Topic 4 - Fractures Flashcards
A break in the continuity of a bone, an epiphyseal plate or a cartilaginous joint surface.
Fracture
When there is a ________, there is always some degree of injury that also occurs to the soft tissues surrounding the bone.
Fracture
A type of fracture in which a long bone bends causing failure on the convex side of bend first.
Transverse (aka. Oblique, Greenstick) Fracture
T/F - In a greenstick fracture, only the concave side breaks into two pieces and the convex side remains bent.
False - In a greenstick fracture, only the CONVEX side breaks into two pieces and the CONCAVE side remains bent.
A type of fracture involving spiral tension failure in a long bone.
Spiral Fracture
A type of fracture involving tension failure from the pull of a ligament or muscle.
Avulsion Fracture
A type of fracture in which forces usually compress cancellous bone.
Compression/Impacted Fracture
A type of fracture leading to a small crack in the bone, which is unaccustomed to repetitive/rythmic stress.
Fatigue/Stress Fracture
A type of fracture resulting from the effects of osteoporosis, boney tumor or other disease.
Pathological Fracture
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
Fracture
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)
Fractures
What are the 3 general phases of healing following a fracture?
1) Inflammatory
2) Reparative
3) Remodelling
A general phase of healing following a fracture involving hematoma formation and granulation tissue formation.
Inflammatory Phase
A general phase of healing following a fracture involving soft and hard callous formation uniting the breach, as well as ossification.
Reparative Phase
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.
Stage of Clinical Union
With the stage of ________ union, movement of the related joints is allowed with caution, avoiding deforming forces at the site of the healing fracture.
Clinical
T/F - When assessing the fracture site during the stage of clinical union, no movement of the fracture site or pain should be felt.
True
A general phase of healing following a fracture involving consolidation and remodelling of bone.
Remodelling Phase
When the bone is considered radiographically healed, or consolidated, when the temporary callus has been replaced by mature bone.
Stage of Radiological Union
With the stage of radiological union, the ______ is reabsorbed and the bone returns to normal.
Callus
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
Fractures
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.
Stable
Osteoporosis
Usually the internal fixation device is removed once the fracture is ______ in order to reverse the osteoporosis.
United
From the 19th century until the 1980s, the medical management of fractures strongly favoured prolonged ______________ and rest.
Immobilization
More recently, medical opinion has come to recognize that prolonged immobilization allows muscle __________ and connective tissue ___________.
Shortening
Contracture
T/F - Successive action of joints is prevented by immobilization, which causes articular cartilage to degenerate and fibrous adhesions to develop within the joint.
True
T/F - It is not possible for extra-articular adhesions to form with prolonged immobilization, meaning there would be no painful ROM restrictions.
False - IT IS possible for extra-articular adhesions to form with prolonged immobilization, meaning there WOULD BE painful ROM restrictions.
T/F - ROM exercises are recommended for patients with fractures as early as safely possible.
True
_______ 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.
Healing
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
1) Children = A) 4-6 weeks
2) Adolescents = C) 6-8 weeks
3) Adults = B) 8-10 weeks
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)
Immobilization
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
Immobilization
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
Inflammation
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)
Spasm
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
Sympathetic
Techniques/modalities to maintain health/___________ of tissues ________ to fracture site during the immobilization stage include:
- Light techniques
- Joint mobs
- Hydro
Circulation
Proximal
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)
Range of Motion
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.
True
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
Immobilization
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.
Muscle
Laceration
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)
Post Immobilization
T/F - There is no potential for osteoarthritis to occur at the fracture site years later.
False - THERE IS potential for osteoarthritis to occur at the fracture site years later.
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
Post Immobilization
Techniques/modalities to reduce lingering ____________/________ during the post immobilization stage of a fracture include:
- Compression
- Effleurage (longer, more specific strokes)
- Shaking
- Joint mobs
- Positioning
Inflammation/Swelling
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.
Post Immobilization
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
Range of Motion
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
Scar
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
Post Immobilization
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
Healing & Complications
Pressure sores or skin sloughing caused by the movement of an inappropriately secured cast against the underlying limb.
Loose Cast Syndrome
A fracture of the distal radius usually resulting in a “dinner fork” deformity. It usually results from a FOOSH injury.
Colle’s Fracture
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
Colle’s
A fracture of the distal third of the shaft of the radius with a disruption to the distal radial-ulnar joint.
Geleazzi Fracture
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).
Pilon (aka. Plafond) Fracture
T/F - Screws and wires are not needed to correct a pilon fracture.
False - Screws and wires are OFTEN needed to correct a pilon fracture.
Casting for a pilon fracture usually lasts __ to ___ weeks.
6-12 weeks
The general term for an ankle fracture affecting one or both malleoli, but often defined as being bi-malleolar.
Pott’s Fracture
______ 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)
Pott’s
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.
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.
Some other common ________ sites include:
- Tibia
- Metatarsals
- Navicular
- Femur
- Humerus
- Pelvis
Fracture
