Introduction to Fractures Flashcards
FRACTURE DESCRIPTION
FRACTURE DESCRIPTION
What are some ways we can describe a fracture?
- Open vs Closed
- Anatomical Site and Extent
- Type: Complete vs Incomplete
- Alignment of fragments
- Direction of fracture lines
- Special features
- Associated abnormalities (dislocation, subluxation, soft tissue injury)
- Special Types (stress fracture, pathological fracture, etc.)
- What is an open fracture?
- What is a closed fracture?
- Open fracture= breaks through skin
- Closed fracture= bone broken, skin intact
Anatomical Site and Extent:
- Long bones divided into ______, ______ and _________ thirds.
- Ends further divided into _____ vs ______ articular.
- proximal, middle, distal
- intra-articular (inside joint) and extra-articular (outside joint)
Type (Complete vs Incomplete):
- In a complete fracture, all _______ are disrupted.
- In an incomplete fracture, these mostly occur in ______ bones and _______. They are generally ________ without subsequent stresses.
- What is a comminuted fracture?
- cortices
- short bones and children, stable
- Comminuted fracture= >2 fragments
Alignment:
- Alignment is the description of the _______ segment in relation to the ________ segment in relation to the normal anatomical position.
- What are some ways to describe alignment?
- distal, proximal
- Displaced, Angulated, Shortened, Rotated
Direction of Fracture Lines:
- In reference to ___________ axis
- What are some ways to describe the direction of fracture line?
- Comminution is described by its ________.
- longitudinal
- Transverse, Longitudinal, Oblique, Spiral
- Degree (minimal, moderate, severe)
Special Features:
- Impaction: ________ with ______ load
- Avulsion: _______ loading of fragment and main body of bone.
- compression with axial load
- tensile
PEDIATRIC FRACTURES
PEDIATRIC FRACTURES
Immature bone heals _______, the potential disruption of _______ is most concerning.
- rapidly
- growth
What are 3 special pediatric fractures?
- Greenstick
- Torus
- Plastic Bowing
With a Greenstick Fracture, we have a fracture on the side of ______________. _______ displacement is common.
- tensile loading
- angular
With a Torus Fracture, we have a fracture on the side on _____________________.
compressive loading
Plastic Bowing involves the capacity for ________ recoil being exceeded. It is likely a component of all pediatric fractures.
elastic
- Tensile Loading side fractured = __________
- Compressive Loading side fractured = _________
- Greenstick
- Torus
Describe the first 5 Types of Pediatric Physeal (growth plate) Fractures.
- Type 1= growth plate only
- Type 2= physis and metaphysis
- Type 3= physis and epiphysis
- Type 4= epiphysis, physis, and metaphysis
- Type 5= crush injury of physis
What is a good way to remember the Types of Pediatrc Physeal Fractures?
SALTR S= slippage A= above physis L= lower physis T= through R= ruined
Type 6 (______) Pediatric Physeal Fracture involves ___________ ring of associated periosteum of physis.
- Rang’s
- perichondral
Type 7-9 (______) Pediatric Physeal Fractures do not directly involve the ______, though may disrupt ______ supply.
- Ogden’s
- physis
- blood supply
With pediatric physeal fractures healing, the _______ phase is more extensive.
remodeling
What are some concerns with physeal fracture healing?
- Limb length
- Angulation (altered joint reaction forces, biomechanical stresses)
FRACTURE SCREENING
FRACTURE SCREENING
General things to look at when screening for fractures?
- Hx/Patient Interview
- American College of Radiology Appropriateness Criteria
- Evidence-Based Fracture Rules (Canadian C-Spine, NEXUS Low-Risk Rules, Ottawa Knee/Anke/Foot Rules)
- Physical Examination Procedures
What instrument is also used for pain provocation or sound conduction in screening for fractures? It is less accurate for stress fractures and hass a questionable sensitivity.
Tuning Fork
REDUCTION AND FIXATION
REDUCTION AND FIXATION
- What is reduction?
- What is fixation?
- Reduction= Fractured surfaces placed back together.
- Fixation= stabilization of fracture for healing.
- A closed reduction is done __________ surgical intervention. Fragments are reduced with manipulation/traction/combo.
- A open reduction is done ________ for access for fixation or alignment.
- without
- surgically
What are the goals of fixation?
- Avoid subsequent soft tissue injury
- Maintain bone length
- Maintain alignment
What are the types of fixation?
- Internal (hardware)
- External (cast, splint)
GENERAL FRACTURE HEALING
GENERAL FRACTURE HEALING
Common immobilization timeframes for adults and children?
- Adults= 6-8 weeks
- Children= 4-6 weeks
Early excessive loading causes a risk for ______________.
pseudoarthrosis
Fracture ealing time frames can also be dependent on the ________/_____ affected.
-location/bone
What are some factors that affect healing rates and prognosis?
- Age
- Degree of local trauma
- Extent of bone loss
- Immobilization (appropriate protection vs appropriate stressing)
- Type of bone (cortical vs trabecular)
- Size of bone
- Concomitant Health Conditions (infection, local malignancy and readiation therapy, other local bone pathology, AVN)
- Hormones
- Approximation
- Blood supply
Complications of Fractures can have what life threatening conditions?
- Hemorrhage
- Fat Embolism
- Pulmonary Embolism
- Gas Gangrene
- Tetanus
