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Orthopedics > Lecture 3: Fractures > Flashcards

Lecture 3: Fractures Flashcards

1
Q

What is an oblique fracture

A

A fracture which goes at an angle to the axis

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2
Q

What is a comminuted fracture

A

A fracture of many relatively small fragments

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3
Q

What is a spiral fracture

A

A fracture which runs around the axis of the bone

Happens a lot with a rotational force. skiing

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4
Q

What is a compound fracture

A

A fracture (also called open) which breaks the skin

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5
Q

What is a simple fracture

A

A simple fracture involves a single fracture line through a bone.

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6
Q

What is a greenstick fracture

A

An incomplete fracture in which the bone bends

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7
Q

What is a transverse fracture

A

A fracture that goes across the bone’s axis

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8
Q

What does it mean when fracture fragments are undisplaced

A

Things are not in an abnormal position

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9
Q

What does it mean when fracture fragments are translated

A

Things have slipped

Fragments are not perfectly aligned, but are not at an angle to one another

The fragments may be shifted sideways relative to each other, may override, or may be distracted from each other

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10
Q

What does it mean when fracture fragments are angulated

A

Fragments do not line up in the original shape of the bone, but rather lie at an angle to each other

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11
Q

What does it mean when fracture fragments are rotated

A

Fragments rotated in relation to one another

spiral fracture

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12
Q

What does it mean when fracture fragments are overriding

A

Bony fragments that overlap and shorten the total length of the bone

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13
Q

Explain primary and secondary healing an how it relates to bone

A

Primary healing bones are put together, and there is no distance between the parts that have to heal.

Secondary healing, edges are not put together.

Cortical bone does much better with primary healing.

Spongy bone is good with secondary healing

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14
Q

What is an impacted fracture

A

Fracture in which one broken end is wedged into the other broken end

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15
Q

What is the difference between a closed and open fracture

A

closed (simple) - skin is intact

Open - bone broke through skin and there is a high risk of infection

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16
Q

Why is there a high risk of infection with an open fracture

A

Bone marrow is exposed to foreign bacteria and this can cause a blood infection

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17
Q

What heals faster cancellous or cortical bone

A

cancellous because of its ability of secondary healing

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18
Q

What heals faster epiphyseal fractures or metaphyseal fractures

A

Epiphyseal fractures because of more cartilage

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19
Q

what heals faster a large fracture surface such as a spiral fracture or a transverse fracture, and why?

A

Spiral has more damage but if in the periosteum it would heal faster. With a spiral fracture the body will make a larger response. So a larger surface area will have a larger degree of inflammatory response.

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20
Q

How does displaced bone affect healing

A

Greater displacement means more periosteal injury and slower healing

More damage to the periosteum the more slower healing

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21
Q

How long does it take for a newborn’s bones to heal

A

1 week

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22
Q

How long does it take for a 5 year old and a 10 yr old bones to heal

A

4 weeks and 8 weeks

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23
Q

How long does it take for an adolescent and adult bones to heal

A

3 months

4 or more months

24
Q

Why do children heal so fast

A

Periosteum in children
◦ Thicker, Stronger, More adherent, More osteogenically active

Rarely is periosteum torn with fracture in children

Intact periosteum promotes faster healing

25
Q

Cancellous bone heals by

A

primary and secondary healing

26
Q

cortical bone heals by

A

only primary

27
Q

What are the phases of bone healing

A

inflammatory
reparative
remodeling

28
Q

What happens in the inflammatory phase of healing

A

Necrosis (Very little necrosis in cancellous bone)

Bone macrophages active

Hematoma formation 48-72 hours

29
Q

what happens in the reparative phase of healing and what are the 4 stages

A

Getting continuity back

1) hematoma forms
2) callus forms
3) stage of clinical union
4) stage of consolidation

30
Q

At what stage of healing is the bone safe enough for the person to return to normal life

A

During the reparative phase in the stage of clinical union. Callus is firm enough to allow no motion

3-4 months

After 3-4 months can resume high level activity

31
Q

What is the soft external callus form

A

periosteum

32
Q

What does the internal callus form

A

endosteum

33
Q

What happens during the stage of consolidation

A

immature bone has been replaced by lamellar bone

smoothness occurs via Wolff’s Law

34
Q

How long does it take for bone to remodel

A

6 to 12 months

35
Q

What is primary/direct healing

A

Mechanism of bone healing seen when there is no motion at the fracture site
-ex: rigid internal fixation

36
Q

Which healing process Primary/direct or secondary/indirect has a callus formation

A

secondary

37
Q

Which healing process Primary/direct or secondary/indirect is faster

A

secondary.

Primary is a slow process (unless ORIF)

38
Q

Which type of bone only does primary/direct healing

A

cortical

39
Q

What is the disadvantage to having a plate inserted

A

Plate takes all weight-bearing, surrounding areas may get osteoporosis, that is why the plate may be removed later (however not routine)

40
Q

What is secondary/indirect healing

A

Mechanism for healing in fractures that are not rigidly fixed
◦ Small degrees of movement at the fracture stimulate callus formation

Bridging periosteal (soft) callus and medullary (hard) callus re-establish structural continuity

Callus subsequently undergoes endochondral ossification

Process fairly rapid weeks

41
Q

Why is secondary/indirect healing fast

A

lots of blood supply

42
Q

What happens during the remodeling phase and how long does this take?

A

bone remodels back to original shape

(no scar)

6-12 months

43
Q

What is osteomyelitis

A

inflammation of bone and muscle tissue

44
Q

Soft tissue injury

A

Muscle contusion, hemorrhage, myositis ossificans

Ligament sprain / tear

45
Q

Peripheral nerve injury

A

compression, contusion, traction

46
Q

What nerves are most at risk?

A

common fibular, ular, radial common sites

47
Q

What are three types of vascular injuries

A

compartment syndrome

Venous injury

Arterial injury

48
Q

What is compartment syndroms

A

It is when to much pressure builds up (progressive edema) in a fixed amount of space.
This compromises circulation –> necrosis and nerve damage

49
Q

What are some specific complications of healing

A

malunion
deformities
issues with long bones

50
Q

What are 3 types of malunions

A

Delayed union
Nonunion
Pseudarthrosis

51
Q

What is a delayed union

A

slow healing

52
Q

What is a nonunion

A

does not come together

53
Q

What is a pseudoarthrosis

A

Fibrous joint:

insead of the bone healing nicely, it might have some movement when there shouldn’t be movement

54
Q

What are some complications that can happen with long bones (3)

A

angulation
shortening
rotational

55
Q

Treatment principles for fractures

A

Do no harm

Accurate diagnosis critical

Specific  aims  of  treatment 
◦ Relieve pain
◦ Fracture  reduction
◦ Facilitate  bony  union
◦ Restore  function

Wolff’s law

Consideration of lifestyle

56
Q

What is the treatment for closed fractures

A

Protection alone
◦ i.e. sling, NWB
Immobilization

Closed reduction ◦Manipulation & immobilization (most common)
◦ Traction & immobilization ◦ External fixation

Open reduction internal fixation

57
Q

what is the treatment for open fractures

A

Wound care

Open reduction vs. closed reduction

Immobilization vs. fixation

Orthopedics (12 decks)

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