Intro to fractures Flashcards
(66 cards)
1
Q
definition of a fracture
A
A fracture is described as a loss of continuity of the substance of bone
Can range from hairline to comminuted
2
Q
is there a difference between break and fracture
A
no
3
Q
How are fractures classified?
A
skin damage
displacement
pattern/shape
4
Q
skin damage
A
open/compound
closed/simple
5
Q
displacement
A
displaced
undisplaced
6
Q
pattern/shape
A
oblique
transverse
spiral
7
Q
open fracture
A
broken skin
risk of infection
blood loss
8
Q
closed fracture
A
Skin intact
no communication to site of fracture
Less risk infection
Bleeding is internal
9
Q
undisplaced fracture
A
Bone ends still in apposition
10
Q
displaced fracture
A
Bone ends do not meet, reduction necessary
11
Q
pattern of fracture i
A
Transverse Oblique Spiral Simple Comminuted Compression / crush
12
Q
pattern of fracture ii
A
Greenstick Hairline Impacted Avulsion Articular Depressed
13
Q
transverse fracture
A
Fracture at right angle
Obliquity < 30 degrees
Direct or indirect violence
14
Q
oblique fracture
A
Angle of fracture > 30 degrees
Direct / indirect or torsional force
15
Q
spiral fracture
A
Line of fracture curves around
Rapid union - large area in contact
16
Q
comminuted fracture
A
More than 2 fragments
Unstable
Greater violence
+/- butterfly segment
17
Q
compression/crush
A
on Cancellous bone
18
Q
impacted fracture
A
One fragment driven into another
Stable, heals quickly
19
Q
greenstick fracture
A
Bend in immature bone
children
20
Q
hairline fracture
A
Trauma - fracture without displacement
Stress fracture
21
Q
avulsion fracture
A
Sudden forceful muscle contraction - high force pulls off portion of bone
22
Q
intra-articular fracture
A
Articular joint surfaces
May have associated haemarthrosis (bleeding within joint)
23
Q
depressed fracture
A
Sharply localised blow depresses fragment of cortical bone
24
Q
causes of fractures
A
Sudden injury Direct trauma indirect trauma Fatigue Repeated stresses No evidence of disease Pathological – Abnormal or diseased bone
25
2 types of trauma
direct violence
| indirect violence
26
direct violence
Most common
Stresses exceed limit of strength of bone
Fall on ground
Hit by moving object
27
indirect violence
Twisting or bending stresses
Sports-related
Common in ankle fractures
28
fatigue/stress fracture
Repeated minor stresses rather than one specific incident
| Pain increases with activity / decreases with rest
29
common sites of fatiure fracture
2nd MT, tibia
30
physical examination of fatigue fracture
localised bony tenderness / swelling / thickening/unable to WB
31
x ray findings of fatigue fracture
may need bone/CT scan
Nothing detectable initially / 2 - 4 weeks changes
+/- faint hairline crack / rarely displaced
Zone of callus formation
32
pathological fracture
Fracture occurs in bone weakened by disease
| Fractures occurs with trivial trauma or spontaneously
33
causes of pathological fracture
```
Tumours: Bone is a common secondary site for cancer
Bone disease (e.g. Osteoporosis)
```
34
stages of fracture healing
```
Haematoma
Subperiosteal & endosteal cellular proliferation
Callus
Consolidation
Remodelling
```
35
initial damage that occurs in fracutre
Periosteum - complete or partial tear
Disruption of Haversian systems
Death of adjacent bone cells
+/- Damage to muscle/nerve and blood vessels
36
haematoma
Tissue damage & bleeding
Haematoma between & around fracture segments
Haematoma clots
37
Subperiosteal & endosteal cellular proliferation
Inflammatory cells appear in haematoma
Proliferation of cells deep surface of periosteum
‘Collar’ of active tissue around fragments
Blood clot ‘pushed aside’
Cellular activity medullary canal
38
- Callus formation
```
Maturation cellular tissue
Osteoblast & osteoclast activity
Intracellular matrix laid down
Removal of dead bone
‘Woven bone’ appears: Callus
Palpable as hard mass
Visible on X Rays
```
39
stage 4 consolidation
```
Woven bone replaced by lamellar (cortical) bone
Solid union
full bone repair
no movement in fracture site
full function can commence
```
40
remodelling
Newly formed bone remodelled to resemble normal bone
| Bone strengthened along lines of stress
41
rate of union - how fast a bone heals in the young
Rapid callus formation 2 weeks
| Consolidation 4 / 6 weeks
42
rate of union - how fast a bone heals in the adults
```
Callus 2 weeks
Consolidation 3 months
Occasionally 4 / 5 months long bones
More rapid in slender bones UL vs LL
Cancellous bone quicker
```
43
condition of bone during initial union
```
Partial repair of bone
Initial callus around bone ends
Minimal movement at fracture site
May give way easily
Visible fracture line on X- Ray
Immature bone
```
44
malunion meaning and where is it most common
Bone has united soundly but in wrong position.
| Common in clavicle fractures
45
non union and what is required to fix the problem
Bone ends do not unite and remain separate.
| May require bone grafting and internal fixation
46
delayed union
Takes longer to unite than normal
| But eventually does so
47
factors influencing healing
```
Type of bone
Type of fracture
Mobility at fracture site
Blood supply
Separation of bone ends
```
48
typical findings on clinical examinations
```
Visible / palpable deformity
Localised swelling
Visible bruising
Marked bony tenderness
Impaired function
```
49
principles of fracture management
```
Obtain sound bony union without deformity
Restore function (work/social/ADLs etc)
Without risk of complications
```
50
reduction aim
Adequate apposition and alignment of bone fragments
51
closed reduction
For minimally displaced fractures - no surgery required
get traction - disengage fragments
+/- Manipulation under anaesthesia (MUA) - reduce risk of infection
Usually immobilised in some form of splint/cast
52
open reduction
Requires Surgery for unstable/displaced fractures
| +/- Internal or external fixation
53
conservative immobilisation
Non-rigid method of support e.g. collar / cuff / brace
Scotch-cast
Continuous traction (rarely used now)
Skin traction or Skeletal traction
54
external fixation
Bony fragments held with external device & pins
55
indications of external fixation
Severe soft tissue damage
Nerve or blood vessel damage
Pelvic fractures that cannot be internally fixated
Infected fractures
56
ORIF and examples
= Open Reduction Internal Fixation
| E.g. Pins, plates, screws, wiring, IM - Inter Medullary nails
57
Indications of ORIF
```
Inherently unstable fracture
Displaced fractures
# cannot be otherwise controlled
# of > 1 bone
Pathological with bone disease
Fractures that unite poorly
```
58
Advantages of ORIF
Likelihood of good reduction and union
Early mobilisation
59
Disadvantages of ORIF
Risk of infection
Additional trauma
60
Role of inpatient physio
```
Post fixation e.g. ORIF
Early mobilisation
Gentle exercise to maintain
Gait education/aids
education/advice
```
61
role of outpatient physio
```
At a later stage
Once fracture healed or cast removed
Exercise e.g.
ROM
Strengthening
Pain Management
```
62
physiotherapy during immobilisation e.g. cast
```
reduce oedema
Maintenance of circulation
Maintain muscle function - active / static contractions
Maintain joint range
Maintain function
```
63
physiotherapy on removal of fixation/cast
Decrease swelling
Regain full ROM
Regain full muscle power
Restore full function e.g hand function (UL)/walking (LL)
64
complications of surgery
```
Pneumonia
Blood loss -anaemia
Shock
Wound infection
Delirium (Acute confusion)
```
65
complications of prolonged immobilisation
Respiratory tract infections
Urinary tract infections
Risk of pressure areas
Disuse muscle atrophy
66
immobilisation POP precautions
wound care
nerve compression
compression of blood vessel
hygience
