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
More recently, medical opinion has come to recognize that prolonged immobilization allows muscle __________ and connective tissue ___________.
Shortening Contracture
26
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
27
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.
28
T/F - ROM exercises are recommended for patients with fractures as early as safely possible.
True
29
_______ 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
30
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
31
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
32
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
33
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
34
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
35
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
36
Techniques/modalities to maintain health/___________ of tissues ________ to fracture site during the immobilization stage include: - Light techniques - Joint mobs - Hydro
Circulation Proximal
37
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
38
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
39
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
40
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
41
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
42
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.
43
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
44
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
45
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
46
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
47
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
48
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
49
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
50
Pressure sores or skin sloughing caused by the movement of an inappropriately secured cast against the underlying limb.
Loose Cast Syndrome
51
A fracture of the distal radius usually resulting in a "dinner fork" deformity. It usually results from a FOOSH injury.
Colle's Fracture
52
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
53
A fracture of the distal third of the shaft of the radius with a disruption to the distal radial-ulnar joint.
Geleazzi Fracture
54
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
55
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.
56
Casting for a pilon fracture usually lasts __ to ___ weeks.
6-12 weeks
57
The general term for an ankle fracture affecting one or both malleoli, but often defined as being bi-malleolar.
Pott's Fracture
58
______ 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
59
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.
60
Some other common ________ sites include: - Tibia - Metatarsals - Navicular - Femur - Humerus - Pelvis
Fracture