Lab: Fracture Flashcards
What are the organic to inorganic ratios for the following?
Children:
Adults:
Elderly:
Children: 1:1
Adults: 1:4
Elderly: 1:7
More organic material means more ___
elasticity
children have more elastic bones
Less organic material means less ___
elasticity
increased risk of fracture
What is elasticity?
Ability of bone to bend and return shape
What is the term for bone’s ability to bend and return shape?
Elasticity
What is plasticity?
Yield point surpassed; permanent deformity without fracture
stress strain curve
What is yield point?
Permanent physical changes begin
stress strain curve
What is the term for the point where permanent physical changes begin?
Yield point
stress strain curve
What is the ultimate yield point?
Point of failure/fracture
stress strain curve
What is the term for the point of failure/fracture?
Ultimate yield point
stress strain curve
What types of fractures are more common in children because of these differences in elasticity and plasticity?
- Salter-Harris (fracture of growth plate)
- Greenstick
- Torus
View:
Anatomy:
Mature/immature:
View: AP ankle
Anatomy: tibia and fibula
Mature/immature: mature
What notes can be made about the bone in this ankle?
Black areas in bone; cortical disruption (fracture) and necrosis
What stage of fracture repair is shown in this ankle specimen?
Inflammatory stage (necrosis is present)
What cellular events occur during the inflammatory phase of fracture repair shown in this ankle specimen?
- Blood vessel rupture
- Hematoma fills gap
- Periosteum tears
- Necrosis
- Fibrin mesh develops
- Procallus
View:
Anatomy:
Mature/immature:
View: AP diaphysis of long bone
Anatomy: diaphysis
Mature/immature: unknown (growth plate not visualized)
What observations can be made about the bone in this specimen?
Complete closed fracture through diaphysis
What stage of fracture repair is shown in this long bone?
Reparative stage (rounding of broken edges)
What cellular events occur during the reparative stage of fracture repair shown in this long bone?
- Osteoclasts and macrophages clean up debris
- Extensive neovascularization/angiogenesis
- Callus formation (chondrocytes)
- Significant osteoblastic activity
View:
Anatomy:
Mature/immature:
View: lateral ulna
Anatomy: proximal ulna, olecranon, diaphysis, metaphysis
Mature/immature: mature
What notes can be made about this ulna?
Dilated mid diaphysis
What stage of fracture repair is shown in this ulna?
Remodeling stage (callus has sealed bone and bone has adjusted strength and shape)
What cells are involved in the remodeling stage of fracture shown in this ulna?
Osteoblasts, osteocytes, and osteoclasts
Anatomy:
Anatomy: clavicle, head of humerus, scapula, sternum
What stage of fracture repair is shown?
Redomeling stage
What has not occured in this fracture repair to lead to pseudoarthrosis?
No formation of procallus; non-union fracture led to pseudojoint
What terminology describes the outcome of fracture in this image?
Pseudoarthrosis
What cellular changes or events explain this pseudoarthrosis?
Lack of debris clean up by osteoclasts and mononuclear cells
View:
Anatomy:
Mature/immature:
View: medial oblique forearm (left), lateral forearm (right)
Anatomy: radius, ulna (accounted for but broken)
Mature/immature: mature
Is this lesion local or systemic?
Local
What notes can be made about the alignment in this forearm?
Medial superior dislocation of proximal radioulnar joint (ulna) and lateral superior dislocation of proximal radiohumeral joint (radius)
What notes can be made about the bones of this forearm?
Complete open fracture of proximal ulnar diaphysis
What notes can be made about the connective tissue and soft tissue in this forearm?
Whiter (radiodense) soft tissue
What stage of fracture repair is shown in this forearm?
Inflammatory stage; radiopacity in soft tissue can be debris or hemorrhage with swelling
What cellular events would explain the radiographic findings in this forearm?
Neutrophils and macrophages present
What specific names apply to this type of fracture?
Complete, transverse, open, noncomminuted
View:
Anatomy:
Mature/immature:
View: AP foot (left), medial oblique foot (right)
Anatomy: accounted for
Mature/immature: mature
Is this foot lesion local or systemic?
Local
What can be noted about the aligment of this foot?
What about connective and soft tissue?
Bunion
Connective and soft tissue are normal
What notes can be made about the bones in this foot?
Cloudy, hazy patch around 3rd metatarsal
What stage of fracture repair is shown in this foot?
Reparative stage
callus forming
What cellular events would explain the radiographic findings in this foot?
- Osteoclasts and mononuclear cells cleaning up debris
- PMNs present
- Neovascularization/angiogenesis
- Osteoblastic activity
- Chondrocytes making callus
reparative stage of fracture repair
What specific names apply to this type of foot fracture?
March fracture (fatigue stress fracture), closed fracture
View:
Anatomy:
Mature/immature:
View: AP knee
Anatomy: accounted for, no patella yet
Mature/immature: immature/young
Is this knee lesion local or systemic?
Local
What can be noted about the alignment of this knee?
What about connective and soft tissue?
Normal alignment
Soft tissue swelling that is radiopaque
What stage of fracture repair is shown in this knee?
Inflammatory stage
hematoma visible, blood vessels ruptured
What cellular events would explain your radiographic findings in this knee?
PMNs/neutrophils and macrophages present with necrosis
inflammatory stage of fracture repair
What specific names apply to this type of knee fracture?
Salter-Harris fracture A (type II)
(A for above)
Complete, open, noncomminuted fracture
A 71 year-old woman reported to the emergency room with pain in her hip and thigh after stumbling while in the grocery store. The patient had a previous history of breast cancer that was treated and went into remission 40 years prior. She has also been receiving drug therapy for high blood pressure for the past 8 years. This is her radiograph.
How would you treat this patient?
Passive care and reference to orthopedic
View:
Anatomy:
Alignment:
View: AP pelvis
Anatomy: all present
Alignment: antalgic lean, superior lateral femur in relation to acetabulum
What notes can be made about the bones in this radiograph?
Thinning of cortical bone, fracture of femoral neck, radiolucent medullary cavity
osteoporosis
Additional tests confirm that this patient suffered from osteoporosis
Given this information, what type of fracture is this?
Pathological insufficiency (stress) fracture due to diseased bone
View:
Anatomy:
Alignment:
View: AP pelvis
Anatomy: all present
Alignment: normal
What is another name for a fracture that isn’t initially visible radiographically?
Occult fracture
