Osteomylitis & fractures

Question 1

what is a fracture

Answer 1

Any break in continuity of bone that occurs when more stress is placed on bone than it is able to absorb

Question 2

Causes of Fractures

Answer 2

++Traumatic (direct/indirect)
Direct – fall
Indirect – muscle contraction that breaks bone

++Fatigue
When bone subjected to repeated, prolonged stress

++Pathologic
Weakened bone
May break spontaneously
Highest risk population - elderly

Question 3

Describing a fracture in 5 areas

Answer 3

Name of bone

Location on bone

Orientation of fracture
Example: spiral

Alignment of fracture
Displaced vs. aligned

Condition of overlying tissue
Open vs. closed

Question 4

9 orientations of fracture

Answer 4

transverse

spiral

longitudal

oblique

comminuted

impacted

greenstick

stress

avulsion of the patella

Question 5

Clinical Manifestations of Fractures

Answer 5

++Pain

++Edema

++Deformity
Loss of function
Abnormal mobility

Question 6

Complications of fractures

Answer 6

Delayed healing

Bone growth impairment (peds)

Compartment syndrome

Fat embolism syndrome

Question 7

3 areas of delayed healing

Answer 7

Delayed union
Bone pain and tenderness increase
Risk factors? smoking

Malunion – unequal stresses
Improper alignment

Nonunion
No healing 4-6 months post-fracture
Causes: Poor blood supply, repetitive stress

Question 8

comparment syndrome seen in

Answer 8

Crush injuries
Cast
Long bone injuries (tibia, radius, ulna)
Severe thermal burns
Animal bites

Question 9

comparment syndrome results from

Answer 9

increased pressure whithin limited anatomic space

Question 10

comparment syndrome creates what effect

Answer 10

“Tourniquet” effect
Edema at fracture site puts intense pressure on soft tissue
Can lead to tissue hypoxia of muscles and nerves

Question 11

Manifestations of comparment syndrome

Answer 11

Extreme pain
5 P’s
Rapid onset

Question 12

what is fat embolism syndrome

Answer 12

Fat molecules in lung following:
Long bone fracture (femur)
Major trauma
Typically occur 24-48 hrs after injury

Question 13

how does the fat get to the lung

Answer 13

Fat molecules from bone marrow or traumatized tissue

Released into blood stream travels to lungs

Question 14

Triad of manifestions in fat embolism

Answer 14

hypoxemia

altered LOC

petechiae

Question 15

what is osteomyelitis

Answer 15

An acute or chronic pyogenic (pus producing) infection of bone

Question 16

usual cause of osteomyelitis

Answer 16

Bacteria – 
Staphylococcus aureus (S. aureus)

Question 17

Where does osteomyelitis happen in teens and adults

Answer 17

Teens – long bones

Adults- vertebrae and hips

Question 18

RF of osteomyelitis

Answer 18

Recent trauma
Diabetes*
Hemodialysis
IV Drug abuse
Splenectomy
Peripheral Vascular Disease*

Question 19

route of DIRECT contamination

Answer 19

\++Open wound
Open fracture
Gunshot
Puncture
Surgery 

Insertion of metal plates or screws

Question 20

route of INDIRECT (hematogenous) contamination

Answer 20

From bloodstream
Most common type
Bacteremia
Usual location: long bones
Highest risk: children under 16

Question 21

patho of hematogenous route

Answer 21

Arterial blood flow brings bacteria into bone
/
Infection results in
Inflammation
Bone destruction
Pus and edema
/
Pressure increases
/
Ischemia/necrosis
/
Osteoblasts lay new bone around old bone
/
Infection is isolated

Question 22

What happens when pressure within bone increases to that of arterial blood flow?

Answer 22

Local arteries collapse!
No supplies of
Oxygen 
Nutrition
Immune cells
Antibiotics

Question 23

What does arterial collapse result in?

Answer 23

impaired healing

Question 24

Clinical manifestations Osteomyelitis

Answer 24

Local
Local tenderness, warmth, redness
Wound drainage
Restricted movement
Spontaneous fractures	

Systemic
Spiking fevers
Positive blood culture
Leukocytosis

Question 25

Pharmacotherapy of Osteomyelitis

Answer 25

Obtain culture

Empiric therapy
Nafcillin
Cefazolin
Vancomycin

Bacteria-specific therapy

Question 26

Osteomymelitis Complications

Answer 26

Chronic osteomyelitis

Local spread of infection

Reduced limb or joint function