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Med Procedures - Quiz 4 > Ortho Splinting > Flashcards

Ortho Splinting Flashcards

1
Q

What are osteoblasts derived from?

A

Mesenchymal cells

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2
Q

What do osteoblasts produce?

A
  • Osteocalcin (which needs Vit D)

- Type I collagen

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3
Q

Osteoblasts are affected by:

A
  • ILs
  • Platelet derived growth factor
  • Insulin derived growth factor
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4
Q

Describe osteoclasts

A
  • Multinucleated giant cells
  • Attach to bone by integrins (decreases acidity, proteolytic digestion)
  • Specific receptors for calcitonin (helps regulate resorption)
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5
Q

What do osteoclasts originate from?

A

Hematopoetic tissue (monocyte progenitors)

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6
Q

What is organic bone matrix composed of?

A
  • Collagen (90% of organic matrix, tensile strength)
  • Proteoglycans (inhibit mineralization, partially responsible for compressive strength)
  • Non-collagenous proteins (osteocalcin, osteonectin, osteopontin)
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7
Q

What is inorganic bone matrix composed of?

A
  • Calcium Hydroxyapatite (responsible for compressive strength)
  • Osteocalcium Phosphate (brushite)
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8
Q

What type of bone makes up 80% of the skeleton?

A

Cortical bone

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9
Q

Describe cortical bone

A
  • 80% of skeleton
  • Haversian canals (nutrient supply)
  • Stress oriented formation
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10
Q

Describe cancellous bone

A
  • Trabecular (spongy)

- Higher rate of remodeling

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11
Q

What are the non-collagenous proteins in organic bone matrix?

A
  • Osteocalcin
  • Osteonectin
  • Osteopontin
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12
Q

Describe immature bone

A

-Not stress oriented
-Elastic in nature
(embryonic skeleton, fracture healing)

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13
Q

Describe pathologic bone

A

-Random organization
-Weak
(tumors)

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14
Q

Stages of fracture healing

A
  • Inflammatory (bleeding/hematoma)
  • Repair (primary callous at 2 weeks, bridging)
  • Remodeling (complete when repopulation of marrow space
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15
Q

When does primary callous occur in fracture healing?

A

2 weeks

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16
Q

Initial response of fracture healing is to:

A

Decrease blood flow

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17
Q

How does bone differ in kids?

A
  • Thicker periosteum

- Cambium has increased ability for osteoblast formation

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18
Q

Why shouldn’t a cast be put on the first few hours following a fracture?

A

Inflammatory response causes bleeding/hematoma and casting it could cause compartment syndrome

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19
Q

What is Wolff’s Law?

A
  • Bone remodeling
  • Decreased stress = decreased density
  • Piezoelectric charges (compression which stimulates osteoblasts, tensile which stimulates osteoclasts)
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20
Q

Salter Harris Classification

A 
I: transverse through physis
II: through physis w/metaphysis fragment
III: physis w/epiphysis fragment
IV: epiphysis, physis and metaphysis
V: crush injury to physis
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21
Q

When does blood flow begin to increase and when does it return to normal after a fracture?

A
  • Begins to increase hours-days after fracture

- Returns to normal 3-5 months

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22
Q

Which piezoelectric charges stimulate osteoblasts?

A

Compression (electronegative)

23
Q

Which piezoelectric charges stimulate osteoclasts?

A

Tensile (electropositive)

24
Q

How are bone types classified?

A

FAILSS

  • Flat
  • Accessory
  • Irregular
  • Long
  • Short
  • Sesamoid
25
Q

How to describe fractures?

A
  • Which bone
  • Open or closed
  • Location (rule of 1/3)
  • Direction of fx
  • Type of comminution
26
Q

How to describe the direction of a fracture?

A
  • Oblique
  • Transverse
  • Spiral
  • Comminuted
27
Q

Types of comminution

A
  • Butterfly

- Segmental

28
Q

How is aposition of a fracture described?

A

Alignment and angulation

29
Q

Describe alignment of a fracture

A
  • Distal fragment in relation to proximal fragment

- 100%, 75%, 50%, 25%

30
Q

Describe angulation of a fracture

A
  • Reference distal fragment

- Reference apex

31
Q

What should ALWAYS be evaluated with fractures and when?

A

Neurovascular status (before AND after treatment)

32
Q

When are closed reductions difficult to manipulate?

A

After 10 days (esp kids)

33
Q

How can most fractures be treated?

A

Closed reduction

34
Q

When should angulations be corrected?

A

Adults

kids - angulations can be accepted

35
Q

Describe fractures in kids

A
  • Angulations can be accepted
  • Kids remodel
  • Kids ok for shortening
  • Kids rarely form non-unions
  • Kids rarely need PT
36
Q

What part of the bone doesn’t remodel as well?

A

Mid-shaft

37
Q

What are layers of the physis?

A

Horizontal (physis)

Spherical (epiphysis)

38
Q

What does the epiphyseal plate consist of?

A
  • Articular cartilage
  • Ossification center
  • Physeal (reserve, proliferation, and hypertrophic zones)
  • Metaphysis
39
Q

Types of growth plate fractures

A
  • Traction (usually apophyseal)

- Compression (usually epiphyseal)

40
Q

What can cause early closure of the growth plate?

A

Growth plate fracture

41
Q

Types of open fractures

A
  • I: less than 1 cm (low energy)
  • II: less than 10 cm (moderate energy)
  • IIIa: high energy, adequate soft tissue coverage
  • IIIb: high energy, massive soft tissue destruction, exposed bone
  • IIIc: high energy, vascular injury
42
Q

Which fractures are considered emergent?

A
  • Open
  • Intra-articular
  • Femur
  • Both bone extremity fractures
43
Q

Which fractures have high complication rate in kids?

A
  • Supracondylar humerus
  • Radial neck
  • Radial head
  • Lateral condylar humerus
44
Q

Which fractures have high complication rate in adults?

A
  • Both bone extremities
  • Pilon
  • Distal humerus
45
Q

Describe splints

A
  • Immobilize fracture (joint above and below)
  • Allows for swelling
  • Extra padding to bony prominence
  • Good as a cast acutely (if applied well)
46
Q

When does most swelling occur after fracture?

A

6-12 hrs post injury

47
Q

Benefits of plaster

A
  • Easily molded
  • Inexpensive
  • Can be removed quickly
48
Q

Cons of plaster

A
  • Weaker
  • Heavier
  • More technical to apply
49
Q

Benefits of fiberglass

A
  • Light weight
  • Strong, durable
  • Waterproof
50
Q

Cons of fiberglass

A
  • Difficult to mold
  • Shorter shelf life
  • More expensive
51
Q

Potential complications of splinting/casting

A
  • Compartment syndrome
  • Skin necrosis
  • Foreign bodies
52
Q

Surgical treatments of fractures

A
  • Percutaneous pinning
  • CRIF
  • ORIF
  • Intramedullary fixation
  • External fixation
53
Q

What indicates child abuse?

A
  • History of prior injuries
  • Story doesn’t match injury
  • Bone scan w/multiple areas of uptake

Med Procedures - Quiz 4 (4 decks)

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