intro to fractures Flashcards
what is a fracture?
loss of continuity of the substance of bone
what are the different types of fractures?
- open / compound fractures
- closed/ simple fractures
-undisplaced fractures
-displaced fractures
compare complete vs incomplete fracture
complete fracture - fracture extends all the way across the bone and breaks it into 2 or more pieces
incomplete fracture - fracture does not involve all the way through and only involves a portion of the bone
what is an open or compound fracture?
when the fracture is protruding into the skin, this is common in certain areas of the body when you have less skin coverage and less adipose tissue eg the tibia
what risks can happen as a result of open or compound fractures?
as the skin is open, there is more risk for infection and also blood loss
what is a closed or simple fracture?
-when the bone does not protrude the skin - ie the skin is intact
- as the skin isn’t broken, there is less risk of infection and bleeding is internal
what is an undisplaced fracture?
there is a fracture- but the 2 ends of the bone still remain in alignment - requires conservative treatment rather than surgical
what is a displaced fracture?
a fracture where the bone ends do not meet and realignment through surgery (called reduction) is required
what is a traverse fracture?
fracture that occurs at a right angle - ie the bone is broken perpendicular to its length (straight line that runs in opposite direction to the bone)
what is an oblique fracture?
when the fracture occurs at an angle that is greater than 30 degrees
what is a spiral fracture?
-when the line of the fracture curves around
-bone is broken in a twisting motion
what is a comminuted fracture?
a fracture involving 3 or more fragments
very unstable
may contain butterfly segment
what is a compression/crush fracture? and give example of where in the body this can happen
a fracture involving cancellous or spongy bone eg the vertebrae
what is an impacted fracture?
-when one fragment one bone is driven into another
-stable fracture and heals quickly
what is a greenstick fracture?
a bend in an immature bone eg in children
what is a hairline fracture?
-a fracture without displacement
-caused by trauma
what is an avulsion fracture?
-when a bone fragment isn pulled away from its main body by muscle that is attached to it
what is an intra-articular fracture?
-a fracture within a joint
-may have bleeding within the joint
what is bleeding within the joint called?
haemarthrosis
what is a depressed fracture?
Sharp localised blow depresses fragment of cortical bone
how is a bone injured?
- sudden injury
-fatigue
-pathological
what is direct trauma?
when the stresses exceed the limit of strength of bone
eg falling on the ground or being hit by a moving object
what is indirect trauma?
twisting or bending stresses, eg may be sport related
what is a fatigue or stress fracture?
-repeated minor stresses
-pain increases with activity and decrease with rest
localised bony tenderness, swelling and thickening
where are examples of common sites of a stress fracture?
tibia and metatarsals (on foot)
what imaging is useful for detecting a stress fracture?
- often not visible on x ray initially, but can show healing and callous formation
-MRI is very good for showing bony oedema
what is a pathological fracture?
fracture that occurs as a result of bone weakening by disease
eg osteoporosis, cancer
what are the 2 main components that bone is composed of?
- cellular component
-extra cellular matter
what are osteoblasts?
bone forming cells
what are osteoclasts?
primary bone re-absorbing cells
what are osteocytes?
highly specialised cells which maintain the bony matrix
what is primary bone healing?
the bony fragments are fixed together through reduction fixation- there is no formation of a callus
what is secondary bone healing?
-occurs when there is slight movement at the fracture site, there is formation of a callus and subsequent remodelling takes place
- braces, bridging plates, IM nailing - non rigid fixation modalities are used
what are the 4 stages of bone healing?
1- haematoma formation
2- granulation tissue formation
3- bony callous formation
4- bone remodelling
what does haematoma formation in bone healing involve?
- blood vessels are disrupted when the fracture occurs, then there is a formation of a haematoma at the fracture site
- this haematoma clots and forms the temporary frame for subsequent healing
what does the granulation tissue formation stage of bone healing involve?
- inflammatory cells appear in haematoma
-proliferation of cells in the deep surface of the periosteum
-angiogenesis occurs - ie the development of new blood vessels
what does the bony callous formation stage of bone healing involve?
- involves osteoblast and osteoclast activity
the intracellular matrix is laid down
-dead bone is removed - hard callous forms - weaker than normal bone but is able to withstand forces
what does the remodelling phase involve?
- longest phase
woven bone is replaced by lamellar bone - the newly formed bone is remodelled to resemble normal bone
what is the union of bone?
-the partial repair of bone
- there is minimal movement at the fracture site
-may give way easily
what is consolidation of bone?
-full repair of bone
-no movement at fracture site
- full function
what is the malunion of bone?
when the bone has united but in the wrong position
what is non-union of bone?
when the bone ends do not unite and remain separate (may require internal fixation)
what is delayed union of bone?
when the bone takes longer to unite than normal, but eventually does so
what are examples of factors that influence healing?
- type of bone involved
-type of fracture
-mobility at fracture site
-blood supply
-age
-infection
-nutrition
what are the main principles of fracture management ?
- obtain bony union (bone repair) without deformity
-restore function
-prevent falls - address bone health
Describe the symptoms of the clinical examination of fracture
-palpable and visible deformity
-localised swelling
-visible bruising
-impaired function
-marked bony tenderness
what are the 3 stages in fracture management?
1- reduction - manipulation of bone to correct anatomical position
2- immobilisation - holding bond in correct reduced position
3- rehab - return to full function post trauma
what is the external fixation method?
when the bony fragments are held with external device and pins
what are the indications that external fixation is needed?
- severe soft tissue damage
-nerve or blood vessel damage
-pelvic fractures that can’t be internal fixated
-infected fractures
what does ORIF stand for?
Open reduction internal fixation
eg with pins, plates, screws
what are the indications that ORIF is necessary?
- unstable fracture
-displaced fractures
-the fracture cannot be otherwise controlled - fractures that unite poorly
what are the advantages of ORIF?
- good reduction and union
-early mobilisation
what are the disadvantages of ORIF?
- risk of infection
-additional trauma
what is the role of a physio with inpatient fractures?
- swelling management
-gentle exercise
-gait education
-safety
-education/advice
what is the role of a physio with outpatient fractures?
- at a later stage
-once fracture is healed or cast is removed
-exercise - strengthening, ROM etc
-manual therapy as indicate
-aim to return to function
what are examples of urgent complications of fractures?
- visceral injury]
-vascular injury
infection
-compartment syndrome (pressure of muscles builds up which can decrease blood flow)
what are the complications of prolonged immobilisation? eg bed rest
- resp tract infections
-UTI’s
-risk of pressure areas
-muscle atrophy from disuse
