Minisymposium: fractures 1 (basics, healing, complications)

Question 1

what is a fracture?

Answer 1

Break in structural continuity of bone, May be a crack, break, split, crumpling, buckle

Question 2

why do bones fail? Fractures occur?

Answer 2

high energy transfer in normal bones, repetitive stress, low energy transfer in abnormal bones - osteoporosis, osteomalacia, tumour which has metastasised

Question 3

what are the 4 stages of fracture repair?

Answer 3

Inflammation - Soft Callus formation - Hard Callus Formation - Bone Remodeling

Question 4

Describe what happens at - Inflammation

Answer 4

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

Question 5

Mesenchymal and Osteoprogenitor cells are also at work - what do they do?

Answer 5

Transformed endothelial cells from medullary canal and/or periosteum. Osteogenic induction of cells from muscle and soft tissues

Question 6

how may we effect the imflammation stage?

Answer 6

use of NSAID’s, loss haematoma (open fractures and surgeries), extensive tissue damage - poor blood supply

Question 7

Name some platelet concentrates commonly used…

Answer 7

buffy coat, Platelet derived growth factor, transforming growth factor beta, insulin like growth factor, vascular endothelial growth factor.

Question 8

Describe what happens at - soft callus formation…

Answer 8

begins when the pain and swelling subsides, lasts until bony fragments are united by cartilage or fibrous tissue. Continuous increase in vascularity

Question 9

how might we effect this soft callus formation stage?

Answer 9

replacement of the cartilage (dmb), jump straight to bone (bone graft, bone substitutes)

Question 10

What is the Gold standard in use for making bone grafts?

Answer 10

Autogenous Cancellous Bone - it is osteoconductive and osteoindictive

Question 11

Name anotherr bone graft option?

Answer 11

Allograft bone - osteoconductive Not osteoinductive, there is also a risk of disease transmission

Question 12

Describe what happens at - Hard callus formation?

Answer 12

Conversion of cartilage to woven bone. Typical long bone fracture - Endochondral bone formation, Membranous bone formation.
Increasing rigidity

Question 13

Describe what happens at - bone remodeling

Answer 13

Conversion of woven bone to lamellar bone. Medullary canal is reconstituted. Bone responds to loading characteristics Wolff’s Law

Question 14

What can cause a Delayed union fracture?

Answer 14

high energy injury, distraction, instability, infection, steroids, immune suppressants, smoking, warfarin, NSAID, Ciprofloxacin

Question 15

What can cause a Non union fracture and what are its characteristics?

Answer 15

failure calcification fibrocartilage, instability -excessive osteoclasis, abundant callus formation, pain + tenderness, persistent fracture line, sclerosis

Question 16

what is considered for Mx when there is delayed healing?

Answer 16

different fixation, dynamisation, bone grafting.

Question 17

what is the definition of a Colles freacture?

Answer 17

distal radial fracture with dorsal displacement and ANGULATION of the distal fragment and the hand - DINNER FORK DEFORMITY

Question 18

what is the defiinition of a smiths fracture?

Answer 18

distal radial fracture with palmar/volar displacement and ANGULATION of the distal fragment and the hand - falling with wrist flexed.

Question 19

xray features seen on Colles

Answer 19

dorsal displacement of the distal fragment. The shaft of the radius is driven into the distal fragment, ulnar angulation, dinner fork deformity

Question 20

outline the examination of the wrist for a colles fracture

Answer 20

swelling, deformity, pulse, tenderness, warmth, sensation, pain on movement

Question 21

what other fractures occur with a colles?

Answer 21

scaphoid, ulnar styloid, radial head

Question 22

tx of a colles fracture

Answer 22

cast in palmar flexion and ulnar deviation for 6 weeks then go to the fracture clinic

Question 23

complicaitons of a colles fracture

Answer 23

carpal tunnel syndrome, stiffness, rupture of extensor policis longus, malunion causing pain and decreased supination, prominence of the distla ulna.