Lecture 3: Fractures Flashcards
What is an oblique fracture
A fracture which goes at an angle to the axis
What is a comminuted fracture
A fracture of many relatively small fragments
What is a spiral fracture
A fracture which runs around the axis of the bone
Happens a lot with a rotational force. skiing
What is a compound fracture
A fracture (also called open) which breaks the skin
What is a simple fracture
A simple fracture involves a single fracture line through a bone.
What is a greenstick fracture
An incomplete fracture in which the bone bends
What is a transverse fracture
A fracture that goes across the bone’s axis
What does it mean when fracture fragments are undisplaced
Things are not in an abnormal position
What does it mean when fracture fragments are translated
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
What does it mean when fracture fragments are angulated
Fragments do not line up in the original shape of the bone, but rather lie at an angle to each other
What does it mean when fracture fragments are rotated
Fragments rotated in relation to one another
spiral fracture
What does it mean when fracture fragments are overriding
Bony fragments that overlap and shorten the total length of the bone
Explain primary and secondary healing an how it relates to bone
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
What is an impacted fracture
Fracture in which one broken end is wedged into the other broken end
What is the difference between a closed and open fracture
closed (simple) - skin is intact
Open - bone broke through skin and there is a high risk of infection
Why is there a high risk of infection with an open fracture
Bone marrow is exposed to foreign bacteria and this can cause a blood infection
What heals faster cancellous or cortical bone
cancellous because of its ability of secondary healing
What heals faster epiphyseal fractures or metaphyseal fractures
Epiphyseal fractures because of more cartilage
what heals faster a large fracture surface such as a spiral fracture or a transverse fracture, and why?
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.
How does displaced bone affect healing
Greater displacement means more periosteal injury and slower healing
More damage to the periosteum the more slower healing
How long does it take for a newborn’s bones to heal
1 week
How long does it take for a 5 year old and a 10 yr old bones to heal
4 weeks and 8 weeks
How long does it take for an adolescent and adult bones to heal
3 months
4 or more months
Why do children heal so fast
Periosteum in children
◦ Thicker, Stronger, More adherent, More osteogenically active
Rarely is periosteum torn with fracture in children
Intact periosteum promotes faster healing
Cancellous bone heals by
primary and secondary healing
cortical bone heals by
only primary
What are the phases of bone healing
inflammatory
reparative
remodeling
What happens in the inflammatory phase of healing
Necrosis (Very little necrosis in cancellous bone)
Bone macrophages active
Hematoma formation 48-72 hours
what happens in the reparative phase of healing and what are the 4 stages
Getting continuity back
1) hematoma forms
2) callus forms
3) stage of clinical union
4) stage of consolidation
At what stage of healing is the bone safe enough for the person to return to normal life
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
What is the soft external callus form
periosteum
What does the internal callus form
endosteum
What happens during the stage of consolidation
immature bone has been replaced by lamellar bone
smoothness occurs via Wolff’s Law
How long does it take for bone to remodel
6 to 12 months
What is primary/direct healing
Mechanism of bone healing seen when there is no motion at the fracture site
-ex: rigid internal fixation
Which healing process Primary/direct or secondary/indirect has a callus formation
secondary
Which healing process Primary/direct or secondary/indirect is faster
secondary.
Primary is a slow process (unless ORIF)
Which type of bone only does primary/direct healing
cortical
What is the disadvantage to having a plate inserted
Plate takes all weight-bearing, surrounding areas may get osteoporosis, that is why the plate may be removed later (however not routine)
What is secondary/indirect healing
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
Why is secondary/indirect healing fast
lots of blood supply
What happens during the remodeling phase and how long does this take?
bone remodels back to original shape
(no scar)
6-12 months
What is osteomyelitis
inflammation of bone and muscle tissue
Soft tissue injury
Muscle contusion, hemorrhage, myositis ossificans
Ligament sprain / tear
Peripheral nerve injury
compression, contusion, traction
What nerves are most at risk?
common fibular, ular, radial common sites
What are three types of vascular injuries
compartment syndrome
Venous injury
Arterial injury
What is compartment syndroms
It is when to much pressure builds up (progressive edema) in a fixed amount of space.
This compromises circulation –> necrosis and nerve damage
What are some specific complications of healing
malunion
deformities
issues with long bones
What are 3 types of malunions
Delayed union
Nonunion
Pseudarthrosis
What is a delayed union
slow healing
What is a nonunion
does not come together
What is a pseudoarthrosis
Fibrous joint:
insead of the bone healing nicely, it might have some movement when there shouldn’t be movement
What are some complications that can happen with long bones (3)
angulation
shortening
rotational
Treatment principles for fractures
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
What is the treatment for closed fractures
Protection alone
◦ i.e. sling, NWB
Immobilization
Closed reduction ◦Manipulation & immobilization (most common)
◦ Traction & immobilization ◦ External fixation
Open reduction internal fixation
what is the treatment for open fractures
Wound care
Open reduction vs. closed reduction
Immobilization vs. fixation
