week 12 musculoskeletal function Flashcards
what is a fracture
-occurs when force applied exceeding tensile or compressive strength of bone
fracture incidence
- varies depending on bone involved, age, gender
- highest incidence of fractures occurs in young males age 15-24 and in adults 65 yrs and older
- rates of hip and wrist fractures tend to be higher in women
what is a complete fracture?
bone broken all the way through
what is an incomplete fracture
bone damaged but still in one piece
what is a closed or simple (complete or incomplete) fracture
-skin is intact
what is a open or compound (complete or incomplete)
-skin broken
what is a comminuted fracture
-bone breaks into more than two fragments
what is a linear fracture
-fracture runs parallel to long axis of bone
what is an oblique fracture
-fracture of shaft of bone is slanted
hidden fracture- we can’t see it
risk factors for fractures- paediatric population
-bone mineral content, bone size, bone accrual all lower low bone mineral density (BMD)
-genetic factors
-poor nutrition
inadequate intake of dietary calcium, milk avoidance, excessive consumption of carbonated beverages
-lack of weight-bearing physical activity
-obesity
-play and sport (exposure to trauma)
risk factors or fractures -older adults
- age
- gender
- osteoporosis (fragility fracture)
- smoking
- alcohol
- steroids
- diabetes
- previous fracture
what is the etiology of fractures?
are most commonly caused by falls, car accidents, and athletic injuries
pathophysiology of fractures
-When bone broken
disrupts periosteum and blood vessels in cortex, marrow, surrounding soft tissues
-Bleeding occurs from damaged ends of bone and from neighboring soft tissue
-Hematoma forms within medullary canal, between fractured ends of bone, and beneath periosteum
-Bone tissue immediately adjacent to fracture dies
-Necrotic tissue and any debris in fracture area stimulate intense inflammatory response
characterized by vasodilation, exudation of plasma and leukocytes, and infiltration by inflammatory leukocytes and mast cells
-Cytokines, including transforming growth factor-beta (TGF-_), platelet-derived growth factor (PDGF), prostaglandins, and other factors are released
promote healing
-Within 48 hours after injury
vascular tissue invades fracture area from surrounding soft tissue and marrow cavity
blood flow to entire bone is increased
-Osteoblasts and osteoclasts in periosteum, endosteum, and marrow are activated
produce subperiosteal procallus along outer surface of shaft and over broken ends of bone
true or false- after a fracture it will heal with normal tissue and no scar tissue?
true
inflammatory phase with healing in a fracture
- last 3-4 days
- bone tissue destruction triggers inflammatory response
- hematoma formation
repair phase with healing in a fracture
- last several days
- capillary ingrowth, monocular cells, and fibroblasts transform hematoma into granulation tissue
- osteoblast w/in pro callus synthesize collagen and matrix to form callus
remodelling phase in a fracture
- last months to years
- unnecessary callus
- is resorbed and trabecular formed
- at the end, bone can w/stand normal stress
- some people like diabetics never get to this stage =amputation or we put a rod in the bone to secure it for weight baring
what are the manifestations of fractures?
- vary according to type and site of fracture, soft tissue injury
- impaired function
- unnatural alignment
- swelling
- muscle spams
- tenderness
- impaired sensation (numbness)
- pain
- fractures usually caused by trauma
- immediate, often severe pain at site of injury occurs
- subsequent pain produced by muscle spasm, overriding of fracture segments, damage to adjacent soft tissues
what are the complications of fractures?
improper reduction or immobilization of fractured bone may result in nonunion, delayed union, or malunion
-Broken bone can damage surrounding tissue, periosteum, and blood vessels in cortex and marrow
-Dislocation and subluxation are most common in persons younger than 20 years
usually associated with fractures
what is nonunion?
failure of bone ends to grow together -this is our biggest fear- not as common in peds but common in diabetics
-gap between broken ends of bone fills with dense fibrous and fibrocartilaginous tissue instead of new bone
what is delayed union?
union that does not occur until approximately 8-9 months after a fracture
what is malunion?
healing of bone in nonanatomic position
age-related complications -paediatrics
-growth plates vulnerable to fracture
-can result in shorter or crooked limb
-we worry about this age group the most bc they are still growing
-growth plates- open space bone on top of bone-hard to see a fracture in this area
we treat peds clinically- we don’t need an x-ray bc this age group between 0-6 don’t know how to lie about pain
age-related complications- older adults
- increased morality, pain, disability, depression and loss of independence
- high risk of morbidity and mortality after osteoporotic fracture
treatment for fractures
- closed manipulation, traction (skeletal or skin), open reduction, internal fixation, external fixation
- Splints, casts
- treatment of delayed union and nonunion fractures
- use of various methods designed to stimulate new bone formation
what is osteoporosis?
-complex, multifactorial chronic disease than often progresses silently for decades until fractures occur
-low bone mineral density (BMD), impaired structural integrity of bone, decreased bone strength, risk of fracture
-those w/ lowest BMD are most at risk for fractures
-old bone reabsorbed faster than new bone being made
-bones loss density–> become thinner and more porous
-may continue until skeleton no longer strong enough to support itself
-bones fracture spontaneously or fracture from falls or bums that would have not previously have caused fracture
the bone is breaking down but it is not building more