Session 10 Flashcards

1
Q

What are the Signs and Symptoms of a Fracture?

A

Pain

Swelling

Deformity

Crepitus

Loss of function

‘Bony’ tenderness

Abnormal movement

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2
Q

What to consider when describing fractures?

A

Location

Configuration e.g. spiral

Parts

Articular (joint surface)

Displacement (of distal fragment)

~Angulation (the younger the child is the more angulation you can accept because bones grow so fast)

~Displacement

~Axial

~Rotation

Clinical Assessment

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3
Q

How would you describe the Mechanism of a Fracture?

A

Fracture pattern

Energy

Soft tissue envelope

Skeletal maturity

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4
Q

What is meant by a Pathological Fracture?

A

Fracture occurring through abnormal bone under physiological load

  • local
  • systemic

E.g. osteoporosis ‘normal bone but less of it’, osteomalacia ‘abnormal bone’ , tumour

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5
Q

What does Fracture Healing depend on, and name the 3 phases

A

Fracture Healing is a balance between stability and biology

3 Phases:

Inflammatory 1-5 days

Reparative 4-40 days

Remodelling 25-200 days (can go for more much longer)

Healing by Callus

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6
Q

What are the Local Factors influencing Fracture Healing?

A

Injury – configuration/soft tissue injury

Bone – cancellous v cortical

Treatment – reduction (restore anatomy)/ stability (e.g. plaster, frame, screws, rod) / infection

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7
Q

What are the Regional and Systemic Fractures influencing Fracture Healing?

A

Regional

Blood supply / muscle cover

Systemic

Age/co-morbidity (e.g. renal failure)/ bone pathology / head injury (healing speeds up due to the response to the head injury)

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8
Q

What is Pearson’s Rule?

A
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9
Q

What happens when fracture healing goes wrong?

A

Malunion (healed in the wrong position) –> deformity, late arthrosis (degeneration of articular cartilage with a subsequent change in the bony articular surfaces, development of osteophyte, deformation of the joint and the development of moderate synovitis)

Non-Union: hypertrophic (extra callus has been laid due to lots of movement causing instability – hypertrophy is body’s response to try to achieve stability), atrophic (no healing potential)

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10
Q

What are Early Local Fracture Complications?

A

Nerve injury

Vascular injury

Compartment syndrome

Avascular necrosis

Infection

Surgical

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11
Q

What are Early Systemic Fracture Complications?

A

Hypovolaemia (due to blood loss) / shock

Fat embolism –> due to fat being released from bone fracture (yellow marrow) –> same effect as pulmonary embolism

Acute respiratory distress syndrome

Disseminated intravascular coagulation (all clotting factors have been used up –> continuous bleeding)

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12
Q

What are Late Local Fracture Complications?

A

Delayed union

Non-union

Malunion

Myositis ossificans

Re-fracture (muscle doesn’t heal properly – becomes calcified –> joint stiffens)

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13
Q

What are Late Regional Fracture Complications?

A

Osteoporosis

Joint stiffness

Chronic regional pain syndrome

Abnormal biomechanics

Osteoarthrosis

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14
Q

What is Compartment Syndrome?

A

raised pressure within an enclosed fascial space leading to localised tissue ischaemia

Pain – excessive/progressive/not relieved by analgesia / ‘passive stretch pain’

Neurovascular changes are late – by the time the pulses have disappeared an amputation is required

If in doubt, perform surgical decompression

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15
Q

Check for puncture wounds when looking at Open v Closed Fractures. How do you assess Open Injuries?

A
  • (After surgical removal of dead tissue)*
  • Gustillo and Anderson*

I: <1cm, clean

II: >1cm, mod contamination (most common)

III: high velocity, farmyard (including neurovascular damage)

A: adequate skin cover

B: bone exposed

C: circulatory compromise

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16
Q

What do you consider when looking at Children’s Fractures?

A

Incomplete Fractures:

  • Buckle (Torus) fractures – compression (the topmost layer of bone on side of the bone is compressed causing the other side to bend away from the growth plate)
  • Greenstick fractures - Tension

Rapid healing

Growth plate (Epiphyseal) fractures

Non-accidental injury

17
Q

What do you need to consider when looking at Epiphyseal Fractures?

A
18
Q

What are Stress Fractures?

A

Repetitive, non-violent ‘subtle’ stresses

‘Fatigue’ v ‘Insufficiency’ – bone hasn’t had time to develop e.g. suddenly running a marathon

Female > men

Predispositions: osteoporosis, sports, eating disorders

19
Q

Discuss Osteoporotic Fractures

A

Osteoporosis is characterised by low bone mineral content, enhanced bone fragility and consequent increased fracture risk/

Sensitivity to osteogrens

Prevention: weight-bearing exercise pre 35 years, vitamin D + calcium

Diagnosis: DEXA Scan wrist / hip / spine (compare against normal bone)

20
Q

Discuss Non-Operative Treatment

A

Protection

Wool and crepe

Sling / collar and cuff

Crutches

Cast – POP / fibreglass

Functional brace

Traction – skin / skeletal

21
Q

Discuss Operative Treatment

A

Protect soft tissues / avoid infection

Open or closed reduction (break put in right space)

Implants – biologically inert

Anatomical reduction *intra-articular*

Inter-fragmentary compression

Stable fixation

Early joint / muscle rehabilitation