Splinting and Fractures Flashcards
Osteoblasts
Derived from mesenchymal cells
Produce osteocalcin
Needs 1,25-Dihydroxyvitamin D
Produce Type I collagen
Osteoblasts are effected by?
Interleukins
Platelet derived growth factor
Insulin derived growth factor
Receptors for osteoblasts
Estrogen Prostaglandins Glucocorticoids 1,25 vitamin D PTH
Osteoclast stimulated by?
stim by calcitonin and inhibited by PTH
Multinucleated Giant cells
collagen
90% of organic matrix
Tensile strength
Prosteoglycans
Inhibit mineralization
Partially responsible for compressive strength
3 Non-Collagenous proteins
Osteocalcin
Osteonectin
Osteopontin
Bone Matrix (inorganic)
Calcium Hydroxyapatite
Responsible for compressive strength
Osteocalcium Phosphate
Brushite
Cortical bone (Lamellar)
80% of skeleton
Haversian canals – nutrient supply
Stress oriented formation
Cancellous bone (Lamellar)
Trabecular (spongy)
Higher rate of remodeling
Immature (Woven)
Not stress oriented
Elastic in nature
Embryonic skeleton
Fracture healing
Pathologic (Woven)
Random organization
Weak
Tumors
Inflammatory response
Bleeding to area of insult
Hematoma – fibrin clot, growth factors
repair of fracture
Primary callous @ 2 wks
Bridging occurs
Assisted by medullary callous
remodeling of fracture
Initiates during repair
Complete when repopulation of marrow space
initial response for fracture healing
decrease blood flow
Hours – days begins increase
Regional acceleratory phenomenon-
Returns to normal 3-5 months
kids bone pathology
Thicker periostium
Cambium has increased ability for osteoblast formation
Wolffs Law
Decrease stress = decrease density Piezoelectric charges Compression – electronegative Stimulates osteoblasts Tensile – electropositive Stimulates osteoclasts
Classification of Bones (6)
Long bones Short bones Flat bones Irregular bones Sesamoid bones Accessory bones
Closed reduction fractures
Most fractures can be treated closed Must understand anatomy Need good plain films minimum of 2 views Peri-ostium can hold you up Can’t accept rotation deformity Difficult to manipulate after 10 days
Kids and Fractures
Kids - angulations can be accepted Kids remodel Mid-shaft doesn’t remodel as well Kids ok for shortening Kids rarely form non-unions Kids rarely need physical therapy
2 layers of physis
Horizontal - physis
Spherical- epiphysis
2 types of growth plate fractures
Traction
Usu. apophyseal
Compression
Usu. epiphyseal
Salter Harris Classification Type 1
Type I – Transverse fracture through physis
Salter Harris Classification Type 2
Type II – Fracture through physis with metaphysis fragment
Salter Harris Classification Type 3
Type III – Fracture through physys with epiphysis fragment
Salter Harris Classification Type 4
Type IV – Fracture through epiphysis, physis and metaphysis
Salter Harris Classification type 5
Type V – Crush injury to physis
Type I and Type II emergent open fractures
Type I <10 cm
Moderate energy
Type IIIa emergent open fractures
Type IIIa
High energy
Adequate soft tissue coverage
Type IIIc emergent open fractures
Type IIIc
High energy
Vascular injury
Type IIIb emergent open fractures
Type IIIb
High energy
Massive soft tissue destruction
Exsposed bone
High complication rate of fractures in children
Supracondylar humerus fractures
Radial neck fractures
Radial head fractures
Lateral condylar humerus fracture
High complication rate of fractures in adults
Both bone extremity fractures
Pilon fractures
Distal Humerus fracture
Splints for fractures
Immobilize fracture Joint above and below Allows for swelling Most swelling 6-12 hours post injury Extra padding to bony prominence Well applied splint is as good as a cast acutely
Casting fractures
Apply after swelling decreases Extra padding of bony prominences Do not use fingers for molding Any complaints evaluate May need to remove Caution about reduction Apply without tension
Caution for splinting and casting
Compartment syndrome
Skin necrosis
Foreign bodies
Surgical Treatment for fractures
Percutaneous pinning Closed reduction with internal fixation Open reduction with internal fixation Intramedullary fixation External fixation
