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6 Orthopedics > L2 Fractures > Flashcards

L2 Fractures Flashcards

1
Q

Signs and Symptoms of Fracture

A
  1. swelling/edema or bruising/ecchymosis over fracture site and distal to site
  2. deformity, especially seen in long bones
  3. pain at fracture site which increases up movement, direct pressure, torsion
  4. Loss of function: NWB, decreased or absent AROM
  5. Open fracture = bone protruding through the dermis
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2
Q

Bending Force

A

angulatory force, causes fracture on convex side

type of fracture = transverse, oblique, greenstick

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3
Q

Twisting force

A

torsional force
causes spiral tension failure
will produce a spiral fracture

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4
Q

Straight pull

A

traction force
causes tension failure from pull of ligament or muscle

will produce an avulsion fracture

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5
Q

Crushing force

A

compression force, will compact or burst the bone

causes a compression, burst fracture or torus fracture in children

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6
Q

Repetitive Microtrauma

A

small crack in bone unaccustomed to stress
will produce a fatigue or stress fracture

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7
Q

Normal force on abnormal bone

A

will cause a pathological fracture due to osteoporosis, tumor, or other disease

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8
Q

Etiology of Fractures

A

Traumatic
Stress
Pathologic

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9
Q

Stress etiology is also characterized as

A

a mismatch of bone strength and chronic load

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10
Q

Insufficiency fracture

A

normal load on abnormal bone, term typically used with osteoporosis

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11
Q

Traumatic Fractures

A

major, high energy trauma
common examples: FOOSH, crush, MVA, fall from height, abuse

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12
Q

Factors that influence rate of healing bones

A
  1. older age >60
  2. Comorbidities
  3. Medications like steroids, chemo, NSAIDs
  4. degree of trauma
  5. Type of immobilization
  6. Infection, malignancy, irradiation
  7. Avascular necrosis
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13
Q

ABCs of Radiography

A

A = adequacy, alignment
B = bone margins, density
C = cartilage
S = soft tissue

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14
Q

Adequacy

A

one view is one view too few, check quality, views, number of images

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15
Q

Alignment

A

what is the normal alignment

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16
Q

“Bone” (ABCs)

A

trace along outline/contours = look for callus, exostosis, changes, fracture
radio-opaque = thicker, than surrounding bones
radio-lucent = thinner bone

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17
Q

Cartilage

A

joint space –uniform, loose bodies

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18
Q

How to describe a fracture

A
  1. alignment/relationship of bony fragments
  2. pattern/configuration of fracture line
  3. anatomic site
  4. relationship to the environment –open/closed
  5. Complete/incomplete
  6. Special features
  7. associated abnormalities
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19
Q

Alignment of bony fragments

A

NAMED FOR HOW THE DISTAL FRAGMENT DISPLACES IN RELATIONSHIP TO PROXIMAL FRAGMENT

nondisplaced
medial displacement
lateral displacement
distracted
overriding with posterior and superior dispalcement
distracted and rotated laterally

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20
Q

Direction of fracture line

A
  1. Transverse
  2. Longitudinal
  3. Oblique
  4. Spiral
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21
Q

Transverse

A

perpendicular to longitudinal axis

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22
Q

Longitudinal

A

parallel to the longitudinal axis

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23
Q

Oblieque

A

not at a right angle across the bone

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24
Q

Spiral

A

curves and winds around shaft of bone

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25
Q

Salter-Harris Classification of growth plate injuries

A

5 different types
used with immature bone
applies to any bone with a growth plate

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26
Q

Type 1 SH Growth Plate

A

through the growth plate, transverse

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27
Q

Type 2 SH Growth Plate

A

transverse fx through growth plate and metaphysis, travels proximally

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28
Q

Type 3 SH Growth Plate

A

through growth plate and epiphysis, travels distally and exits into the adjacent joint

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29
Q

Type 4 SH Growth Plate

A

through all three elements, travels proximally and distally

most damaging problem
can cause incongruency and fracture into the joint space

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30
Q

Type 5 SH Growth Plate

A

crush injury of growth plate

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31
Q

FOOSH/Colles Fracture

A

common extra-articular fx of distal radius at distal radial metaphyseal region with dorsal angulation and impaction, without involvement of articular surface

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32
Q

Tx for Colles Fx

A

closed reduction and cast immobilization
cast should go from the elbow to the metacarpal heads. Wrist is in slight flexion and ulnar deviation

patients should perform active finger motion exercises

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33
Q

Non-displaced FOOSh

A

a removable splint can be worn

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34
Q

Distal radius fx treated without surgery

A

should have repeated xrays for three weeks and the use of a splint or cast is discontinued

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35
Q

Greenstick will crack on ____ and stay intact on ____

A

convex
concave

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36
Q

Common visual appearance of colles fracture

A

dinner fork deformity

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37
Q

Neck of Femur Fracture

A

relatively common in older patients, those with unsteady gait, reduced bone density, females

this fx has significant complications w/out surgery, including avascular necrosis and non union

can weight bear as tolerated

38
Q

What is the weakest point of the femur?

A

the neck

39
Q

Tibial Plateau Fractures

A

MOI: axial loading like falling from a signficant height

fractures on the lateral plateau are more common than medial

soft tissue injuries are in 10% of fxs

40
Q

Younger vs Older tibial plateau fxs

A

younger = splitting pattern

older = depression pattern, most common with osteoporosis

41
Q

Tibial Plateau Fx Tx

A
  1. early mobilization – >3 weeks of immob increasing the potential for losing ROM permanently
  2. left uncorrected, the depression of plateau can cause a varus/valgus deformity, with increased OA
  3. PT can detect ligament injuries, which can lead to OA and malalignment
42
Q

Vertebral Fracture

A

also known as a wedge deformity

caused by an isolated failure of anterior column, usually due to forward flexion and compression

43
Q

Treatment for vertebral fracture

A

normally a stable fracture
early ambulation is encouraged

should use a hyperextension orthoses

avoidance of compression overloads for a period of 12 weeks

44
Q

Other types of vertebral fractures

A

compression
burst
flexion-distraction

45
Q

Boxer fracture

A

most common type of MC fx, usually in young adult males

transverse fx of the 5th metacarpal. Occurs in the transverse plane through metacarpal neck, Dorsal angulation of distal fragment

46
Q

Treatment of boxer fracture

A

relatively unstable, so wire fixation is often required

palmar angulation is fine, but rotational deformity is NOT. can cause significant deformity with the little finger covering the other digits

can also use a short arm splint, with flexion of MCP joint, for 2-3 weeks

47
Q

Avulsion Fracture

A

small bone fragments at the end of long bones, adjacent to joints

usually occur in locations with tendon or ligament attachments

MOI: tension force

48
Q

Avulsion Fracture treatment

A

typically stable

surgery is required for pain or to regain anatomic fixation

treated on an outpatient basis with crutches pain meds, modified pain

recovery is in 4 to 6 weeks

49
Q

Humeral Shaft Fractures

A

-3-5% of all fractures
-common in younger males and older females
-usually the middle third of the humerus is fx

most commonly associated with a radial nerve injury

50
Q

MOI for Humeral Shaft

A

direct blow to the upper arm = transverse

indirect trauma from fall or twisting = spiral/oblique/open

51
Q

Humeral Shaft Treatment

A

-supportive cast and then splint
-does not require ORIF
-shortening with some angulation is fine

52
Q

Internal Fixation for a humeral shaft fracture is required

A
  1. adequate alignment cannot be maintained
  2. open fx
  3. presence of vascular injury
  4. segmental fracture
  5. poly-trauma, brachial plexus injury
  6. non-union
  7. pathological etiology
53
Q

Radial Nerve Injury

A

associated with middle 1/3 humeral shaft fx
-can either be a laceration, entrapment, crush, demylenation (neuropraxia)

a closed fx will see the nerve heal within 3-4 months

54
Q

Immediate open exploration required for these with radial nerve injury:

A

open fx, irreducible fx, vascular injuries, radial nerve palsy after manupulation, intractable neuro pain

16-18 weeks of management after surgery

55
Q

Jones Fracture

A

transverse fracture at the base of the fifth metatarsal

MOI: significant adduction force to the forefoot with ankle in PF

common athletic injury, often mistreated

56
Q

Jones Fracture Treatment

A

prone to non-union; need to use internal fixation or grafting

immobilization is important; NWB cast for 6-8 wks

57
Q

Diastasis/Subluxation

A

abnormal separation of two anatomical structures that are normally located together

MOI: shear and tension (falling from a horse)

58
Q

Stress Fracture

A

occurring due to a mismatch of bone strength and chronic mechanical stress

can either be fatigue or insufficiency

59
Q

Fatigue fracture

A

abnormal stresses on normal bone

60
Q

Insufficiency Fracture

A

normal stresses on abnormal bone
an example of a pathological fracture

61
Q

Most common sites for fatigue stress fractures

A

tibia
tarsals
metatarsals
femur
pelvic ring

62
Q

Most common populations for fatigue stress fractures

A

athletes
military
dancers

female

63
Q

RF for fatigue stress fractures

A

repetitive overuse
sudden change in training regimen
alterations in training surface
female
leg length discrepancy
diminished muscle strength

64
Q

CP of Fatigue Stress Fractures

A

pattern of decreased WB tolerance over time
localized pain
tenderness with palpation
antalgic gait
minimal joint ROM loss for extra-articular lesions

65
Q

Plain films for fatigue stress fractures?

A

NO
low sensitivities
plain films can be negative for 14 to 21 days

MRI and bone scan are the gold standard

66
Q

Osteophony

A

percuss distal to suspected lesion, while auscultate proximal to suspected lesion

confounding factors are joint effusion, bilateral injury, non-traumatic lesions

positive test lets us know that there is a bone pathology

67
Q

Tx for stress fracture

A

dependent on location
options include conservative, plaster cast, internal fixation

you must reduce the activity which has led to the fracture

68
Q

How can a fracture be stable?

A

incomplete fracture
intact periosteum
lack of significant angulation

avulsion and compression are usually stable

69
Q

Instability characteristics

A

shear injuries tend to be unstable

periosteal tissue disruption leads to increased fx instability

unstable fx will display gross motion between shaft and head fragments

70
Q

Femoral neck fxs stability

A

A = tension side of neck
B = compression side of neck, less likely to be displaced, more stable

71
Q

Night stick fracture

A

isolated fracture of the ulnar shaft

72
Q

Stable night stick

A

displaced < 50%
periosteum and interosseus membrane intact and act as restraint to rotation

73
Q

Unstable night stick

A

displaced >50% or at a 10-15° of angulation

displacement/angulation towards the IM is poorly tolerated

associated with radial head fx or dislocation

74
Q

Stress Sharing device

A

permits some transmission of load across fracture site

ex: cast, rods, pins, wires

75
Q

Stress shielding device

A

protects the fracture completely from mechanical stress, transfers stress to the fixation device

ex: surgical plates, external fixators

76
Q

Traumatic fracture complications

A
  1. Hemorrhage
  2. Fat embolism
  3. Brachial artery injury
  4. Axillary nerve injuries
  5. Avascular necrosis
77
Q

Hemorrhage

A

pelvic fractures
closed femoral fx

78
Q

Fat embolism

A

multiple or crushing type injuries, develops within 3 days of injury

79
Q

Brachial artery injury

A

supracondylar fx

80
Q

Axillary nerve injury

A

proximal humeral fx

81
Q

Avascular necrosis

A

scaphoid fx

82
Q

Minor traumas are…

A

sneeze, misstep, lifting a gallon milk, raising a window, basic ADLs, etc

83
Q

Most common sites for suspicious fx

A

vertebral bodies
femur
distal radius

84
Q

Rf for decreased bone density

A

family hx
caucasian/asian
female
age 50+
low body weight
immobilization
inactivity
long term exposure to alcohol, tobacco
medications
co-morbidities
dietary deficiencies
northern european ancestry

85
Q

Medications that can caused decreased boney density

A

aluminum
anticonvulsants
corticosteroids
cytotoxic drugs
excessive thryoxine
heparin
lithium
tamoxifen

86
Q

Examples of diseases that cause decreased bone density

A

diabetes
enodmetriosis
MS
COPD
hyperthyroidism

87
Q

Secondary bone tumors

A

metastatic tumors
most common >50

shoes up as localized pain, palpable tenderness, edema, mass, fever, weight loss, malaise

88
Q

Malignant tumors

A

osteosarcoma

89
Q

Benign tumor

A

osteochondroma

90
Q

Osteosarcoma

A

most common in bone tumor in children

occurs in the knee usually, proximal humerus, proximal femur, pelvis

S/S: painless bony mass, limited ROM

91
Q

Osteochondroma

A

an abnormal extension of metaplastic cartilage that responds to the factors that stimulates the growth plate resulting in exotosis growth

most common at knee, in males, younger than 20

6 Orthopedics (17 decks)

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