Fractures, Fracture Repair, And Fracture Healing

Question 1

Fracture risk factors

Answer 1

Decreased bone density and muscle mass, increased age, female, vitamin D deficiency, chronic medical conditions, medications, poor nutrition, lack of physical activity, tobacco use, alcohol use

Question 2

Subluxation

Answer 2

Partial disruption of joint

Question 3

Dislocation

Answer 3

Complete disruption of a joint

Question 4

Fracture

Answer 4

Break in bone continuity

Question 5

Fracture dislocation

Answer 5

Disruption of bone and disruption of a joint occur simultaneously

Question 6

Open fracture

Answer 6

Skin is no longer intact

Question 7

Closed fracture

Answer 7

Skin is still intact

Question 8

Transverse fracture

Answer 8

Horizontal line across the bone (perpendicular to bone)

Question 9

Oblique fracture

Answer 9

Diagonal fracture across bone

Question 10

Spiral fracture

Answer 10

Fracture around bone in a spiral shape

Question 11

Distracted fracture

Answer 11

Fracture resulting in lengthening bone due to widening of bone components

Question 12

Impacted fracture

Answer 12

Shortening of bone length due to bones being shoved against each other

Question 13

Simple fracture

Answer 13

One fracture, two total fragments

Question 14

Comminuted fracture

Answer 14

Three or more fragments due to multiple fractures

Question 15

Complete fracture

Answer 15

Fracture goes through the bone, end to end

Question 16

Incomplete fracture

Answer 16

Fracture is present, but does not go end to end. Common in children, can be bowing, buckle, or greenstick

Question 17

Displaced fracture

Answer 17

Pieces no longer lined up, displaced either medial or lateral from midline, distance described as either measurement or as shaft widths

Question 18

Angulation of fractures

Answer 18

Apex angulation (lateral) measured from normal bone to displaced bone, angulation of the distal fragment (medial) is measured just the opposite

Question 19

Intra-articular fractures

Answer 19

Fracture extends into the joint

Question 20

Extra-articular fractures

Answer 20

Fracture is not in the joint

Question 21

Pathologic fractures

Answer 21

Occur in abnormal bone as a result of tumor or infection

Question 22

Fracture repair

Answer 22

Immobilize, possibly with hardware (plates, nails, screws, etc)

Question 23

Bone healing (within 48 hours of injury)

Answer 23

Inflammatory cells arrive

Question 24

Bone healing (7-14 days)

Answer 24

Granulation tissue forms between fragments with vascularization of hematoma, radiograph shows lucency and softening of fracture

Question 25

Bone healing (4-16 weeks)

Answer 25

Progenitor cells differentiate into fibroblasts and chondroblasts, produce matrix of fibrous tissue and cartilage, woven bone is deposited by osteoblasts, callus seen in radiograph

Question 26

Bone healing (months)

Answer 26

Woven bone is replaced by lamellar bone

Question 27

Bone healing (months to years)

Answer 27

Remodeling, can continue as long as 7 years

Question 28

Bone healing in children

Answer 28

Much more accelerated in children than in adults (due to presence of periosteum), healing time basically half of adult

Question 29

Complications of healing

Answer 29

Delayed union, non-union, malunion

Question 30

Delayed union

Answer 30

Fracture healing takes about twice as long as it should

Question 31

Non-union

Answer 31

AKA pseudoarthrosis, fracture healing does not occur within 6-9 months, can be hypertrophic (huge callus, but no healing), oligotrophic (no callus, rounded fracture ends), atrophic (bone resorption due to infection or impaired blood supply), or infected

Question 32

Malunion

Answer 32

Healing in abnormal position

Question 33

Hardware complications

Answer 33

Loosening, peri-hardware fracture, hardware fracture, infection, particle disease