Introduction To Trauma And Fractures Flashcards
What is the definition of a fracture?
- A fracture is a break in the continuity of a bone
It can be caused by: - Direct force
- Indirect force
- Repetitive strain (stress)
- Underlying pathology
What is a fatal injury and what are the main causes?
- Trauma remains the leading cause of death in individuals aged 1 to 44 years, with the majority of injuries preventable
- Road traffic collisions (RTC) are the leading cause of trauma death in all age groups between 1 to 65 years
- In individuals over 65 years, falls become the leading cause of death
What is a non-fatal injury and the main causes?
- Falls: 0 to 14 years and 25 years and older
- Unintentionally struck: leading cause of injury 15 to 24 years
- Motor vehicle collisions (RTC): second leading cause of injury 15 to 24 years
What are the three basic classes of fractures?
- Simple (closed)
- Compound (open)
- Pathological
Describe a simple (closed) fracture.
Clear deformity of the bone but has not pierced/ penetrated the skin.
Describe a compound (open) fracture and the two types it includes.
In-to-out: sharp ends of bone penetrate the skin from beneath
Out-to-in: high energy injury penetrates the skin causing trauma to soft tissues and bone
List the seven types of fractures.
- Transverse
- Linear
- Oblique non-displaced
- Oblique displaced
- Spiral
- Greenstick
- Communited
Describe a comminuted fracture.
Bone that is broken in at least two places.
List the three types of complicated fractures.
- Intra-articular = involving the joint surface
(Within joint) - Avulsion = bone fragment is pulled away at a ligamentous/tendinous attachment
Could be due to hyperflexion - Growth plate = involving the physeal growth plate
List the Salter-Harris 1963 Classification system.
SALTR
-Slipped - fracture involves physics (growth plate)
-Above
-Lower
-Through
-Rammed
Describe the Salter-Harris type l fracture.
Type I fracture is when there is a fracture across the physis with no metaphysial or epiphysial injury.
S - Slipped
Describe the Salter-Harris type ll fracture.
Type II fracture is when there is a fracture across the physis which extends into the metaphysis.
A- Above
Describe the Salter-Harris type lll fracture.
Type III fracture is when there is a fracture across the physis which extends into the epiphysis.
L- lower
Describe the Salter-Harris type lV fracture.
Type IV fracture is when there is a fracture through metaphysis, physis, and epiphysis.
T- Through
Describe the Salter-Harris type V fracture.
Type V fracture is when there is a crush injury to the physis.
R- Rammed
List the signs and symptoms of fractures.
- Severe pain/local tenderness
- Unnatural movement
- Swelling/bruising
- Deformity
- Irregularity
- Angulation/rotation
- Limb shortening
- Depression
- Crepitus (crunching)
What is shock following a trauma?
- Shock is the body’s physical response to trauma and can be life-threatening.
- Not enough oxygenated blood is circulated, depriving vital organs of oxygen.
- Be aware of common signs of shock.
List the common signs of shock.
- Dizziness
- Enlarged Pupils
- Shallow and rapid breathing
- Blue/grey fingernails/ lips
- Cold, pale/clammy skin
- Drowsiness, irritability, anxiety and fainting
- Faint pulse
- Excessive sweating
- Nausea/vomiting
List the three types of treatments of fractures.
Reduction
- Closed manipulation
- Open reduction
- Mechanical traction
Immobilisation
- Plaster of Paris/Fibre glass
- Splints
- Screws, plates, pins, rods,
wires
Rehabilitation
List the four stages of healing of a fracture.
- Haematoma formation
- Fibrocartilaginous tissue formation
- Callus formation
- Bone remodelling
Explain haematoma formation.
- A blood clot (haematoma) is formed between the bone ends around 6-8 hours after injury.
- Nearby bone cells die because of restricted blood circulation.
- Swelling and inflammation occurs.
- Phagocytes and osteoclasts remove dead or damaged tissue around the haematoma.
Explain Fibrocartilaginous tissue formation.
- Fibrocartilaginous tissue is formed on the fracture site surfaces and grows together, absorbing the haematoma and forms the first link between the bone fragments.
- This occurs within 24 hours.
Explain the callus formation.
- After 7 days, osteogenic cells develop into osteoblasts to produce spongy bone trabeculae.
- This joins living and dead fragments of bone.
- Fibrocartilaginous tissue is converted to spongy bone.
- Bony callus is formed.
- Fluffy bone formation normal 7-10 days (areas bright white on X-ray)
Explain the process of Bone remodelling.
- Dead portions of the original fragments of broken bone are reabsorbed by the osteoclasts. (Clearing the bone)
- Spongy bone is replaced (remodelled) by compact bone.
- The surfaces form a firm bony reunion.
What is AABCS?
A- Adequacy
A- Alignment
B- Bony margin
C- Check joint space
S- Check for swelling
How is AABCS used in trauma radiographs?
A- Adequacy - Check the adequacy of the image
A- Alignment - Follow alignment of the bones in a systematic order (e.g. dislocation and subluxation - still some connection but maligned but not dislocated)
B- Bony margin - Follow the cortical margin of each bone, checking for density and trabecular pattern -> No disruption
C- Check joint space - Check that each joint space is uniform in width. (Is it even)
S- Check for swelling - Check for swelling, particularly in the area of interest.
How many images are required?
When looking for pathology, two (orthogonal, 90o) views are required.
