MS1: Fractures Flashcards
what is a fracture
break in continuity of bone or cartilage na mag aaffect sa function and strength nila
possible causes for fractures
TRAUMA
acquired disease - osteoporosis, tumors
congenital disease - osteogenesis imperfecta
what is pathologic fracture
fracture due to pre-existing bine disease
tumors, cyst, osteoporosis, osteomyelitis
what is stress fracture
fracture due to repeated loading and weak muscles support
BONE FATIGUE
how do we describe fractures
open or closed
complete or incomplete
pattern
displacement
location
bone involved
side involved
modifiers
what are closed fractures
intact skin and mucus membranes
BASTA DI NAG BREAK yuNG SKIN
what are open fractures
OPEN SKIN - NAEXPOSE SA ENVIRONMENT
debridement and irrigation of open fractures should be done within
within 8 hrs tas need mag antibiotics
what are complete fractures
tlagang into 2 or more pieces
both cortices are disrupted
what are incomplete fractures
cortex is not totally disrupted
where in the population does incomplete fracture usually happen
children
what are kinds of incomplete fractures
greenstick - parang tangkay fracture of cortex pero may naka kabit pa
torus - buckling of cortex; nabend tas nag crack medj
bowing - pre greenstick; mag ccurve yung bone
pattern of fracture due to tension
transverse
pattern of fracture due to compression
oblique
pattern of fracture due to bending
comminuted or butterfly
pattern of fracture due to torsion
spiral
diifer comminuted and segmented fracture
comminuted - > 2 fragments; bc of rapid and excessive loading
segmental - 4 point bending
how is the displacement of a fragment named
based in the direction of the distal fragment;
ant, post, med, lat or rotation
name of fracture location if on metaphysis
proximal or distal
name of fracture location if on diaphysis
into thirds
upper third, middle third, lower third
name of fracture location if on specific parts
pwede din kung like sa femoral neck, tibial plateu, lateral epicondyle ganun
mechanism of stress fracture
NORMAL BONE under continued overuse until failure occurs
mechanism of pathologic fracture
PATHOLOGICALLY WEAKENED BONE under normal use
what are modifiers
if there is presence of dislocation
difference between displacement and dislocation
displacement - refers to fractured bone segment kung sa napunta
dislocation - if bone goes out of normal joint position ganun
what is the optimal condition for fracture healing
adequate vascular supply
minimal necrosis
good reduction
immobilization
physiologic stress - wolf’s law
absence of infection
most important factor for fracture healing
blood supply
response of bone blood flow to fracture
initially mag ddecrease sa fracture site
tas mag ppeak at 2 wks - 1-3x normal
return to normal at 3-5 months
when does blood flow peak in fracture healing
2 wks
when does blood flow return to normal in fracture healing
3-5 months
what are the stages of fracture healing
inflammation - hematoma
repair
- soft callus
- hard callus
remodelling - lamellar bone
what happens in the inflammation stage
mga macrophages, growth factors and mesenchymal stem cells iinvade site tas mag cclot
what replaces the clot in the inflammation stage
reparative fibrovascular granulation tissue
when does primary callus occur
within 2 wks
what happens in the soft callus stage
osteoblasts from inner cambium ng uninjured laydown primitive osteoid
nodules of cartilage from cartilaginous tissue around fracture site
how much WB in soft callus stage
25% of body weight muna until kaya mag FWB
what happens in hard callus stage
enchondral ossification begins - soft callus becomes hard callus
osteoid mineralize sa medullary cana
bridgins callus in fracture site is formed
FWB na
what happens in remodeling stage
firm continuity is formed via mature callus tas normal na force transmission
how does bone remodel
callus follows along stress dictated lines tas dun mag osteoblast/clast activity
internal variables that affect healing
blood supply
head injury that affects pituitary gland can inc
mechanical variables that affect healing
affectation of soft tissue
local injury
bone loss
pattern
what fracture patter takes longest to heal
comminuted and segmental tas inc chance of non union due to dec blood supply
external variables that affect healing
low intensity pulse ultrasound - inc vascularity and strength of callus
COX2 - enzyme promotes healing - inc stem cells - inc osteoblast
high dose radiation - remodelling long term
bone sim - direct current, pulse EMF
patient factors that affect fracture healing
low vit D and calcium = non union
diabetes mellitus - 1.6x longer remodeling
nicotine - 79% longer; inhibits growth of new bv and weak callus
infection (HIV) - fragility fracture due to poor blood supp, effect of meds and poor nutrition
how does bisphosphonate affect fracture healing
can cause osteoporotiv fractures
how does steroids affect fracture healing
weakens muscles and ligs
how does NSAID affect fracture healing
if COX2 inhibitor
how does quinolones affect fracture healing
toxic to chondrocytes
3 types of deformity associated w fractures
angulation
shortening
rotation
gold standard of imaging
xray
ct scan pag complex
mri kung may ligament damage
what are the 3 phases of management of fractures
fracture reduction
maintenance of reduction
preservation and restoration of function
most common from of reduction
manipulation
advantages of closed reduction
uses natural repair process
few complications
disadvantages of closed reduction
more difficult to perform
slight angulation and rotation commonly occur
indications of open reduction
failure of closed reduction
articular fractures bc need accurate reduction
unstable fractures
unite poorly
pathologic - trauma
polytrauma
most common method of maintaining reduction
external fixation -
type of EF effective where bones are superficial
casts - pag deep kase like femur gagalaw sa dami ng muscles
type of EF for comminuted, open fractures nd soft tissue injury
pins, bars and rods
used for fractures not adequately immobilized by casts
traction
how does traction work
muscles act as internal splint to protect fracture
disadvantage of traction
requires patient to be in bed
identify if skin or bone traction
applied by means of adhesive or rubber strips and elastic bandage
skin traction
identify if skin or bone traction
not more than 5-6 lbs bc causes maceration of skin
skin traction
identify if skin or bone traction
bucks and russels traction
skin traction
identify if skin or bone traction
wire/pin is drilled through bone
bone traction
identify if skin or bone traction
higher forces 20-30 lbs
bone traction
identify if skin or bone traction
can be applied to distal areas like ankle
bone traction
when is IF used
when other methods of maintaining is unreloable
advantage of IF
direct visualization of fracture = anatomic reduction
disadvantage of IF
converts closed to open fracture
infection
disadvantage of IF
converts closed to open fracture
infection
IF used for oblique fractures esp tibia
transfixation screw
what are bone plates
IF - fastened to bone fragments above and below the fracture
IF used commonly in femoral shaft fracture
intermedullary nails
advantages of IM
promotes contact-compression
removes immob of joint
enables PWB - crutches
what is fracture disease
from prolonged immob
pain and swelling
stiff joint
contractures and adhesions
atrophy
osteoporosis
difference of pediatric bone
thicker periosteum kaya more support and resistance
heal fast bc high vascular
high capacity for remodeling
non union is rare unless ma infect
ligs stronger than bone
lower modulus
method of reduction for pediatric
CLOSED
weak spot in pediatric bone
physis kaya predispose ma injure - affects growth
type 1 salter-harris
physeal fracture
type 2 salter-harris
physeal and metaphyseal
type 3 salter-harris
physeal until epiphysis
type 4 salter-harris
physeal
metaphyseal
epyphyseal
type 5 salter-harris
compression fracture of growth plate
when is it considered delayed union in LE
20 wks
when is it considered delayed union in UE
10 wks
causes of delayrd union
inaccurate reduction
kulang or interrupted immob
local trauma
impairment to circulation
infection
bone loss
separation of fragments
treatment for delayed union
prolong immob or repeat
control infection
WB in walking boot or wolfs law to accelerate
electrical stim
when is it considered non union
6 months and above
factors to non union
extensive soft tissue damage
impaired blood supply
infection
clinical features of non union
mobility at fracture site
motion of fragments = pain
pain on WB
swelling
if sever atrophy
pathology of non union
fracture ends are covered by fibrocartilage and pseudocapsule na may synovial fluid
radiographic exam of non union
gap or line
marrow cavity sealed by scelrotic
proliferation of proximal rounding of distal fragment
what is atrophic non union
ends are thinned and tapered
treatment of non union
brace for stability
bone graft
type of bone graft taken from patient
autogenous
type of bone graft taken from another person
homogenous
treatment that has greatest osteogenic potential
iliac cancellous bone graft
15% of non union cases
femoral neck kase anatomically poor blood supply
treatment for non union in femoral neck
< 60 - graft
> 70 - thr
treatment for non union in femoral shaft
trim fracture end tas IM and graft
most common site of non union
lower 1/3 of tibia kase poor din blood supply
treatment for non union in tibia
compression plate and screw w bone graft
causes of malunion
kulang reduction and immob
where is shortening more problematic
LE
acceptable shortening
up to 1 inch if more mag surgery na
mechanism of rotational malunion
distal fragment heals naka IR or ER
mechanism of angulation mal union
angulated so abnormal stress on adjacent joints
varus of femur = pain on medial knee
treatment for malunion
if minor usually kaya naman mag adapt
pero pwede surgery if severe or cosmetic
most common site for march fracture
2nd metatarsal neck kase less flexible and longest so prone to torsional tas sha pinaka WB
occurence of march fracture
more in females
ATHLETES AND MILITARY
pathology of march fracture
repetitive impact on metatarsals - osteoblastic lags behind during - WB exercises
PE of march fracture
pain improves w rest but inc w activity
pain is dull and aching
bone tenderness
LIMP
imaging for march
xray padin pero baka after 2-4 wks pa makita from onser
MRI w in 234 hrs of onser
treatment for march
RICE
analgesics
walking boot 4-8 wks
stretch and gradual lng na exercise
mechanism of smith
fall on flexed wrist or direct blow to back of wrist
wha tis smith fracture
fracture of radius w volang angulation of distal fragment
treatment of smith fracture
CR and cast
ORIF if malaki dispalcement
what is monteggia fracture
fracture of proximal 1/3 of ulna w radial head dislocation
here is monteggia common in population
children 4-10 yo
treatment for montiagga
CR pag children - cast in supination
ORIF if acute and open or unstable
- adult at commninued
- if di nag reduce yung radius
what is potts fracture
fracture of fibula 2-3 inches above distal tibia w rupture of medial ligament and lateral sublux of talus
FRACTURE OF MEDIAL OR LATERAL MALEOLI W LIG INJURY
ANKLE FRACTURE
MECHANISM of potts
twisting of ankle while running or walking
imaging for potts
x ray of anke leg in 15-20 deg IR
management for potts
nonop if undisplaced and stable
ORIF for falies CR, displaced and unstable
most common osteoporotic fracture
vertebral compression fracture
clinical features of VCF
pain local to fracture
pain can be dermatomal and around rib cage
kyphosis - from multiple compression
potts disease
lost of vertebral height by 20% or at least 4mm
imaging for VCF
xray of entire spine
treatment for VCF
non op - brace lng and bisphosphonates
op - vertebroplasty, kyphoplasty, decompress
