Session 10 - Common Fractures Flashcards
What is a pathological fracture?
-A fracture which occurs to abnormal bone under physiological load
What are local causes of pathological fractures?
- Infection
- Tumour
Name some systemic causes of pathological fractures?
- Osteomalacia
- Malabsorption
- Tumour
What factors influence how bones heal?
- Local factors -> soft tissue injury, type of bone involved, treatment
- Regional factors -> blood supply, muscle cover
- Systemic factors -> age, co-morbidity, bone pathology
Which bones have a classical poor blood supply?
- Radial head
- Scaphoid
- Talus
What are the approximate of healing times of upper limb and lower limb in children and adults?
- Upper limb -> Child 3 weeks, Adult 6 weeks
- Lower limb -> Child 6 weeks, Adult 6-12 weeks
What is malunion? What are the consequences of malunion?
- When bones don’t heal in the right place
- Deformity
- Late arthritis
What are the two types of non-union?
- Hypertrophic
- Atrophic
What are the signs and symptoms of fractures?
- Pain
- Loss of function
- Swelling
- Deformity
- Crepitus
- Abnormal movement
What anatomical features of fractures are important when describing the fracture?
- Location
- Parts
- Displacement (angle, axial, rotation)
Briefly describe fracture healing by callus
- Haematoma formation
- Soft callus formation as cartilage is laid down and calcified -> granulation tissue forms
- Bony callus formation->Soft callus becomes cancellous bone
- Remodelling
How is healing by callus effected when using screws and plates to treat a fracture?
-Callus formation is limited
What is hypertrophic non-union?
-Excess callus deposition but the bone does not heal due to large mobility of the bones
When does atophic non-union often occur?
-When there is poor blood supply
Name some early local complications which can occur with fractures?
-Nerve injury, vascular injury, compartment syndrome, infection, avascular necrosis
Name some early systemic complications of fractures
- Hypovalaemia/shock in open fracture
- Fat embolism
- Thrombus formation
- Acute respiratory distress syndrome
- Disseminated intravascular coagulation
Name some late local fracture complications
- Delayed union (fracture takes longer to heal)
- Non-union
- Malunion
- Myositis ossificans
- Refracture
What is myositis ossificans?
-Belleding into muscle causes calcification and muscle resembles bone
What is compartment syndrome?
-Raised pressure within an enclosed fascial space leading to localised tissue ischaemia
What are the classic symptoms of compartment syndrome if caught early?
- Progressive pain which does not match original injury and is not relieved by analgesia
- Pain on passive strectching
- Feeling of tightness
What is the treatment for compartment syndrome?
-Surgical decompression
Why is it often too late when neurovascular changes are occurring in compartment syndrome?
-Ischaemia has often already ensued and muscle cannot regenerate
What are the two types of incomplete childrens fracture?
- Greenstick fracture
- Buckle fracture
What type of fractures only occur in children (or young adults)?
-Epiphyseal plate fracture
How are epiphyseal plate fractures graded?
- Salter and Harris
- Metaphyseal, articular or growthplate
What is a stress fracture?
-Repetitive, non-violent stresses cause bones to fracture
What predisposes to stress fractures?
- Osteoporosis
- Sports
- Eating disorders
Describe the bone in osteoprososis
-Low bone density, enhanced bone fragikity and consequent increased fracture risk
How is osteoporosis diagnosed?
-DEXA scan
How are fractures assessed?
- Airway, breathing, circulation
- NVT assessment
- Prioritise soft tissues
- Splint
- Look, feel move
- Assess joint above and below injury
Name some non-operative treatments of fractures
- Sling/ collar
- Crutches
- Cast
- Functional brace
- Traction
When would you tell a patient to return when wearing a cast?
- If fingers are pale, blue or swollen
- Plaster becomes loose or cracked
- Increasing pain
