Introduction to Fractues Flashcards
What is a fracture
Loss of continuity of the substance of a bone
Fracture classifications - Skin Damage (2)
- Open aka Compound where the skin is broken and risk of infection and blood loos
- Closed aka simple where the skin is intact and less risk of infection and bleeding is internal
Fracture classifications- Displacement
- Undisplaced is when bond ends still in apposition
- Displaced is earn bone ends do not meet
SEE one note for detailed photos of fractures
one note
Causes of fracture (3)
- Sudden injury
-Fatigue aka repeated stress - Pathological where there is abnormal of disease bone
What is direct violence trauma
Stresses exceed limit of strength of bone
example fall on ground or hit by moving object
What is indirect violence trauma
Twisting or bending stress
Example ankle fracture in sports
Fatigue/stress fracture definition and examination
Repeated minor stresses rather than one specific incident and pain increases with activity
Examination would be localised bony tenderness/swelling and unable to WB
Pathological
Fracture occurs in bone weakened by disease
Tumours or a bone disease
Fracture occurs with trivial trauma or spontaneously
Name the 5 fracture healing stages
1.Haematoma
2. Subperiosteal & endosteal cellular proliferation
3. Callus
4. Consolidation
5.Remodelling
STAGE 1
Tissue damage and bleeding
Haematoma between or around fracture segment s
Stage 2
–
Inflammatory cells appear in haematoma
– periosteum
Proliferation of cells deep surface of periosteum
Collar’ of active tissue around fragments
Blood clot ‘pushed aside’
Cellular activity medullary canal
Stage 3
– – – – – – –
Maturation cellular tissue
Osteoblast & osteoclast activity I
ntracellular matrix laid down
Removal of dead bone
‘Woven bone’ - callus
Palpable as hard mass
Visible on X Rays
Stage 4
woven bone replaced by cortical bone
solid union
stage 5
Newly fired bone remodelled to resemble normal bone
Bone strengthened along lines of stress
Whta is malunion
bone has united soundly but in wrong position
What is non union
Bones ends do not unite and remain separate
May require bone grafting and internal fixation
What is delayed union
Takes longer to unite than normal but eventually does so
9 factors influencing healing
Type of bone
Type of fracture
Mobility at fracture site
Blood supply
Separation of bone ends
Age
Infection
General health
Nutrition
3 principle of fracture management
Obtain sound bone union without deformity
restore funciton
without rest of complications
What is the 1st stage of fracture management
- Reduction - apposition and alignment of bone fragment
2 types
Closed reduction for minimally displaced fracture and immobilised in splint/cast
Open reduction require surgery for displaced fracture
What is the 2nd stage of FM
Immobilisation to hold bones in correct reduced position
Non rigid/rigid / traction
What is external fixation during immobilisation and why?
Bony fragments held with external device and pins
Why? - severe soft tissue damage, nerve or blood vessel damage . for pelvic fracture or infected fractures
What is ORIF AND ITS ADVANTAGES AND DISADVANTAGES
ORIF - open reduction internal fixation eg pins screws wiring, nails
Advantages - good union and early mobilisation
Disadvantages - risk of infection and additional trauma
Role of Physiotherapy - Inpatient
Swelling management
Gentle exercise to maintain
Gait education/aids
Safety
Education/Advice
D/C planning for home
Role of physiotherapy - outpatient
Once fracture healed or cast removed
Exercise e.g. ROM
Strengthening
Pain Management
Manual therapy as indicated
Aim to return to function
Immobilisation precautions 5
- wound care
- nerve compression
- compression of blood vessels
-Hygiene - at risk pressure areas
