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Current Medical Diagnosis & Treatment > Power Point 2 > Flashcards

Power Point 2 Flashcards

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USMLE® Step 1 flashcards
1
Q

fracture

A

structural break in the continuity of bone, epiphyseal plate, or cartilagenous joint surface

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2
Q

fracture: structural break in the continuity of bone, epiphyseal plate, or cartilagenous joint surface

A
  • typically accompanied by injury to surrounding soft tissue
  • that injury not appreciated on x-ray
  • clinical significance of the fracture may be defined by the bone itself, or possibly by ht surrounding soft tissue that was injured
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3
Q

load characteristics of a bone include

A
  • direction of the applied force
  • magnitude of the load
  • rate of load application
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4
Q

load characteristics of a bone include: direction of the applied force

A 
tension
compression
bending
torsion
sheer
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5
Q

basic biomechanics

A
  • majority of fx to cortical bone the result of tension failure
  • bending
  • axial loading (tension, compression)
  • torsion
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6
Q

fracture mechanism for bending loads

A
  • compression strength greater than tensile strength

- fails in tension

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7
Q

fracture mechanism for torsion

A
  • the diagonal in the direction of the applied force is in tension - cracks perpendicular to this tension diagonal
  • spiral fracture 45 degrees to long axis
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8
Q

cortical bone fracture types

A

impacted

depressed

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9
Q

cortical bone fracture types: depressed

A

broken bone is pressed inward (ie skull fracture)

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10
Q

etiologies of fractures

A

direct trauma
indirect trauma
continuous stress
pathological fracture

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11
Q

etiologies of indirect trauma fractures

A
  • by transmission of stress

- by muscular contraction

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12
Q

etiologies of pathological fractures

A

because of cortical desruption which resulted from bone diseases such as osteomyelitis and benign, malignant, or metastitic lesions of bone, the fracture happened with slight trauma

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13
Q

describing the fracture

A
  • anatomical site
  • configuration displacement
  • articular involvement/epiphyseal injuries
  • soft tissue injury
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14
Q

describing the fracture: configuration displacement

A
  • three planes of angulation
  • translation
  • shortening
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15
Q

describing the fracture: articular involvement/epiphyseal injuries

A
  • fracture involving joint
  • disloaction
  • ligamentous avulsion
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16
Q

site: diaphysis

A

shaft

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17
Q

site: epiphyseal

A

one end of a long bone

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18
Q

site: metaphysis

A

growth plate region

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19
Q

site: medullary cavity

A

marrow cavity

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20
Q

site: endosteum

A

lining of marrow cavity

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21
Q

site: periosteum

A

tough membranecovering bone but not the cartilage

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22
Q

extent of fracture

A

incomplete

complete

23
Q

extent of fracture: incomplete

A 
crac
hairline
buckle
greenstick
simple (closed): little or no bone displacement
24
Q

displacement of fracture

A 
angular
lateral
shortening
separated
rotational
distracted
overriding
impacted
25
Q

close fractured

A
  • fracture is not exposed to the environment
  • all fractures have some degree of soft tissue injury
  • commonly classified according to the Tscherne classification
  • don’t underestimate the soft tissue injury as this affects treatment and outcome!
26
Q

Tscherne Classification

A

Grade 0
grade 1
grade 2
grade 3

27
Q

grade 0 fracture

A
  • minimal soft tissue injury

- indirect injury

28
Q

grade 1 fracture

A
  • injury from within

- superficial contusions or abrasions

29
Q

grade 2 fracture

A
  • direct injury
  • more extensive soft tissue injury with muscle contusion, skin abrasions
  • more severe bone injury (usuallly)
30
Q

grade 3 fracture

A
  • severe injury to soft tissues
  • degloving with destruction of subcutaneous tissue and muscle
  • can include a compartment syndrome, vascular injury
31
Q

open fracture

A

a break in hte skin and underlying soft tissue leading directing into or communicating with the fracture and its hematoma

32
Q

open fracture: a break in the skin and underlying soft tissue leading directing into or communicating with the fracture and its hematoma

A
  • commonly described by the Gustilo system
  • routinely applied to all types of open fractures
  • emphasis on size of skin injury
  • fracture healing, infection and amputation rate correlate with the degree of soft tissue injury
33
Q

type I open fracture

A
  • inside-out injury
  • clean wound
  • minimal soft tissue damage
  • no significant periosteal stripping
34
Q

type II open fracture

A
  • moderate soft tissue damage
  • outside-in mechanism
  • higher energy injury
  • some necrotic muscle, some periosteal stripping
35
Q

Type IIIA open fractures

A
  • high energy
  • outside-in injury
  • extensive muscle devitalization
  • bone coverage with existing soft tissue not problematic
36
Q

Type IIIB open fracture

A
  • high energy
  • outside-in injury
  • extensive muscle devitalization
  • requires a local flap or free flap for bone coverage and soft tissue closure
  • periosteal stripping
37
Q

complications of open fractures

A
  • infection
  • avascular necrosis
  • DVT
  • fat embolism
  • RSD
  • mal-union (deformity of shortening)
  • non-union
  • injury to large vessels
  • nerve compression/entrapment
  • compartment syndrome
38
Q

fracture healing

A
  • unique, integrated, and highly reproducible process
  • closely related to external factors (mechanics)
  • motion at the fracture site results in endochondral ossification (secondary bone healing)
  • stability at the fracture site results in intramembranous ossification (primary bone healing)
  • most of the time there is a combination of the two processes with one more prominent than another
39
Q

two types of bone healing

A
  • primary, healing without external fibrocartilagenous callus formation
  • secondary, healing with a small gap between bone ends
40
Q

primary bone healing

A
  • seen with rigid (exact) internally or externally fixated reductions
  • no callus process
  • bone is (stress protected)
  • rate of healing the same as secondary bone healing
41
Q

healing fractures (secondary intention)

A
  • stage of haematoma
  • stage of sub-periosteal and endosteal cellular proliferaion (external callus and internal callus)
  • stage of callus formation
  • stage of consolidation
  • stage of remodelling
42
Q

salter-harris fractures

A
  • salter-harris fractures are fractures through a growth plate (physis); therefore, they are uinque to pediatric patients
  • several types of fractures have been categorized by the involvement of the physis, metaphysis, and epiphysis
  • the classification of the injury is important because it affect the treatment of the patient and provides clues to possible long-term complications
43
Q

classifications of salter-harris fractures

A

I - V

44
Q

Type I salter-harris fracture

A
  • pure epiphyseal separation

- if non-displaced, joint effusion may be only sign

45
Q

type II salter-harris fracture

A

metaphyseal fracture + epiphyseal separation

46
Q

type III saltar-harris fracture

A

epiphyseal fracture

47
Q

type IV saltar-harris fracture

A

vertically oriented fx thur epiphysis + metaphysis

48
Q

type V saltar-harris fracture

A

crush injury of epiphysis (not detected acutely)

49
Q

principles of fracture of managment

A

reduction
immobilization
rehabilitation
first, do no harm

50
Q

goals of fracture treatment

A
  • restore the patient to optimal functional state
  • provent fracture and soft-tissue complications
  • get the fracture to heal, and in a position whihc will produce optimal functional recovery
  • rehabilitate the patient as early as possible
51
Q

theraoy during immobilization

A
  • reduce edema - to prevent the adhesion formation
  • assist the maintenance of the circulation, active exercise either by static or isotonic muscle activity
  • maintain muscle function by active or static contraction
  • maintain joint range where possible
  • maintain as much function as allowed by the particular injury and the fixation
  • teach the patient how to use special appliances such as crutches, sticks, frames, and how to care for these or any other apparatus
52
Q

therapeutic implicatiosn for treating immobilized fractures

A
  • active ROM exercises to joints above and below immobilized region
  • ISOMs
  • resistive ROM exercises to muscle groups that are not immobilized
53
Q

therapeutic implications for fractures once the cast or immobilization device has been removed

A
  • gentle but progressive resistance exercises of all immobilized joints
  • evaluate strength of joints(s) and compare to non-injured couterparts
  • return to vigorous activity only after strength descrepency < 15%
54
Q

bone graft substitutes and groth factors

A
  • allograft
  • calcium sulfate
  • calcium phosphate
  • collagen-calcium phosphate composite
  • polymer
  • BMP with matrix carrier

Current Medical Diagnosis & Treatment (2 decks)

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