exam
  • Cause of joint ROM restriction
  • Weakness
  • Muscle shortening
  • Problems with joint itself
  • CV training
122
Q

What should be considered when evaluating an ROM limitation?

A
  • Weakness?
  • Muscle shortening?
  • Joint problem?
123
Q

Why muscle the choice of exercise be carefully considered?

A

Muscles put a huge amount of force through the bone.

Diagnostic Imaging (14 decks)

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