Principles of Fracture Treatment

Question 1

Are more fractures due to direct trauma or indirect trauma?

Answer 1

Indirect

Question 2

What are some examples of indirect trauma causing fractures?

Answer 2

Twisting or bending forces

Question 3

Very low energy fractures are usually due to what?

Answer 3

An underlying weakness of bone, pathological fracture

Question 4

What provides the shock absorption for the ends of long bones?

Answer 4

Spongey bone

Question 5

Describe primary bone healing?

Answer 5

This occurs when there is a minimal fracture gap (< 1mm) which will be filled in with new bone by osteoblasts

Question 6

Give some examples of when primary bone healing would occur?

Answer 6

Hairline fractures, following fixation with plates/screws

Question 7

Once a substantial fracture has occurred, secondary bone healing will need to take place. What is the first thing that will happen after the fracture?

Answer 7

There is inflammation of the damaged tissue forming a haematoma

Question 8

Following the formation of a haematoma, what are the functions of macrophages and osteoclasts?

Answer 8

Macrophages remove debris, and osteoclasts resorb the bone ends

Question 9

What is the next step in secondary bone healing, following the actions of macrophages and osteoclasts?

Answer 9

Granulation tissue forms from fibroblasts and new blood vessels form

Question 10

Following the laying down of granulation tissue in secondary bone healing, what then forms the soft callus?

Answer 10

Chondrocytes laying down cartilage

Question 11

After the soft callus is formed in secondary bone healing, endochondral ossification takes place. What is this?

Answer 11

Osteoblasts lay down new bone matrix

Question 12

What forms the hard callus in secondary bone healing?

Answer 12

Calcium mineralisation

Question 13

What is the last stage of secondary bone healing?

Answer 13

Remodelling

Question 14

Give some examples of when secondary bone healing would occur?

Answer 14

Colles fracture, IM nail, external fixation

Question 15

When you look at an x-ray of a healing fracture, what is it that can be seen?

Answer 15

The hard callus of calcified bone

Question 16

In terms of the timescale of secondary bone healing- when do both the soft and hard callus’ form?

Answer 16

Soft = 2-3 weeks, hard = 6-12 weeks

Question 17

What things must there be, for secondary bone healing to be successful?

Answer 17

Good blood supply for oxygen and nutrients, stem cells, the ability of a little movement

Question 18

If a fracture is trying to heal with secondary healing but there is a lack of blood supply, no movement, too big a fracture gap or tissue trapped in the fracture gap, what can this result in?

Answer 18

Atrophic non-union

Question 19

What are some factors which negatively impact fracture healing?

Answer 19

Smoking, chronic ill health, malnutrition, vascular diseases

Question 20

What causes hypertrophic non-union?

Answer 20

Inadequate immobilisation with adequate blood supply

Question 21

What causes atrophic non-union?

Answer 21

Inadequate immobilisation with inadequate blood supply

Question 22

In which type of non-union is there lots of hard callus formation but too much movement to bridge the gap?

Answer 22

Hypertrophic

Question 23

What investigation is the gold standard in assessment of fractures?

Answer 23

X-ray

Question 24

What investigation can be used to assess awkward bones?

Answer 24

CT