General Principles of Fracture Care (From Required Medscape Readings)

Question 1

What is the difference between primary/direct and secondary/indirect healing?

Answer 1

Primary healing occurs when the bone fragments are in close approximation and can heal without the formation of a bone callus. Secondary healing occurs when the bone fragments are farther apart and must form a callus/bone bridge to heal.

Question 2

The four phases of bone healing are __________________.

Answer 2

• First 7 days: Fracture and inflammatory phase
• 7 to 21 days: Granulation tissue/soft callus formation
• 4 to 16 weeks: Hard callus formation, including woven bone creation
• Months to years: Remodeling, including lamellar bone creation

Question 3

What medications can make bone healing take longer?

Answer 3

• NSAIDs

* Corticosteroids

Question 4

These things should be included in taking a history from a patient with a suspected fracture: ________________.

Answer 4

• History of prior fractures
• Mechanism of injury
• Loss of consciousness
• Dominant handedness (if it’s the upper extremity)
• Medications
• Surgical history

Question 5

What is often done in the examination of open fractures?

Answer 5

Take a picture so that future clinicians can see the wound without having to take the dressing off again.

Question 6

Describe some of the ways fractures are described.

Answer 6

• Displacement
• Angulation
• Rotation
• Shortening
• Fragmentation
• Soft tissue involvement

Question 7

Neurovascular integrity must be assessed in the physical exam of someone with a fracture. What should you do if you can’t feel pulses in the distal part of a fractured extremity?

Answer 7

Immediately realign the limb

Question 8

_________________ occurs when tissue pressure exceeds perfusion pressure in a closed anatomic space.

Answer 8

Compartment syndrome