Fractures (trauma, stress, pathological) incl. classifications, radiology, management, complications, healing and stability Flashcards
What are the three types of connective tissues?
- Bony -osteoid made by osteoblasts
- Cartilagenous - chondroid made by chondroblasts
- Fibrous - collagenous tissue made by fibroblasts
What types of collagen are found in skin and bone?
Skin - types I and III
Bone - types I
Hyaline cartilage - type II
What are the parts of a long bone? Which part is most metabolically active?
Epiphysis, metaphysis (near epiphyseal lin) and diaphysis
Metaphysis is most metabolically active
What orientation do pathological fractures usually have?
They are usually transverse
Does bone growth occur equally along the bones?
No - ‘to the elbow I grow, from the knee I flee’
Bone growth is more active at the farthest ends from the elbow and nearest to the knee
What are the types of joints?
- Fibrous joints/syndesmoses
- Cartilaginous joints/synchondroses
- Synovial joints - allow greatest mobility
What is hilton’s law?
The nerve supply of a joint is the same as that of the overlying muscles moving the joint and the skin over the insertions
What is the name for an injury where skin is sheared from the deeper layers?
Degloving injury
How are gunshot wounds classified and which are more common?
Low-velocity - more common e.g. by handgun or revolver
High-velocity e.g. assault rifle
Why are high-velocity gunshot wounds more dangerous despite looking innocent?
Phenomenon known as cavitation
Organs are pulled along the path of the bullet
Air/debris may be sucked in causing more contamination
What is a comminuted fracture?
When bone is broken into more than 2 fragments
What are the different ways of describing fracture type?
Transverse - usually due to force applied directly to the site
Spiral or oblique fracture - due to twisting force
Greenstick - cortex on concave side usually remains intact
Crush fracture - cancellous bone due to compression fracture
Burst fracture - usually in short bone like vertebrae due to impaction of the disc
Avulsion - caused by traction and bony fragment torn off by tendon/ligament
Fracture dislocation/subluxation - malalignment of joint surfaces
What is a ‘complicated’ fracture?
One that is associated with damage to nerves, vessels or internal organs
What type of fracture?
Crush fracture
What is the difference between dislocation and subluxation?
dislocation is a complete loss of congruity of the joint surfaces
subluxation is a partial loss of contact of the joint surface
What type of fracture?
Burst fracture
Summarise the salter-harris classification.
In the stages of fracture healing when does callus formation occur? What about complete radiological union?
What are the 3 main principles of fracture management?
- Reduce
- Immobilise/maintain reduction
- Rehabilitate
Should open fractures be closed straight away?
No - risk of infection needs to be eliminated first, sepsis excluded
Sometimes closure can be done early if there is little contamination and the open fracture is less than 6 hours old
What are the reasons for fracture reduction?
- Cosmesis
- Function
- Mobility
- Union
- Neurovascular compromise
What are the advantages and disadvantages of the plaster of Paris?
What are the types of fracture reduction?
- Manipulation under anaesthesia
- Traction - slow reduction when manipulation is inappropriate e.g. risky anaesthetic
- Open reduction - accurate but risk of infection
- Closed reduction and fixation
What are 3 different techniques used for maintaining fracture stability?
Intrinsic stability i.e. require no stabilisation
External splintage -
- casting - e.g. plaster of Paris (but this is heavy), polythene, plastazote
- cast bracing - hinged or jointed
- traction - usually needs in patient stay so less used now;many different types
- frame fixation
Internal fixation - bone stability promotes soft tissue healing;
- screws
- plates
- compression plates
- IM nails
- wires
What are the advantages and disadvantages of internal fracture fixation?
In what situations is fracture fixation important?
- When external splinatge is not adequate reduction
- When early movement is needed
- When you must avoid long periods of immobility e.g. elderly
- In cases of multiple trauma to simplify treatment
- In some pathological fractures where union is uncertain
Name this traction.
Gallows or Bryant traction
What fractures is this traction used for?
Tibial or femoral fractures
What are the main immediate complications from fracture?
- Shock - from haemorrhage which is internal or external
- Injury to important organs e.g. brain, lung, liver
- Injury to nerves or vessels
- Skin loss or damage
What are the intermediate complications of fracture (i.e. occuring during treatment)?
- DVT/PE
- Chest infection
- Renal calculi, acute retention, other UTI
- Fat embolism syndrome - usually 3-10 days after fracture of long bone, cause unknown. Presents as confusion and resp difficulties
- Crush syndrome - extensive tissue damage results in ATN with renal failure; may be prevented by removing damaged tissue
Locally:
- Compartment syndrome
- Gangrene
- Pressure sores and nerve palsies
- Infection and wound breakdown
- Loss of alignment
- Tetanus and gas gangrene
What are the late complications of fractures?
General - PTSD or psychological disturbance
Local
- Delayed and non-union
- Late wound sepsis with skin breakdown
- Failure of internal fixation
- Joint stiffness and contracture
- Regional pain syndrome - previously known as reflex sympathetic dystrophy, Sudek’s atrophy or algodystrophy. Unknown cause. Causes pain, swelling and discolouration with patchy porosis on XR which then resolves after weeks-months.
- Osteoarthritis
What is a sign of delayed union?
No callus formation
Name 3 factors which affect fracture union.
- Age - favourable in young, no effect in old
- Fracture site - blood supply
- Degree of violence - slower
- Infection
- Immobilisation
- Bone or generalised disease
- Distraction of the bone ends
