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Ortho > Treatment of Fractures > Flashcards

Treatment of Fractures Flashcards

1
Q

What does the skeleton provide for the body?

A

Strength
Stiffness
Rigidity

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2
Q

Types of Cells within Bones

A

Osteoblasts
Osteocytes
Osteoclasts
Marrow elements

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3
Q

What does type 1 collagen provide for the bone?

A

Tensile strength

Resiliency

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4
Q

What does the periosteum provide for healing of fractures?

A

Vascular supply

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5
Q

What triggers the healing process in bone fractures?

A

Bleeding

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6
Q

3 Phases of Fracture Healing

A

Reactive phase
Reparative phase
Remodeling phase

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7
Q

What is part of the reactive phase of fracture healing?

A 
Fracture & inflammatory phase
Formation of granulation tissue formation
Vessels contrac
Hematoma
Fibroblasts take over
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8
Q

Parts of the Reparative Phase of Fracture Healing

A

Cartilage callus formation
Lamellar bone deposition
Periosteal cells -> chondroblasts
Form fracture callus

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9
Q

Parts of the Remodeling Phase of Fracture Healing

A

Remodeling to original contour

Trabecular bone replaced with compact bone

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10
Q

Factors Affecting Healing Rates

A 
Age
Comorbidities
Nutritional Status
Thyroid & GH levels
Calcitonin
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11
Q

Common Conditions that Impair Healing

A 
DM
Arteriovascular disease
Anemia
Vitamin A, C deficiencies
Tobacco use
Chronic alcohol abuse
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12
Q

Medications that Impair Healing

A

NSAIDs
Glucocorticoids
Cipro

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13
Q

Evaluation of the Fracture Patient

A 
Vitals
Mental status
Mechanism of injury
Neurovascular status of the extremity
Where is the deformity?
Open or closed?
Check joints above and below
Minimum of 2 X-ray views
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14
Q

Common Fractures when Landing on an Outstretched Hand

A

Scaphoid
Radial head
Wrist
Proximal humerus

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15
Q

Common Fractures When Falling off of a Roof

A

Os calcis
Tibial plateau
TL compression fracture

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16
Q

Describing Fractures

A 
Name of bone
Location
Orientation of fracture
Condition of overlying tissues (open vs. closed)
Unique fracture names
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17
Q

Location of Fractures

A 
Dorsal
Volar
Epiphysis
Metaphysis
Diaphysis (proximal, middle, or distal third)
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18
Q

Orientation of Fractures

A 
Transverse
Oblique
Spiral
Angulated
Comminuted
Segmental
Intra-articular
Displaced
Compression
Impaction
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19
Q

Unique Names of Fractures

A

Supracondylar
Colles
Boxer’s

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20
Q

Factors that Effect Treatment

A 
Open vs. closed
Nature & severity of fracture
Possible neuro-vascular injuries/complications
Age
Health
Demands of patient
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21
Q

Complications of Fractures

A 
Pelvic & femoral: severe bleeding
Injuries to other structures
Acute compartment syndrome
Increased risk of venous thrombosis with major trauma
Fat embolism syndrome 
Complex regional pain syndromes
Osteomyelitis
Non/mal-union, post-traumatic arthritis
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22
Q

Principles of Fracture Treatment

A

Acute stabilization

Definitive treatment

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23
Q

Possible Options when Stabilizing a Fracture

A

Splinting
Provide analgesia: ice, elevation, pain meds
Decide on definitive treatment

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24
Q

Definitive Treatment of Fractures

A

Create conditions where body will heal the fracture while keeping the patient as functional as possible

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25
Q

Treatment Options for Fractures

A 
Reassurance
Immobilization: cast, sprint, brace
Traction: more historical
Reduction: cast, hardware, both
Surgical fixation
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26
Q

When is surgical fixation warranted?

A 
Displaced,unstable fractures
Early mobilization
Quick return to function
Displaced intra-articular fractures
Down side: cost, complications
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27
Q

When are casts the prescription of choice for fractures?

A

Undisplaced
Stable
Some reduced fractures

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28
Q

How do you cast a diaphyseal fracture?

A

Include joints above & below

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29
Q

Complications of Casting

A 
Pressure sores
Neurovascular compromise
Compartment syndrome
Disuse atrophy
Joint stiffness
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30
Q

Surgical Options for Fractures

A 
Pins & wires
Plates & screws
External fixtures
Intramedullary devices
Replacements
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31
Q

Unique Fractures in Children

A 
Buckle (torus)
Growth plate injury
Greenstick
Plastic deformation
Apophyseal avulsion
32
Q

Salter Harris Classification of Fractures in Children

A

1: undisplaced
2: physis + metaphysis
3: physis + epiphysis
4: across the physics
5: crush injury

33
Q

Treatment of Stable Mid-Shaft Clavicular Fractures

A

Sling

Figure 8 splint

34
Q

Treatment of Displaced, Angulated, or Over Riding Clavicular fracture

A

Surgery

35
Q

Treatment of Distal Third Clavicular Fractures

A

Undisplaced: conservative
Others: surgery

36
Q

Treatment of Proximal Third Clavicular Fractures

A

High energy injury
Rare
Watch for internal injuries

37
Q

When do shoulder fractures generally occur?

A

Advancing age

Fall from standing height

38
Q

Treatment of Impacted or Non-Displaced Shoulder Fractures

A 
Sling
Limitation of activities
Pain meds
Mobilize as tolerated
PT/OT
Sleep in recliner initially
39
Q

What shoulder fractures should be referred to a specialist?

A

Anatomic neck
Complex fractures
Dislocations

40
Q

What distal forearm fractures in children need to be referred?

A

Neurovascular compromise
Open fractures
Gross deformity
Displaced Salter fracture

41
Q

Treatment of Stable Distal Forearm Fractures in Children

A

Cast
Brace
Depends on patient/parent preference

42
Q

Describe a Colle’s Fracture

A

Dorsal displacement/angulation of distal radius

Increased risk with age

43
Q

Treatment of a Colle’s Fracture

A

Splint
Pinning
Plating

44
Q

What does treatment of metacarpal fractures depend on?

A

Displacement
Angulation
Rotation

45
Q

What determines treatment with a base of thumb fracture?

A

Stability of thumb joint

46
Q

How do vertebral compression fractures occur?

A

With/without trauma

Osteoporosis

47
Q

Treatment of Vertebral Compression Fractures

A

Pain relief
Correction of osteoporosis
Bracing
Surgery

48
Q

What does bracing provide for a compression fracture?

A

Pain relief

Increased activity

49
Q

When is surgery performed for a compression fracture?

A

Neuro compromised

Unresponsive patient

50
Q

Caution with Pelvic Fractures in Children

A

Major trauma
Blood loss
Injuries to other organs

51
Q

Pelvic Fractures in the Elderly

A

See pubic rami or sacral fractures with minimal trauma

52
Q

Risks for Pelvic Fractures in the Elderly

A 
Osteoporosis
Low body weight
Smoking
Steroids
Limited activity
53
Q

When should we be suspicious for a pelvic fracture in the elderly?

A

Vague pelvic pain
Pain with leg motion
Inability to bear weight

54
Q

Diagnosing a Pelvic Fracture in the Elderly

A

X-rays

MRI

55
Q

Treatment of Pelvic Fractures in the Elderly

A

Pain control

Early, protected ambulation

56
Q

What is a significant source of morbidity & mortality in the elderly?

A

Hip fractures

Could be pathologic fractures

57
Q

Treatment of Hip Fractures

A

Surgery: either pinning or total hip if previous arthritis

58
Q

Diagnosis of Femoral Neck Fractures

A

Shortening & external rotation of leg

Groin pain

59
Q

Treatment of Femoral Neck Fractures

A

Replacement > pinning

60
Q

Treatment of Intertrochanteric Hip Fractures

A

Surgery: plate & screws

61
Q

Major concern with Intertrochanteric Hip Fractures

A

Blood loss

Type & screen prior to surgery

62
Q

Subtrochanteric Hip Fractures

A

Unstable
Intramedullary device
Significant blood loss

63
Q

Location of Low Energy Tibial Shaft Fractures

A

Distal metaphysis

64
Q

What type of tibial fractures are caused by rotational injuries?

A

Spiral
Oblique
Distal fractures

65
Q

Location of High Energy Tibial Fractures

A

Mid-shaft fracture

66
Q

Treatment of Tibial Shaft Fractures

A

Orthopedist
Conservative (stable)
Most: surgery

67
Q

When do adults usually obtain ankle fractures?

A

Twisting injuries of the foot/ankle

68
Q

Physical Exam Findings in Ankle Fractures in Adults

A

Neurovascular status

Medial & lateral tenderness

69
Q

Treatment of Stable Ankle Fractures in Adults

A

Conservatively

70
Q

Treatment of Unstable Ankle Fractures in Adults

A

Surgery

71
Q

When is surgery mandatory for ankle fractures?

A

Ankle joint diastasis

LOOK AT MORTICE

72
Q

Conservative Treatment of Forefoot Fractures

A

Short leg walking cast
Walking boot
Stable toe fracture: buddy tape
Displaced or unstable toe fracture: pinning

73
Q

Treatment of Metastatic Fractures

A

Stabilize fracture
Remove tumor
Early lesion (pre-fracture): radiotherapy

74
Q

Diagnosing a Stress Fracture

A

X-ray: often not seen

MRI or bone scan

75
Q

Treatment of Stress Fractures

A

Most: decreased activity, immobilization

76
Q

Fractures & Child Abuse Signs

A

Injuries inconsistent with history
Metaphyseal corner fracture
Rib, sternum, scapula, spinous processes fractures
Multiple fractures in different stages of healing
Bilateral long-bone fractures
Skull fractures in children less than 18 months

77
Q

When to Refer Fractures to Ortho

A 
Open injuries
Neurovascular compromise
High energy injuries
Excessive pain
Significantly angulated or displaced fracture
Hip fractures
Scaphoid fractures
Displaced long bone fractures
Patient or parent concerns

Ortho (22 decks)

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