Minisymposium: fractures 1 (basics, healing, complications) Flashcards
what is a fracture?
Break in structural continuity of bone, May be a crack, break, split, crumpling, buckle
why do bones fail? Fractures occur?
high energy transfer in normal bones, repetitive stress, low energy transfer in abnormal bones - osteoporosis, osteomalacia, tumour which has metastasised
what are the 4 stages of fracture repair?
Inflammation - Soft Callus formation - Hard Callus Formation - Bone Remodeling
Describe what happens at - Inflammation
haematoma and fibrin clot.
Platelets,
granulocytes (neutrophils, monocytes, macrophage) allow this to happen.
There is also the presence of lysozymal enymes.
Fibroblasts.
Mesenchymal & Osteoprogenitor cells. Angiogenesis
Mesenchymal and Osteoprogenitor cells are also at work - what do they do?
Transformed endothelial cells from medullary canal and/or periosteum. Osteogenic induction of cells from muscle and soft tissues
how may we effect the imflammation stage?
use of NSAID’s, loss haematoma (open fractures and surgeries), extensive tissue damage - poor blood supply
Name some platelet concentrates commonly used…
buffy coat, Platelet derived growth factor, transforming growth factor beta, insulin like growth factor, vascular endothelial growth factor.
Describe what happens at - soft callus formation…
begins when the pain and swelling subsides, lasts until bony fragments are united by cartilage or fibrous tissue. Continuous increase in vascularity
how might we effect this soft callus formation stage?
replacement of the cartilage (dmb), jump straight to bone (bone graft, bone substitutes)
What is the Gold standard in use for making bone grafts?
Autogenous Cancellous Bone - it is osteoconductive and osteoindictive
Name anotherr bone graft option?
Allograft bone - osteoconductive Not osteoinductive, there is also a risk of disease transmission
Describe what happens at - Hard callus formation?
Conversion of cartilage to woven bone. Typical long bone fracture - Endochondral bone formation, Membranous bone formation.
Increasing rigidity
Describe what happens at - bone remodeling
Conversion of woven bone to lamellar bone. Medullary canal is reconstituted. Bone responds to loading characteristics Wolff’s Law
What can cause a Delayed union fracture?
high energy injury, distraction, instability, infection, steroids, immune suppressants, smoking, warfarin, NSAID, Ciprofloxacin
What can cause a Non union fracture and what are its characteristics?
failure calcification fibrocartilage, instability -excessive osteoclasis, abundant callus formation, pain + tenderness, persistent fracture line, sclerosis
what is considered for Mx when there is delayed healing?
different fixation, dynamisation, bone grafting.
what is the definition of a Colles freacture?
distal radial fracture with dorsal displacement and ANGULATION of the distal fragment and the hand - DINNER FORK DEFORMITY
what is the defiinition of a smiths fracture?
distal radial fracture with palmar/volar displacement and ANGULATION of the distal fragment and the hand - falling with wrist flexed.
xray features seen on Colles
dorsal displacement of the distal fragment. The shaft of the radius is driven into the distal fragment, ulnar angulation, dinner fork deformity
outline the examination of the wrist for a colles fracture
swelling, deformity, pulse, tenderness, warmth, sensation, pain on movement
what other fractures occur with a colles?
scaphoid, ulnar styloid, radial head
tx of a colles fracture
cast in palmar flexion and ulnar deviation for 6 weeks then go to the fracture clinic
complicaitons of a colles fracture
carpal tunnel syndrome, stiffness, rupture of extensor policis longus, malunion causing pain and decreased supination, prominence of the distla ulna.
