Intro Traumatic Fractures

Question 1

Anatomic sites and extent of fracture of long bone:

Answer 1

• Proximal end (intra-articular/extra-articular)
• proximal 1/3
• Middle 1/3
• Distal 1/3
• Distal end (intra-articular/extra-articular)

Question 2

Complete fracture -

Answer 2

All cortices disrupted

Question 3

Incomplete fracture mostly in -

Answer 3

Mostly in short bones & children

Generally stable without subsequent stresses

Question 4

Comminuted fracture -

Answer 4

> 2 fragments

Question 5

Alignment of fractures described by ___ segment in relation to ___

Answer 5

distal segment in relation to proximal

Question 6

Direction of fracture lines -

Answer 6

• In reference to longitudinal axis
• Transverse (perpendicular to long axis of bone)
• longitudinal (incomplete fracture along long axis of long bone)
• oblique (angulation)
• spiral (spiral orientation along long axis of long bone)

Question 7

Impaction -

Answer 7

• compression with axial load (bone buckles on itself)

- Depression & compression

Question 8

Avulsion -

Answer 8

• tensile loading of fragment & main body of bone
• Muscle contraction (with lengthening at same time) or passive loading
  EX: Inversion of ankle sprain (Around insertion of tendon, pulls off fragment)

Question 9

Pediatric fractures of immature bones heals (slowly/rapidly)

Answer 9

Heals rapidly

Question 10

If pediatric fracture involves growth plate, what can that mean?

Answer 10

Potential disruption of growth concerning

Question 11

Greenstick fracture -

Answer 11

• Fracture on side of tensile loading

- Angular displacement common

Question 12

Torus fracture -

Answer 12

Impaction fracture on side of compressive loading

Question 13

Plastic bowing -

Answer 13

• Longitudinal compression forces exerted, capacity for elastic recoil exceeded
• Likely a component of all pediatric fractures

Question 14

Pediatric Physeal (growth plate) Fractures Type 1:

Answer 14

Growth plate only

Question 15

Pediatric Physeal (growth plate) Fractures Type 2:

Answer 15

Physis and metaphysis

Question 16

Pediatric Physeal (growth plate) Fractures Type 3:

Answer 16

Physis and epiphysis

Question 17

Pediatric Physeal (growth plate) Fractures Type 4:

Answer 17

Epiphysis, physis, & metaphysis

Question 18

Pediatric Physeal (growth plate) Fractures Type 5:

Answer 18

Crush injury of physis

Question 19

Pediatric Physeal (growth plate) Fractures SALTR:

Answer 19

Distal end
S – slip
A –  above physis
L – lower 
T – through 
R – ruined (crush injury)

Question 20

Pediatric Physeal (growth plate) Fractures Type 6 (Rang’s):

Answer 20

involves perichondral ring (more superficial layer) or associated periosteum of physis

Question 21

Pediatric Physeal (growth plate) Fractures Type 7-9 (Ogden’s):

Answer 21

do not directly involve physis, though may disrupt blood supply
VII: Osteochondral fracture of epiphysis
VIII: Fracture of metaphysis
IX: avulsion of periosteum

Question 22

Which phase is more extensive in healing of pediatric physeal fractures?

Answer 22

Remodeling

Question 23

Remodeling & potential for subsequent deformity of pediatric physeal fractures dependent on what 3 things?

Answer 23

1. Skeletal age (Time to remodel vs. time for deformity to develop)
2. Distance of fracture from growth plate
3. Severity of displacement of fragments

Question 24

Concerns of deformity of pediatric physeal fractures?

Answer 24

1. Limb length
2. Angulation
   - Altered joint reaction forces
   - Biomechanical stresses

Question 25

Fracture screening using tuning fork looking for what?

Answer 25

Pain provocation or sound conduction

Question 26

Fracture screening using tuning fork better for identifying what type of fracture?

Answer 26

Transverse

Question 27

Fracture screening using tuning fork less accurate for what type of fractures?

Answer 27

Stress fractures

Question 28

Closed reduction -

Answer 28

- Without surgical intervention - Fragments reduced with manipulation/ traction/ combo - Soft tissue hinge promotes reduction under tension

Question 29

open reduction -

Answer 29

Surgical access for fixation or alignment

Question 30

Goals of fixation -

Answer 30

1. Avoid subsequent soft tissue injury 2. Maintain bone length 3. Maintain alignment

Question 31

Types of fixation -

Answer 31

1. Internal (screws inside – maintain alignment of fracture site) 2. External (e.g. splint, plaster cast)

Question 32

Common immobilization/ protection timelines for bone healing: Adults = Children =

Answer 32

``` Adults = 6-8 weeks Children = 4-6 weeks ```

Question 33

Early excessive loading of a bone fracture is a risk for what?

Answer 33

risk for pseudoarthrosis (false joint)

Question 34

T/F Insufficient loading of bone fracture may be detrimental

Answer 34

True

Question 35

What radiographic indicator of fracture healing?

Answer 35

callous formation when expected

Question 36

Factors affecting healing and prognosis of bone injuries:

Answer 36

1. Age 2. Degree of local trauma 3. Extent of bone loss 4. Immobilization - Appropriate protection vs. appropriate stressing 5. Type of bone (cortical v. trabecular) 6. Size of bone (diameter) 7. Concomitant Health Conditions (Infection, Local Malignancy & radiation therapy, Other local bone pathology, AVN (avascular necrosis)) 8. Hormones 9. Approximation (bone not in alignment) 10. Blood supply

Question 37

life threatening complications of fractures?

Answer 37

Hemorrhage PE Tetanus

Question 38

Fracture Complication in associated tissues?

Answer 38

Nerve injury Infection Arterial Injury

Question 39

Fracture complications of bone at fracture site?

Answer 39

Delayed union Pseudoarthrosis Avascular necrosis

Question 40

Fracture late-effect complications?

Answer 40

Limb length discrepancy