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Musculoskeletal > Ortho Fractures > Flashcards

Ortho Fractures Flashcards

1
Q

Osteogenesis

A

Ossification, the process of bone tissue formation

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2
Q

Endochondral Ossification

A

Bone replaces cartilage models, contain physis

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3
Q

Intramembranous Ossification

A

Undifferentiated mesenchymal cells that differentiate into osteoblasts which form bone (skull bones)

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4
Q

Appositional Ossification

A

Osteoblasts deposit new bone on existing bone resulting increased width of bone. Also plays part in proximal bone healing

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5
Q

Osteoprogenator Cell

A

From mesenchymal stem cells that lead to the formation of osteoblasts, cartilage, or fibrous tissue

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6
Q

Osteoblasts

A

Form bone by generating organic non-mineralized matrix, produces alkaline phosphatase

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7
Q

Osteocytes

A

Osteoblasts that have been surrounded by newly formed mtrix and are the living cells of the bone, communicate by canaliculi. Stimulated by calcitonin and inhibited by PTH

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8
Q

Osteoclast

A

Originate from macrophage lineage, have brush border and create Howship’s lacunae. Function to reabsorb bone and inhibited by calcitonin

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9
Q

Resting Zone

A

Small scattered condrocytes that store glycogen and proteoglycan for later bone and matrix formation

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10
Q

Proliferating Zone

A

Chondrocytes stack into lines in direction of bone growth and proliferate and divide. Longitudinal bone growth occurs

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11
Q

Zone of Hypertrophy

A

Chondrocytes enlarge and responsible for 44-59% of long bone growth. Also MOST COMMON AREA of FRACTURE!

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12
Q

Zone of Calcified Cartilage

A

Chondrocytes die and matrix calcifies, calcification begins at longitudinal septa

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13
Q

Apoptosis

A

Process by which cells undergo programmed cell death and plays role in terminally differentiating chondrocytes by preparing the matrix for calcification

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14
Q

Type 1 Collagen

A

Bone

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15
Q

Type 2 Collagen

A

Cartilage

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16
Q

Function of Calcified Cartilage

A

Remnants of cartilage act as scaffold for osteoid ad diaphyseal vessels invade

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17
Q

Mineralization

A

Collagenous matrix is seeded with calcium hydroxyapatite crystals (accretion=crystal growth)

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18
Q

Bone Cells

A

Osteocytes form when osteoblasts get trapped within newly formed lacunae

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19
Q

Physeal Closure

A

At adulthood skeletal maturity is reached and growth plate becomes solid. Decline in width of physis. Under control of ESTROGEN in both sexes that stops replication of chondrocytes

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20
Q

Ossification Center

A

Location in tissue where ossification begins

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21
Q

Bipartite Patella

A

Patella that has two ossification centers (Patella exhibits intramembranous ossification)

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22
Q

Fracture

A

Break in the integrity of a bone cause by a load/force to the bone that results in decrease in functional capability of the bone

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23
Q

Fracture Patterns

A

Determined by the type/direction of the force, physical characteristics of bone, and speed of the force

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24
Q

Location of Bone Fracture

A
  1. Epiphyseal
  2. Metaphyseal
  3. Diaphyseal
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25
Q

Transverse Fracture

A

Perpendicular to long axi

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26
Q

Oblique Fracture

A

Angulated fracture line

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27
Q

Spiral

A

multi-planar break

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28
Q

Comminuted

A

More than two fragments

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29
Q

Segmental

A

Separate segments

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30
Q

Intra-articular

A

Enters joint

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31
Q

Naming Direction of Fracture

A

Always name the direction of the distal fragment

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32
Q

Non-displaced Fracture

A

Bone still in anatomical alingment

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33
Q

Displaced

A

Not in anatomical Alingment

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34
Q

Angulated

A

Fracture has an angle between the fragments

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35
Q

Bayonet

A

Longitudinal overlap of fragments

Ex: causes short leg in tibia fracture

36
Q

Distraction

A

Gap between fragments

37
Q

Type 1 GA Classification

A 
Wound size less than 1 cm
Low velocity/energy
Minimal soft tissue Damage
No crush
Little contamination
38
Q

Type 2 GA Classification

A 
1-10cm wound
High velocity/energy 
No extensive soft tissue damage
Slight to moderate crush
Moderate contamination
39
Q

Type 3 A GA Classification

A 
Wound size greater than 10cm
High velocity/energy
Extensive soft tissue damage with adequate coverage and no need for flaps
No significant vascular injury
High contamination
40
Q

Type 3 B GA Classification

A 
Wound greater than 10cm
High velocity/energy
Extensive soft tissue damage with periosteal stripping requiring flap covering of bone
No vascular injury
Massive contamination
41
Q

Type 3 C GA Classification

A

Same exact findings as Type B except they do have vascular injury that requires repair for limb salvage

42
Q

Plastic Deformation

A

Pediatric classification where there is bending of bone

43
Q

Buckle (torus)

A

Only one cortex in pediatric bone is involved

44
Q

Greenstick

A

Crack of one cortex and buckle of opposite cortex

45
Q

Epiphyseal Plate

A

Most common type of pediatric fracture, usually in Zone of Hypertrophy

46
Q

Apophyseal Plate

A

Fracture in pediatrics, this area does not add length to bone
Ex: tubercles and trochanters

47
Q

Pediatric Skeleton

A

Bone is more porous then adults. Has higher amounts of cartilage, blood supply, osteoblasts compared to adult bone. Joint injuries uncommon because epiphyseal plate fractures more common and fractures can remodel easily

48
Q

Why are fracture around hip in children so severe?

A

Devastating due to AVN of femoral head which is not easily fixed in child because they are growing and can’t receive hip replacement

49
Q

Tiplane and Tallaux Fractures

A

Ankle fracture that are intra-articular and require anatomic reduction. Fracture due to asymmetrical growth of tibia growth plate

50
Q

Identifying Child Abuse

A

Look for fractures in various states of healing

51
Q

S-H Type 1

A

Widening of epiphyseal plate

52
Q

S-H Type 2

A

Fracture through plate and Metaphysis

53
Q

S-H Type 3

A

Fracture through plate and epiphysis

54
Q

S-H Type 4

A

Fracture through both metaphysis and epiphysis

55
Q

S-H Type 5

A

Crushed epiphysis leading to fusion and closure of growth plate at early age

56
Q

Stages of Fracture Healing

A

1) Bleeding- devascularizes and forms hematoma
2) Resorption- osteoclasts and inflammatory response
3) Mesenchymal differentiation into osteo and fibro progenitor cells
4) Callous formation

57
Q

Bone Circulation

A

Bone receives 5-10% of cardiac output

1) Nutrient artery system
2) Metaphyseal-epiphyseal system
3) Periosteal system (outer third of diaphysis)

58
Q

Bone Repair Stages

A

1) Hematoma/ inflammatory response
2) Fracture hematoma maturation
3) Conversion of hypertrophic cartilage into bone
4) Bone remodeling

59
Q

Bone Morphogenic Protein

A

early post-fracture mesenchymal and osteoprogenitor cells facilitate BMP’s which convert undifferentiated perivascular mesenchymal cells to form osteoblasts and bone formation

60
Q

TGF-B

A

Induces mesenchymal cells to produce Type 2 collagen, regulates cartilage and bone formation in fracture callus

61
Q

Fracture Hematoma Maturation (Soft Callus)

A

Provides progenitor and growth factors for mesenchymal differentiation and endochondral ossification repair

62
Q

Woven Bone (Hard Callus)

A

Weaker haphazard arrangement of collagen when hypertrophic chondrocytes differentiate and calcify during repair

63
Q

Osteoclastic tunneling

A

Remodeling of cortical bone (cutting cones)

64
Q

Clastic Resorption

A

Remodeling cancellous bone followed by blasts laying down new bone

65
Q

Wolff’s Law

A

Bone remodels in response to mechanical stress (ex: edema or hematoma)

66
Q

Piezoelectric Charge

A

Compression side (neg charge) activates blast and tension side (pos charge) activates clasts

67
Q

Why immobilize a fracture?

A

The more a fracture is immobilized and brought into proximity of broken ends, the better facilitated repair is and less callus formed - Primary Cortical Healing

68
Q

Delayed Union

A

Fracture that has not healed in twice the normal healing time

69
Q

Nonunion

A

Fracture that had not healed in three times the normal healing time (6 months)

70
Q

Atrophic Nonunion

A

Bone near the fracture becomes pointed with no apparent healing of fracture

71
Q

Hypertrophic nonunion

A

Bone at fracture site form enormous amounts of bone with no healing

72
Q

Malunion

A

Fracture that is united with unacceptable angulation, rotation, or shortening

73
Q

Fracture Blisters

A

Occur in response to increased compartmental pressure

74
Q

Jone’s Fracture

A

Fracture of 5th metatarsal and rarely heals

75
Q

Local Complication of Fractures

A

Vasculare injury, compartment syndrome, tendon/soft tissue injury

76
Q

Thromboembolism Complication

A

DVT and PE are at increased risk when patient suffers fracture in long bone of extremities or in pelvis. Decreased immobilization and compliance in these patients increases risk of embolism.

77
Q

Homan’s Sign

A

Sever pain in dorsiflexion of foot for patients with DVT. Also, edema seen distally to obstruction

78
Q

Fat Embolism Syndrome

A

Microvascular occlusions throughout organs due to embolizing fat. May occur with long bone fractures and bone marrow seeping into blood. usually occurs within 48 hours of break

79
Q

Conditions Associated with Fat Embolism

A

1) Steroid Therapy
2) Sickle Cell
3) Alcoholic fatty liver

80
Q

Classic Triad Finding of FE

A

1) Neurological Abnormalities
2) Hypoxemia
3) Petechial Rash

81
Q

Compartment Syndrom

A

Increased pressure in a compartment due to bleeding, increased cappillary perm, or compression (tight dressing) can lead to compromise of circulation and function of tissue

82
Q

Symptoms of Compartment Syndrome

A

Pain, Palor, Paresthesias, Pulselessness

83
Q

RSD

A

Reflex Sympathetic Dystrophy
AKA Complex Regional Pain Syndrome is disruption of autonomic nervous system
Type 1: triggered by tissue injury
Type 2: Triggered by nerve injury

84
Q

Stages of CRPS

A

Acute, Dystrophic, Atrophic

85
Q

Pathological Fractures

A

Bone break in an area weakend by another disease process, usually during normal activity.
Treatment must address underlying disease process

86
Q

Stress Fracture

A

Pathological fracture that is secondary to repeated microtrauma due to repeated stress causing little breaks over and over

Musculoskeletal (7 decks)

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