Treatment of Fractures Flashcards
BONE:
- Skeleton provides what? 3
- Cells that are involved in bone structure? 4
- Organic component is primarly what type of collagen?
- What does it provide? 2 - What is the key to fracture healing?
- Fractures cause what which trigger the healing process?
- Skeleton provides
- strength,
- stiffness
- rigidity - Cells:
- osteoblasts,
- osteocytes,
- osteoclasts,
- marrow elements - Organic component is primarily type 1 collagen
- Provides tensile strength and resiliency - Periosteum provides the vascular supply, key to Fx healing
- Fractures cause bleeding which triggers the healing process
What are the phases of fracture healing? 3
- Reactive phase
- Reparative phase
- Remodeling phase
Describe the steps in the following phases:
- Reactive phase? 4
- Reparative phase? 4
- Remodeling phase? 2
- Reactive phase
- Fracture and inflammatory phase
- Granulation tissue formation
- vessels contract, hematoma
- fibroblasts take over - Reparative phase
- Cartilage callus formation
- Lamellar bone deposition
- periosteal cells - - > chondroblasts
- form fracture callus - Remodeling phase
- Remodeling to original contour
- Trabecular bone is replaced with compact bone
Healing rates:
- Effected by what? 3
- Common conditions that impair healing? 4
- Substance use that impairs healing? 2
- Meds that impair healing? 3
- Effected by
- thyroid and
- growth hormone levels,
- calcitonin - Common conditions that impair healing:
- Diabetes,
- arteriovascular disease,
- anemia,
- vitamin deficiencies (A C)
3.
- Tobacco use,
- chronic alcohol abuse
4. Med’s: - NSAIDS,
- glucocorticoids,
- Cipro
Evaluation of Fxs: Mechanism of injury – beware of what?
high energy injuries
COMMON INJURY PATTERNS: Outstretched hand? 4
- scaphoid
- radial head,
- wrist,
- proximal humerus
COMMON INJURY PATTERN: Fall off roof? 3
- os calcis,
- tibial plateau,
- TL compression Fx
FRACTURE DESCRIPTION…..get your book out before calling ortho 6
- Name of the injured bone
- Location (dorsal, volar – epiphysis, metaphysis, diaphysis)
- Diaphyseal: proximal, middle, or distal third - Orientation of the fracture (transverse, oblique, spiral)
- Also: angulated, comminuted, segmental, intra-articular, displaced, compression, and impaction
- Condition of overlying tissues (open or closed) 1 puncture; 2 laceration with mod ST injury 3 grossly contaminated
- Some fractures have unique names -Supracondylar, Colles, Boxer’s,
FACTORS THAT EFFECT TREATMENT 6
- Open or closed injury Nature and severity of the fracture
- Energy involved - Stable or unstable
- Is the position acceptable
- Is the joint involved
- Possible neuro-vascular injuries/complications -N/V issues and compartment syndromes
- Age, health, demands of the patient
COMPLICATIONS OF FRACTURES 6
- Pelvic and femoral fractures can have significant blood loss
- Injuries to other structures: Nerves/vessels, especially at knee & elbow
- Acute compartment syndromes
- Increased risk of venous thrombosis with major trauma
- Fat embolism syndrome
- Complex regional pain syndromes (sympathetic dystrophy)
COMPLICATIONS OF FRACTURES: Late signs? 3
Late:
- osteomyelitis,
- non/mal-union,
- post-traumatic arthritis
PRINCIPLES OF TREATMENT Acute stabilization? 4
Acute stabilization
- Evaluate the patient
- Immobilize the Fx – usually splinting
- Provide analgesia: ice, elevation, immobilization, pain meds
- Decide on definitive treatment
Treatment options
- Reassurance or minimal treatment? 4
- Immobilization with cast, splint, or brace: works well for who?
- Down side is what? 3 - Fracture reduction closed or open
- Maintain with what? 2 - Surgical fixation: for what? 4
- Complications: surgical? 2
1.
- Rib fractures,
- torus fractures,
- metacarpal fractures,
- toe fractures
2. Works well for stable, well-aligned fractures - prolonged immobilization, loss of reduction, functional limits
3. cast, hardware, or both
4.
- Displaced, unstable fracture
- Early mobilization
- Often the best option – quick return to function
- Displaced intra-articular fractures
5. Down side is - cost,
- complications including infection
- Casting is the tx of choice for what? 3
- What kinds? and what are their advantages?
- May splint initially: use what for forearm and wrist? What for ankle?
- What are diaphyseal Fxs?
- Complications? 5
- Rx of choice for undisplaced, stable, and some reduced Fx’s
- Plaster of Paris or fiberglass
- Plaster easier to mold
- Fiberglass more durable - May splint initially – safer than a cast in acute setting
- Volar splint forearm and wrist
- Sugar tong splint for ankle - Diaphyseal Fx’s: include joints above and below the fracture
- Complications include:
- pressure sores,
- N/V compromise,
- compartment syndrome,
- disuse atrophy,
- joint stiffness
Surgical options for Fractures
- What are pins and wires for?
- Use what?
- What are plates and screws used for?
- External fixators for?
- Intramedullary devices for?
- What are for unstable hip fractures?
- Replacements for what? 3
Pins and wires
- Reduction of fracture, pin fixation, and cast
- Cerclage and tension band wiring
Plates and screws
- Initially thick and unbending
External fixators
- For unstable injuries and contaminated fractures
Intramedullary devices
- For long bone Fx’s, options for cross locking screws
- Gamma nails for unstable hip fractures
- Replacements
- Hip,
- shoulder,
- radial head
What is this?
CERCLAGE
WIRES
What are these?
TENSION BAND WIRING
What are these?
EXTERNAL
FIXATORS
What are these?
INTRAMEDULLARY DEVICES