S1_L3: Fracture Healing (Timeframe & Complications) Flashcards
Modified TF
A. The fracture ends of a pseudoarthrosis have a bursal sac and synovial fluid in between.
B. The treatment for pseudoarthrosis is to resect the ends, put a plate, then allow it to heal.
TT
Modified TF
A. The older the skeletal age, the more remodeling potential.
B. The nearer the fracture is to the physis/growth plate, the better the remodeling.
FT
A: younger - more remodeling potential
Modified TF: Avascular necrosis
A. Aseptic necrosis and osteonecrosis are negative on X-ray in the initial stages.
B. Density increases in later stages, resulting in a more white, radiodense or radiopaque image.
TT
Note: In later stages, the extracellular matrix has disappeared, while the inorganic calcium and phosphorus has remained.
TRUE OR FALSE: The more severe the displacement, the less or no remodeling is expected.
True
Modified TF
A. A little or no callus is seen in cortical bone healing.
B. Healing occurs via direct osteoblastic activity (creeping substitution) in cancellous bone healing.
FT
A: cancellous bone healing
Modified TF
A. Cortical bone healing occurs through the formation of a callus to bridge the gap.
B. New bone is deposited on either side of the fracture away from actual fracture line, then proceeds towards the gap to fill in the gap and unite the fragments together.
TT
Modified TF
A. The primary callus is more organized in response to mechanical stresses of normal function.
B. The secondary callus is made up of randomly organized immature bone.
FF
A: secondary callus
B: primary callus
TRUE OR FALSE: Radiologic monitoring of fracture healing after non-surgical treatment is done once a week (weekly) for the next 5 weeks, then at the 6th week from injury prior to removal of cast/splint.
False, it’s once a week (weekly) for the next 3 weeks, then at the 6th week from injury prior to removal of cast/splint
Modified TF
Radiologic monitoring of fracture healing after surgical treatment is done:
A. Immediately post-op
B. 4-8 weeks post-op to see healing or cortical union
TF
B: 4-6 weeks post-op
Modified TF
A. The remodeling phase accounts for 40% of fracture healing time.
B. The reparative phase accounts for 70% of fracture healing time.
FF
A: Reparative phase = 40%
B. Remodeling = 70%
Modified TF
A. The reparative phase is more extensive in children.
B. Direct osteoblastic activity with little or no periosteal reaction or callus formation occurs in surgically compressed healing.
FT
A: remodeling phase is more extensive in children
Note for B: If there is callus formation, it may mean there is some movement present, so a callus forms.
The findings associated with osteomyelitis are the following, except:
A. Developing trabecular bone architecture
B. New bone apposition
C. Eventual peripheral sclerosis
D. None
A. Developing trabecular bone architecture
It should be loss of trabecular bone architecture
The findings associated with osteomyelitis are the following, except:
A. Focal bony lysis or cortical loss
B. Regional osteopenia
C. Periosteal reaction/thickening (periostitis)
D. Endosteal scalloping
E. None
E. None
Modified TF
A. Osteomyelitis occurs due to a contiguous dissemination of a pathogen from a closed fracture or surgical fixation.
B. The dissemination must extend at least 3 cm and compromise 30 to 50% of bone mineral content to produce noticeable changes on plain radiographs.
FF
A: open fracture or surgical fixation
B. must extend at least 1 cm
Modified TF
A. The phases of healing overlap with each other.
B. The majority of nonoperative extremity fractures heal in 4 to 6 weeks.
TF
B: 4 to 8 weeks
Complications in fracture healing
- Fracture fails to unite in the specified time frame required for union
- Fracture healing process has stopped
A. Delayed union
B. Non-union
C. Malunion
- A
- B
Complications in fracture healing
- Commonly seen in scaphoid fractures
- Healed fracture, but a significant residual deformity exists
A. Delayed union
B. Non-union
C. Malunion
- B
- C
Complications in fracture healing
Fractures have successfully united and healed, but a degree of angular or rotary deformity exists.
A. Delayed union
B. Non-union
C. Malunion
C. Malunion
Complications in fracture healing
Fragments fail to unite, and the processes of bone repair have ceased completely.
A. Delayed union
B. Non-union
C. Malunion
B. Non-union
Delayed union may be caused by the following, except:
A. Disrupted vascularity
B. Infection, inadequate or interrupted immobilization
C. Satisfactory reduction
D. Severe local trauma
E. Bone loss & distracted fragments
C. Satisfactory reduction
It should be unsatisfactory
TRUE OR FALSE: Corrective surgery may be performed when there is a significant residual deformity in malunion. The surgery will allow the patient to return to function.
True
TRUE OR FALSE: The inflammatory phase accounts for 10% of the total healing time.
True
Complications in fracture healing
- Fracture ends connected by dense fibrous or fibro-cartilaginous tissue
- Aseptic necrosis, osteonecrosis
A. Pseudoarthrosis
B. Osteomyelitis
C. Avascular necrosis
- A
- C
Complications in fracture healing
- Infection of the bone
- False joint
A. Pseudoarthrosis
B. Osteomyelitis
C. Avascular necrosis
- B
- A
Complications in fracture healing
- Disruption of blood supply leading to localized bone death
- Associated with nonunion
A. Pseudoarthrosis
B. Osteomyelitis
C. Avascular necrosis
- C
- A
TRUE OR FALSE: Regional osteopenia is represented as radiolucent/dark on an x-ray.
True
Remodeling is not expected in these cases of severe displacement, except:
A. Significant displaced fx
B. 90º Angulation
C. Rotational Deformities
D. Displaced fracture crossing the growth plate
E. Intra-articular fracture
F. None
F. None
