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Orthopedic Pathology > Orthopedic Pathology 3 Fractures > Flashcards

Orthopedic Pathology 3 Fractures Flashcards

0
Q

Incidence and risk factors of fracture

A

Very common, increasing in occurrences due to high impact sports, high velocity travel, industry

Higher occurrence in elderly due to osteoporosis

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1
Q

Fracture

A

Is a break/defect in the continuity of a bone

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2
Q

Causes of Fractures

A

A trauma or sudden force
-Direct: a bone breaks at the point of impact
-Indirect: bone breaks at a distance from the force
Overuse or repeated wear
-Stress fracture
Pathologies
-Osteoporosis, tumors, local infection or bone cysts
-Can cause brittleness or weakening of bone

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3
Q

Classification of fractures

A 
site
extent
configuration
relationship of fragments to each other
Relationship to environment
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4
Q

Site of Fracture

A 
Diaphyseal
Metaphyseal
Epiphyseal
Intra-articular
Fracture-dislocation
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5
Q

Salter-Harris Classification description

A

Classification system used to describe fractures affecting the epiphyseal plate or growth plate

Only applies while bone is still growing (0-20 years old)

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6
Q

Salter Harris classification types

A

Type I
Transverse fracture through the growth place 5%
Type II
Fracture through the growth plate and metaphysis 75% MOST COMMON
Type III
Fracture through the growth plate and epiphysis 10%
Type IV
Fracture through the growth plate, epiphysis and metaphysis 10%
Type V
Compression fracture through the growth plate Uncommon

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7
Q

Extent of Fracture

A

Complete: Bone is broken in two or more pieces

Incomplete: Bone is bent or cracked and the periosteum remains intact (e.g. compression, greenstick, perforation, stress)

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8
Q

Compression Fracture

A

Bone is crushed, occur in cancellous bone (such as vetebral body)

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9
Q

Greenstick fracture

A

Bone is bent or partially broken

Found in children younger than 10 years old (bones are more pliable than those of adults)

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10
Q

Perforation fructure

A

Result of a missile wound, bullet

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11
Q

Stress fracture

A

Cracks in the bone due to overuse or repetitive actions.

Common sites: Tibia, metatarsals, navicular, femur, pelvis, generally parallel to axis of the bone

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12
Q

Configuration

A

Linear: Fracture that run parallel to the long axis of a bone
Transverse (chalkstick): fracture that is at a right angle to the bone’s long axis
Oblique: fracture that is diagonal to a bone’s long axis
Spiral: at least one part of the bone has been twisted
Comminuted: Consists of two or more fragments
Avulsion: Occurs when a ligaments pulls the portion of the bone that is attached away from the bone itself
Compacted/impacted: Bone or bone fragments are driven into each other
Osteochondral: Occurs when fragments of articular cartilage are shared from the joint surface

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13
Q

Relationship of fragments to each other

A
  • Consideration include displacement, distraction and angulation
  • Reduction/surgery may be required
  • Longer healing
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14
Q

Relationship of fragment of environment

A
  • Closed or simple fracture: skin is intact
  • Open or compound fracture: the end of the bone have broken through the skin or into a body cavity, more prone to infection

Closed fracture easier to treat with better prognosis.

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15
Q

Symptoms

A 
Unnatural mobility
Muscle splinting
Deformity
Shock
Pain
Bleeding, 
Swelling, bruising
Decreased function
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16
Q

Colles Fracture

A

Transverse fracture of radius proximal to wrist
Fragment rotates and displaces dorsally
Usually from fall on outstretched hand
Dinner fork appearance
Complications (reflex sympathetic dystrophy: doesn’t respond properly)
Malunion (bones don’t heal correctly)

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17
Q

Smith’s fracure

A

AKA reverse Cole’s fracture
The distal fracture fragment is displaced ventrally
Spoon appearance

18
Q

Galeazzi Fracture

A

Fracture of radial shaft and dislocation of distal radioulnar joint
MOI- fall on hand with rotational component
Complications
Ulnar nerve injury

19
Q

Barton’s fracture

A

An intra-articular fracture of the distal radius with dislocation of the radiocarpal joint

Two types: Dorsal and palmar
Caused by a fall on an extended and pronated wrist

20
Q

Rolando fracture

A

Is a comminuted intra-articular fracture through the base of the first metacarpal bone

Fracture consist of 3 distinct fragments (T or Y shaped)

21
Q

Boxer’s (Brawler’s) fracture

A

Fracture of the 5th MC
Due to punching an object with a closed fist
Pain and denderness around knuckle, snapping/popping sensation, discolouration, misalignment of finger, cut on hand

22
Q

Bennett’s fracture

A

Fracture-dislocation of the 1st carpometacarpal jt.
Longitudinal force along the xis of the 1st MC when thumb is flexed
Significant swelling, tenderness and reluctance to use the thumb

23
Q

Monteggia fracture

A

A fracture in the proximal part of the ulna with dislocation of the head of the radius

24
Q

Pott’s fracture

A

Ankle fracture affecting one of both malleoli
Distal fibula fractures close to lateral malleolus
Deltoid ligament can rupture and avulse medial malleoli

25
Q

Dupuytren’s fracture

A

Fracture is higher up on fibula
Medial malleoli avulses and talus pushed superior between tibia and fibula
MOI: eversion with some external rotation
Compications: malunion, joint stiffness

26
Q

Jones Fracture

A

AKA dancer’s fractures

Is an injury to the 5th metatarsal bone of the foot: occurs at the proximal end (midfoot)

27
Q

Maisonneuve Fracture

A

Is a spiral fracture of the proximal third of the fibula
-associated with a tear of the distal tibiofibular joint and interosseus membrane
Medial malleolus fracture and possible rupture of the deltoid ligament

28
Q

Toddler’s fracture

A

AKA childfood accidental spiral tibial fractures
Distal part of the tibia in toddlers aged 9 months to 3 years and children under 8 years old
Invovled the distal third to distal half of the tibia
Undisplaced and in a spiral pattern

29
Q

Trimalleolar fracture

A

A fracture of the ankle that Involved the lateral malleolus, medial malleolus and the distal posterior aspect of the tibia

30
Q

Healing of fracture depends on…

A 
Types of bone that is injured
Amount of movement at fracture site
Complications
Nutrition
Concurrent disease
Age
31
Q

Stage 1 (cellular phase)

A

Hematoma forms around ends of fractured bone within 72 hours of initial trauma
Incites an inflammatory response
Mesh of fibrin forms around the injury site
Granulation tissue eventually invades and replaces hematoma (will ultimately become a callus)

32
Q

Stage 2 (Vascular phase)

A

Inflammatory reaction continues
Specialized circulatory network develops around fracture
Proliferation of osteoblasts at periosteum
Fibrocartilaginous bridge between fragment ends forms

33
Q

Stage 3 (primary callus phase)

A

Soft callus or splint is formed from mass of proliferating osteoblasts and exudate
Osteoclasts clean up dead bone and debrisFibrous, immature bone (woven bone) is gradually calcified
Movement decreases
Union occurs at about 4 weeks
Repair is incomplete as callus is not yet mature

34
Q

Stage 4 (reparative phase)

A

Consolidation

Immature bone matures into lamellar bone

35
Q

Stage 5 (remodeling phase)

A

Remodelling of irregular surfaces
Reshaping of marrow space
Realignment along lines of stress

36
Q

Early Complications

A
  • Torn muscles and tendons
  • Ligament damage
  • Acute compartment syndrome (can occur in forearm or leg, swelling increases pressure within fascial compartment, cycle of reduced circulation, ischemia, edema can leading to necrosis and gangrene)
  • Nerve compression
  • vascular damage (red, black, blue bruising distal to FX)
  • Bone/soft tissue infection (fever, pain, edema, odour, seepage)
  • DVT (esp. in lower limb (calf with clients confined to bed, elderly and CV pathologies)
  • Cast dermatitis
  • pressure or plaster sore (ischemia over bony prominence)
  • Loose cast syndrome
37
Q

Late complication

A
  • Nerve compression or entrapment
  • Joint stiffness
    -Disuse atrophy
  • Disuse osteoporosis
  • myositis ossificans
  • metal plates (local inflammation, screws may loosen or break)
  • non union
    Delayed union (bone dos not unite within expected time frame, due to inadequeate circulation, insufficient splinting, excessive traction, infection)
  • non union (failure of bone to heal before repair process finishes, due to large gap, bone destruction, bone loss)
    -Malunion (unacceptable joining of bony ends resulting in deformity, can leads to altered biomechanics, tendinitis, bursitis, osteoarthritis)
38
Q

Osteonecrosis

A

Avascular necrosis of bone
Occurs in bones that are poorly vascularized
Scaphoid, neck of femur, talus, lunate

39
Q

Avascular Necrosis

A

Tissue ischemia brought on by impairment of blood vessels
Mimimum of 2 hours of anoxia required for permanent loss of bone tissue
May be secondary to trauma or thrombosis
Bone with limited circulation are susceptible
Also bones covered extensively by cartilage
joint may be irreparably damaged
entire process takes years
spontaneous healing does not occur

40
Q

Avascular necrosis conditions

A

Trauma, DM, gout, alchoholism, obesity, pregnancy, oral contraceptives, steroid use, transplantation, etc.

41
Q

Avasclar necrosis clinical Sx

A 
Asymptomatic initially
initial presenting complaint is pain
Often mild
Progresses to severe
slow progressive stiffening of joint
Deformity (late)
DJD (Very late)
42
Q

Avascular Necrosis Diagnosis and treatment

A

X ray initially normal

Watch and wait, surgery

Orthopedic Pathology (6 decks)

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