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T4 MSK > Topic 4 - Fractures > Flashcards

Topic 4 - Fractures Flashcards

1
Q

A break in the continuity of a bone, an epiphyseal plate or a cartilaginous joint surface.

A

Fracture

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2
Q

When there is a ________, there is always some degree of injury that also occurs to the soft tissues surrounding the bone.

A

Fracture

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3
Q

A type of fracture in which a long bone bends causing failure on the convex side of bend first.

A

Transverse (aka. Oblique, Greenstick) Fracture

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4
Q

T/F - In a greenstick fracture, only the concave side breaks into two pieces and the convex side remains bent.

A

False - In a greenstick fracture, only the CONVEX side breaks into two pieces and the CONCAVE side remains bent.

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5
Q

A type of fracture involving spiral tension failure in a long bone.

A

Spiral Fracture

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6
Q

A type of fracture involving tension failure from the pull of a ligament or muscle.

A

Avulsion Fracture

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7
Q

A type of fracture in which forces usually compress cancellous bone.

A

Compression/Impacted Fracture

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8
Q

A type of fracture leading to a small crack in the bone, which is unaccustomed to repetitive/rythmic stress.

A

Fatigue/Stress Fracture

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9
Q

A type of fracture resulting from the effects of osteoporosis, boney tumor or other disease.

A

Pathological Fracture

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10
Q

Some signs and symptoms of a possible ________ include:
- History of a fall, direct blow, twisting injury or accident
- Localized pain aggravated by movement
- Muscle guarding with passive movement
- Decreased function at the joint
- Swelling, deformity or abnormal movement
- Possible presence of bruising
- Sharp, localized tenderness at the site

A

Fracture

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11
Q

Some risk factors for _________ include:
- Sudden impact (e.g. accident, abuse, assault)
- Osteoporosis (more common in females than males)
- History of falls (especially with increased age, low BMI and low levels of physical activity)

A

Fractures

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12
Q

What are the 3 general phases of healing following a fracture?

A

1) Inflammatory
2) Reparative
3) Remodelling

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13
Q

A general phase of healing following a fracture involving hematoma formation and granulation tissue formation.

A

Inflammatory Phase

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14
Q

A general phase of healing following a fracture involving soft and hard callous formation uniting the breach, as well as ossification.

A

Reparative Phase

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15
Q

When the fracture site is firm enough that it no longer moves and the fracture is still visible on imaging. At this stage, immobilization may no longer be required.

A

Stage of Clinical Union

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16
Q

With the stage of ________ union, movement of the related joints is allowed with caution, avoiding deforming forces at the site of the healing fracture.

A

Clinical

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17
Q

T/F - When assessing the fracture site during the stage of clinical union, no movement of the fracture site or pain should be felt.

A

True

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18
Q

A general phase of healing following a fracture involving consolidation and remodelling of bone.

A

Remodelling Phase

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19
Q

When the bone is considered radiographically healed, or consolidated, when the temporary callus has been replaced by mature bone.

A

Stage of Radiological Union

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20
Q

With the stage of radiological union, the ______ is reabsorbed and the bone returns to normal.

A

Callus

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21
Q

When it comes to medical treatment for _________, sometimes it is necessary to surgically apply an internal fixation device (e.g. rod, plate with screws) to protect the healing bone

A

Fractures

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22
Q

Internal fixation devices allow the fractured bone to be kept ______ as it heals, but disuse ____________ of the bone can occur as normal stresses are transmitted through the implant instead.

A

Stable
Osteoporosis

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23
Q

Usually the internal fixation device is removed once the fracture is ______ in order to reverse the osteoporosis.

A

United

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24
Q

From the 19th century until the 1980s, the medical management of fractures strongly favoured prolonged ______________ and rest.

A

Immobilization

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25
Q

More recently, medical opinion has come to recognize that prolonged immobilization allows muscle __________ and connective tissue ___________.

A

Shortening
Contracture

26
Q

T/F - Successive action of joints is prevented by immobilization, which causes articular cartilage to degenerate and fibrous adhesions to develop within the joint.

A

True

27
Q

T/F - It is not possible for extra-articular adhesions to form with prolonged immobilization, meaning there would be no painful ROM restrictions.

A

False - IT IS possible for extra-articular adhesions to form with prolonged immobilization, meaning there WOULD BE painful ROM restrictions.

28
Q

T/F - ROM exercises are recommended for patients with fractures as early as safely possible.

A

True

29
Q

_______ time will vary depending on the age of the patient, any underlying health conditions, location/type of fracture and the blood supply of the fracture site.

A

Healing

30
Q

Match the healing time with the corresponding population:
1) Children
2) Adolescents
3) Adults

A) 4-6 weeks
B) 8-10 weeks
C) 6-8 weeks

A

1) Children = A) 4-6 weeks
2) Adolescents = C) 6-8 weeks
3) Adults = B) 8-10 weeks

31
Q

Some impairments during the ______________ stage of a fracture include:
- Pain locally & possibly distal to fracture site
- Reduced circulation, edema, disuse atrophy & CT contracture of tissues under cast
- Decreased cartilage health in immobilized joints
- Pain from protective spasm of muscles crossing fracture site
- Increased tone & TrPs in compensating structures (e.g. crutch use)
- Short term complications (e.g. compartment syndrome, nerve compression, infection, plaster sores, poor cast fit, non-union)

A

Immobilization

32
Q

Some goals of treatment during the ______________ stage of a fracture include:
- Reduce inflammation
- Reduce pain from spasm
- Decrease sympathetic NS firing
- Maintain health/circulation of tissues proximal to fracture site
- Maintain ROM
- Maintain health of compensating structures

A

Immobilization

33
Q

Techniques/modalities to reduce ____________ during the immobilization stage of a fracture include:
- Hydro (caution with pooling fluid, hardware)
- LD (if there is still pooling fluid/lymph)
- Positioning (elevation if possible/safe)
- Taping
- Light techniques
- AF ROM

A

Inflammation

34
Q

Techniques/modalities to reduce pain from _____ during the immobilization stage of a fracture include:
- PNF/PIR (consider what joint is involved/is it safe)
- Low grade joint mobs (pain free)
- GTO (e.g. c-bow, s-bow)
- Light techniques (e.g. effleurage, shaking, muscle approximation)
- AF ROM & PROM (pain free)

A

Spasm

35
Q

Techniques/modalities to decrease ___________ NS firing during the immobilization stage of a fracture include:
- Breathing
- Vibrations
- Joint mobs (direct spinal treatment that are directly linked to the part of the NS you are trying to affect)
- Peripheral work to affect autonomics associated with the SNS
- Light/calming techniques

A

Sympathetic

36
Q

Techniques/modalities to maintain health/___________ of tissues ________ to fracture site during the immobilization stage include:
- Light techniques
- Joint mobs
- Hydro

A

Circulation
Proximal

37
Q

Techniques/modalities to maintain _____ of ______ during the immobilization stage of a fracture include:
- Pain free ROM exercises
- MFR in surrounding area/crossing joints
- PNF/PIR
- Joint mobs (pain free)

A

Range of Motion

38
Q

T/F - You can choose any applicable techniques when maintaining the health of compensating structures during the immobilization stage of a fracture, as long as they are done safely.

A

True

39
Q

Some contraindications/cautions during the ______________ stage of a fracture include:
- Do not traction the limb before union has occurred
- Hot hydrotherapy should be avoided distal to the cast

A

Immobilization

40
Q

If the fracture was at a site of ______ attachments or if there was a __________/severance of the tendons crossing the fracture site, AF/PR movements should be performed carefully. Check in with MD first.

A

Muscle
Laceration

41
Q

Some impairments during the ____ ______________ stage of a fracture include:
- Decreased tissue health in tissue covered by the cast (tissue will be fragile with decreased muscle tone & skin will likely be dry, flaky & scaly)
- More pronounced CT contractures will be present (causes pain & decreased ROM at immobilized joints)
- Possible loss of proprioception
- Scar tissue formation if pins, plates or screws were used
- Increased tone & TrPs in muscles crossing fracture site as well as in compensating structures
- Disuse atrophy & muscle weakness in muscles crossing fracture site
- Occasionally a pocket of chronic edema may remain local to injury site
- Long-term complications may occur (e.g. delayed union, non-union, malunion, myositis ossificans, nerve compression, Volkmann’s ischemic contracture)

A

Post Immobilization

42
Q

T/F - There is no potential for osteoarthritis to occur at the fracture site years later.

A

False - THERE IS potential for osteoarthritis to occur at the fracture site years later.

43
Q

Some goals of treatment during the ____ ______________ stage of a fracture include:
- Reduce lingering inflammation/swelling
- Decrease tone & TrPs
- Improve tissue health
- Increase ROM at immobilized joints
- Mobilize scar tissue
- Increase strength, function & proprioception

A

Post Immobilization

44
Q

Techniques/modalities to reduce lingering ____________/________ during the post immobilization stage of a fracture include:
- Compression
- Effleurage (longer, more specific strokes)
- Shaking
- Joint mobs
- Positioning

A

Inflammation/Swelling

45
Q

During the ____ ______________ stage of a fracture, we have the ability to be more specific in our treatment and intent when decreasing tone/TrPs and improving tissue health. We can be a bit more aggressive and go deeper within the patient’s tolerance.

A

Post Immobilization

46
Q

Techniques/modalities to increase _____ of ______ during the post immobilization stage of a fracture include:
- Joint mobs
- Specific work to affected joint now
- Specific ROM exercises
- All appropriate techniques are able to be used

A

Range of Motion

47
Q

Techniques/modalities to mobilize ____ tissue during the post immobilization stage of a fracture include:
- MFR & specific/deep work in the area
- Engagement of the tissue
- ROM

A

Scar

48
Q

Some contraindications/cautions during the ____ ______________ stage of a fracture include:
- Overpressure of the joints before union has occurred
- Hydro temperature extremes are to be avoided on casted tissues (potential dysaesthesia & altered perception of temperature/pressure)
- Avoid all heat over pins/plates
- Be cautious with deep petrissage techniques & passive stretching until optimal tissue health has been achieved

A

Post Immobilization

49
Q

Some signs of abnormal _______ & _____________ with fractures include:
- Malunion, delayed union & non-union
- Compartment syndrome
- Nerve compression
- Infection
- DVT
- Pressure/plaster sore
- Cast dermatitis
- Loose cast syndrome
- Myositis ossificans
- Avascular bone necrosis
- Volkmann’s ischemic contracture
- Disuse osteoporosis
- Fat embolism
- Problems with fixation devices (e.g. displacement of screws, breakage of wires)
- Re-fracture

A

Healing & Complications

50
Q

Pressure sores or skin sloughing caused by the movement of an inappropriately secured cast against the underlying limb.

A

Loose Cast Syndrome

51
Q

A fracture of the distal radius usually resulting in a “dinner fork” deformity. It usually results from a FOOSH injury.

A

Colle’s Fracture

52
Q

Complications following a _______ fracture include:
- Reflex sympathetic dystrophy (aka. complex regional pain syndrome)
- Shoulder-hand syndrome (edema/capsular tightening painfully affect the wrist & shoulder)
- Carpal tunnel syndrome

A

Colle’s

53
Q

A fracture of the distal third of the shaft of the radius with a disruption to the distal radial-ulnar joint.

A

Geleazzi Fracture

54
Q

A fracture involving a break to the distal tibia and possibly fibula as well. The talus is shoved superiorly between these 2 bones, often resulting from high-energy trauma (e.g. motorcycle accident, fall from height, skiing accident).

A

Pilon (aka. Plafond) Fracture

55
Q

T/F - Screws and wires are not needed to correct a pilon fracture.

A

False - Screws and wires are OFTEN needed to correct a pilon fracture.

56
Q

Casting for a pilon fracture usually lasts __ to ___ weeks.

A

6-12 weeks

57
Q

The general term for an ankle fracture affecting one or both malleoli, but often defined as being bi-malleolar.

A

Pott’s Fracture

58
Q

______ fractures can occur from:
- Landing a jump
- Rolling an ankle
- Activities involving a sudden change of direction
- In combination with other injuries (e.g. inversion injury, dislocation of ankle, other fractures of foot/ankle/lower leg)

A

Pott’s

59
Q

T/F - Originally, Pott described a fracture of fibula 5 inches above the distal tip with an associated rupture of the medial ligaments and lateral subluxation of talus.

A

False - Originally, Pott described a fracture of fibula 2-3 INCHES above the distal tip with an associated rupture of the medial ligaments and lateral subluxation of talus.

60
Q

Some other common ________ sites include:
- Tibia
- Metatarsals
- Navicular
- Femur
- Humerus
- Pelvis

A

Fracture

T4 MSK (4 decks)

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