Orthopedic trauma - Cheung Flashcards
for open fractures, name 2 urgent medical managements
tetanus and antibiotics
- surgical debridement
what image modality is most sensitive for fractures
MRI
what bone graft is osteogenic, osteoinductive, and osteoconductive
autogratfs
define fractures
disruptions in continuity of bone
define open fracture
broken bone is exposed through skin
emergency
high energy fractures are associated with what
extensive soft tissue damage, leading to disruption of healing pathways
acute fractures are associated with what
trauma, sometime high energy
stress fractures have what history
insidious onset of pain, particularly with weight bearing
for a fracture what else must you examine
skin
regional joint stability
nerve and vessels for injury
If high energy, one must evaluate other limbs and spine for
occult injury
for fractures what is the best test for order
X-rays
long does it take stress fractures to show up on X-ray
1-4 weeks
how well are CT scans for fractures
difficult for 3-D fractures
what are the 4 R’s for fracture
recognition
Reduce
Retain
Rehab
retain?
keep reduction either with cast or surgery
reduce?
set bone straight, either with manipulation or surgery
nonunion
bone does not heal
-lack of radiographic evidence of progression of callus formation over a 3-5 month period
malunion
bones heals in unacceptable way
compartment syndrome
swelling from soft tissue damage compresses nerves and vessels, causing permanent damage
- wear loose clothing
Nerve and vessel damage how to treat
Emergency!
repaired or bypassed
what is primary fracture healing
rigid fixation from plates
- direct healing with no callous
- intramembranous
what is secondary fracture healing
- enchondral
- indirect formation of bone from uncommitted mesenchymal cells
- controlled motion
what are the 3 stages of secondary fracture healing
inflammatory for 48 hours
- reparative for 8 weeks
remodeling for 1 year
what are some risk factors for nonunion
smoking
malnutrition
poor immunization
name 3 types of bone grafts
osteogenic
osteoinductive
osteoconductive
osteogenic
bone forming
- only autologous bone graft contains viable osteoblasts
osteoinductive
bone stimulation
- encourages differentiation of mesenchymal cells into osteoblasts
BMP-2
BMP-7
osteoconductive
bone scaffold
cancellous allograft
Allografts
osteoconductive
carry infection
demineralized bone matrix
inductive
expensive
synthetic substitutes
inductive and conductive
good compressive strength
expensive
BMP
inductive
expensive
external ultrasound can improve what
healing potential
Are IM nails load sharing
no, load bearing
