Lecture 18 - Bone injuries

Question 1

Name the 9 types of bone fractures

Answer 1

comminuted
spiral
transverse
oblique
segmental
avulsed
impacted
torus
greenstick

Question 2

describe the levels of the SALTER-harris epiphyseal fracture classification

Answer 2

S - slips - heals well
A - above - above line of growth
L - Lower - through growth plate and lower - loose piece of bone
T - through - through growth plate
R - Rammed - bones rammed against each other - destruction of growth plate

Question 3

What are the Ottawa Ankle Rules/Midfoot

Answer 3

pain near malleoli or base of 5th or navicular

inability to weight bear 4 steps

Question 4

What are the Ottawa Knee Rules

Answer 4

age>55
inability to WB 4 steps
tenderness over patella 
tenderness at head of fib 
inability to flex to 90

Question 5

Benefits/negatives of an x-ray

Answer 5

effective, cheap, good resolution

problems: radiation, poor sensitivity to subtle pathology, poor differentiation between soft tissue structures

Question 6

Describe a CT scan

Answer 6

cross sectional image of tissues
good resolution of soft tissues
assesses articular injury
shows more detail of how deep fracture is and how much it affects the jt

Question 7

Describe Bone scan

Answer 7

radioisotope injection
accumulates at fracture site
Best for Stress #

Question 8

Describe MRI

Answer 8

expensive

useful for combined bone and soft tissue injuries

Question 9

What are the 4 phases to bone healing

Answer 9

Inflammation, Soft Callus, Hard Callus, Remodeling

Question 10

Describe the inflammation phase of bone healing

Answer 10

first couple of days
hematoma formation 
bone necrosis at fracture site 
fibrin and collagen fibers present in hematoma - replaced by granulation tissue 
osteoclasts remove necrotic tissue

Question 11

Describe the soft callus formation

Answer 11

first 2-3 w
growth of callus 
fibroblasts and chondrocytes replace hematoma 
fragments no longer move freely 
keep immobilized during this time!

Question 12

Describe the hard callus formation

Answer 12

4-6 w
intra-membranous bone formation continues
ossification of soft tissue in gap
bone callus growth from peripheral –> central
soft tissue replaced by woven bone
fragments unite

Question 13

Describe the Remodeling phase

Answer 13

lamellar bone replaces woven bone

Question 14

What factors affect the rate of bone fracture union

Answer 14

age, blood supply - smoking/diabetes, fracture type, infection

Question 15

What are the general principles for management of a fracture

Answer 15

Reduce - align fragments
Hold - immobilize
Move - treat associated impairments

Question 16

What are some common fracture sites

Answer 16

Wrist (colles) - FOOSH
Hip/Groin - ramus, fem neck
Femoral Shaft
Patella
Tibial  Shaft
Knee (subcondylar + tibial plateau) 
Ankle 
Foot

Question 17

What are the types of patella #

Answer 17

minimal displaced
transverse
lower pole
vertical
stellate

Question 18

True or false the tibial shaft fracture has a poorer healing potential than the femoral shaft?

Answer 18

true

Question 19

What are the WEBER classifications of ankle #

Answer 19

A: fib# below syndesmosis - evulsion of ATFL, CFL, PTFL - 6 w
B: fib #through syndesmosis - internal fix
C: fib # above syndesmosis - no wb for 10 w, pin

Question 20

What are the types of hind-foot fracture

Answer 20

Calcaneal, Talus, Calcaneal stress #

Question 21

What are the types of # at midfoot

Answer 21

navicular stress# - jump sprint

Lisfranc # - tarsometatarsal - between stirrups, twist and fall from height

Question 22

What are the types of # of the forefoot

Answer 22

Stress # of 2nd/3rd MT - overuse, walking boot

Jones - avulsion of 5th, peroneus brevis, inversion injury, closed reduction - walking boot

Question 23

How do you manage fractures

Answer 23

address impairments - pain, swelling, ROM, stiffness, strenght, length, motor control, gait, balance