Unit 5 - common fractures Flashcards
What are the clinical signs of a fracture?
Pain Deformity Swelling Discolouration/bruising Loss of function Crepitus
What methods can be used to investigate fractures?
Xrays - mainstay for investigating. Usually 2 angles are needed
Tomograms (CAT) - a view of a slice through a body part. Useful if there are many overlapping structures
Ultrasound - can be useful to show accumulation of fluid (esp blood) in a fracture
Radioisotope scanning - more metabolically active sites (eg #) can be detected therefore can show hard to detect #s
What is an open fracture?
One that has broken the skin
Name 4 fracture shapes
Spiral
Oblique
Transverse
Linear
What is a comminuted fracture?
When the bone is broken into many fragments
What features are described when talking about a fractures postion?
Displacement (anterior, posterior, medial, lateral)
Angulation (anterior, posterior, varus, valgus)
Rotation (internal, external)
What is a pathological fracture?
One in which the fracture seems out of proportion to the severity (energy involved in) of the injury
What is involved in the immediate management of a fracture?
Pain relief:
- pain killers
- splintage (should encompass joint above & below injury)
Blood loss:
- in major long bones (particularly femur) & pelvis, # can cause large blood loss
- should be crossed matched early
Open fractures:
- clean & remove dead tissue
- surgical emergency therefore take to theatre asap
What 2 ways may reduction of a fracture be achieved?
Closed reduction - traction and relocation of distal fragment onto proximal fragment by manipulation
Open reduction - if closed unsuccessful # site opened and fragments relocated directly under vision
Name 4 ways a fracture may be held in place
Casting
External fixation
Internal fixation
Traction
What is the most common form of casting & how doesit work?
Plaster of Paris:
- acts as a splint
- controls joint movement & position
- moulded so pressure is exerted at 3 points, holding # on correct position
What are the disadvantages of plaster of Paris?
Heavy & immobilises joint
Cannot examine covered part or xray (need to remove)
Immobility results in muscle wasting & joint stiffness
What are functional braces?
Casts that involve moulding along with hinges to allow movement at joints
Over come disadvantages of
plaster casts
When may external fixation be used?
In high-energy #s with extensive soft tissue damage (often with skin breaching)
Allows soft tissue healing & access to wound
Internal fixation may cause ischaemia and wound contamination
What 4 methods may be used for internal fixation of a #?
Apposition - once fracture is realigned is may only need to be held in alignment for healing to proceed (particularly true for children)
Interfragmentary compression - holding 2 bone fragments together with screws
Onlay device - usually metal plate used to buttress weak structures around joints & fix long bones
Inlay device - intramedullary methods correct alignment of broken bones without disrupting natural bone healing
Why may a bone be weaker after an internal fixation device has been used?
Plate off-loads the bone and that bone gets thinner than if it were not off-loaded
How does traction work as a holding method?
Stimulates muscles to contract and is sufficient to hold a broken bone in position achieved at reduction
Traction in this situation is a holding and moulding device as muscles effectively “massage” aligned fracture ends until natural healing takes place
What 3 methods of traction may be used for holding a fracture?
Static - used for short periods where pull is applied against another part of the body (Thomas splint)
Balanced - pull against the ring is balanced by a weight attached to the whole splint. This takes the pressure off the skin around the ring while maintaining traction
Dynamic - used where joints are still permitted to move but, by means of pulleys, the pull is still maintained along the line of broken bone. In this case weights provide the pull and counter force is achieved by tilting bed (may require a pin to be inserted into bone)
What happens at each of the following stages in fracture healing:
- 1st 2 weeks
- 2-6 weeks
- 6-12 weeks
- 6-12 months
- 1-2 years
Swelling
Callus forming
Bone forming
Bone
Remodelling taken place & bone returns to normal
What stimulates bone to heal?
Micromovement along the long axis of the bone at right angles to the break
Bones do heal if there is no movement but very slowly
Name early complications of a fracture (primary) and/or treatment (secondary)
Blood loss Infection Fat embolism Renal failure Soft tissue injury Compartment syndrome
Plaster disease
Renal stones
Immobility
What is the commonest cause of bone infection in the west?
Internal fixation
What causes fat embolism?
2 hypothesis:
- trauma cuases breakdown of fats to fatty acids which precipitate inflammation in lungs
- fat globules from disrupted marrow fat precipitate in lungs
Why may a fracture lead to compartment syndrome?
Broken bone leads to bleeding & inflammation in adjacent compartment causing increase in pressure that reduces blood flow & leads to ischaemia
What is the clinical presentation of compartment syndrome?
Pain out of proportion of injury
Loss of function
Paresthesia
Pale
Stretching muscles in that compartment precipitates extreme pain
What is plaster disease & what other issues may immobility cause?
Muscle wasting, stiffness, skin sores
Osteoporosis Renal stones (excess calcium from bone thinning)
What are the possible late complications of fractures?
Non-union Delayed union Mal-union Growth arrest Arthritis
How long do fractures take to heal & when would there to be non-union?
Upper limb ~ 6 weeks
Lower limbs ~ 12 weeks
Non-union:
- > 10 weeks for upper limb
- > 20 weeks for lower
What may cause non-union?
Excess movement Too little movement Soft tissue interposition Poor blood supply Infection Excessive traction Intact adjacent bone
What is the treatment for non-union?
Remove underlying cause
Stimulate union (bone graft)
What is delayed union?
Period between expected union & non-union
What is malunion?
When a fracture has healed in an incorrect position & will not allow normal function
Usually implies failure of treatment or non-attendance at out-patient clinics
When may a fracture cause growth arrest?
If it breaches germinal layer of epiphyseal growth plate
When may a fracture lead to arthritis?
If a joint is excessively stressed
If articular surfaces are disrupted causing uneven forces on it
