principles of fractures

Question 1

what is an intra-articular fracture?

Answer 1

a fracture that goes through the joint and/or cartilage

Question 2

what is an avulsion?

Answer 2

a tear in a ligament or tendon

Question 3

what does fracture healing depend on?

Answer 3

-blood supply
-soft tissue health
-type of bone
-amount of movement at fracture site (displaced/non-displaced)

Question 4

how long does it take for a fracture and its surrounding soft tissue to heal?

Answer 4

a minimum of 6-8 weeks (could be longer depending on the pt. general health and condition of the bone and soft tissue)

Question 5

why and when would a splint be used for a fracture?

Answer 5

• alleviate pain
  -ensure that bone union takes place in a good position
  -permit early movement and return of function

Question 6

what is the primary and secondary intention of healing?

Answer 6

1-primary: bone to bone joining (reduction)
2-secondary: callus formation (the bone heals it)

Question 7

what are the stages of fracture healing?

Answer 7

1- tissue distruction and hematoma formation
2- inflammation and prolifration
3-callus formation (fracture sticky, wooven bone)
4- consolidation (lamellar bone, strong enough to bear normal load)
5- remodling

Question 8

explain the first stage of fracture healing

Answer 8

hematoma: damage and bleeding at the fracture site, and the bone ends die a few millimeters back

Question 9

explain the second stage of fracture healing

Answer 9

inflammation: inflammatory cell appear in the hematoma

Question 10

explain the third stage of fracture healing

Answer 10

callus formation: the population is changed to osteoblasts and osteoclasts, the dead bone is mopped up and woven bone appears in the fracture callus

Question 11

explain the fourth stage of fracture healing

Answer 11

consolidarion: the wooven bone is replaced by lamellar bone and the fracture is solidly united

Question 12

explain the fifth stage of fracture healing

Answer 12

remodling: the new formed bone is remodled to resemble the normal structure

Question 13

till what stage musct the fracture be protected?

Answer 13

the consolidation stage

Question 14

what is vasular necrosis?

Answer 14

the death of bone tissue

Question 15

where does vascular nercrosis happen the most?

Answer 15

femoral head and scaphiod

Question 16

why does spongy bone heal better/faster than cortical bone?

Answer 16

because it has more blood supply and also contains bone marrow

Question 17

what are some complications of traction?

Answer 17

-blood supply cutoff
-nerve injury
-pin-site infection

Question 18

what are some internal fixation complications?

Answer 18

-infection
-non-union
-implant fialure
-refracture

Question 19

what are some external fixation complications?

Answer 19

-soft tissue damage
-over-distraction
-pin track infection
-refracture

Question 20

early complications of fractures

Answer 20

-visceral injury
-vascular injury
-nerve injury
-infection
pressure sores
compartment syndrome

Question 21

what could compartment syndrome lead to?

Answer 21

Volkmann’s ischemic contracture

Question 22

ischemic means?

Answer 22

decreased blood supply

Question 23

how does compartment symdrome cuase Volkmann’s ischemic contracture?

Answer 23

-pressure within the muscle builds to dangerous levels
-pressure decreases blood flow
-prevents nourishment and oxygen to reach nerve and muscles (leading to necrosis)

Question 24

late compliactions of fractures

Answer 24

-delayed union
-non-union
-malunion
-avascular necrosis
-growth disturbance
-bed sores
-nerve compression
-joint stiffness
-osteoartheritis

Question 25

why is decresed ROM common after a fracture?

Answer 25

due to joint stifness