Week 7 - Fracture management Flashcards
What is a fracture?
A disruption to the structural continuity of bone or cartilage cause by an overloading of the tissue beyond its tolerance levels
What are the most common causes of fracture?
Trauma
Repetitive overload (stress fracture)
Abnormal weakening of the bone (osteoporosis etc)
What are the 2 types of trauma?
Direct and indirect
What is indirect trauma?
Occur further away from the force application
What is direct trauma?
At the specific site of force application
What are the signs and symptoms of a fracture?
Un-natural degree of mobility at the site Crepitus or grating of bony ends Deformity Pain Loss of function Muscle spasm Swelling and/or bruising Confirmation through x-ray
What are the 7 basic principles of describing a fracture?
Considered in every fracture:
- Anatomical site and extent of #
- Type of #
- Alignment of # fragments
- Direction of the # line
Considered only in certain types of fracture
- Special # features
- Associated abnormalities
- Special aetiological considerations
How do we describe the anatomical site of the fracture?
- Name the bones involved
- Long bones require description of location
- Intra or extra articular
- Anatomical descriptor
What are the 3 main types of fracture?
- Complete - # in the full continuity of the bone
- Incomplete: Partial disruption in the continuity of the bone
- Comminuted: # with more than 2 bony fragments
What is an open fracture?
A compound fracture, where the bony fragment pierces the skin and is visible to the naked eye.
What is a closed fracture?
A simple fracture, where the skin remains in tact
What is a displaced fracture?
Some loss of apposition or contact between the bony fragments
What is a non-displaced fracture?
Contact between bony fragments remains
What are the 5 directions of the fracture line?
Transverse Spiral Oblique Comminuted Segmental
What are the special features of a fracture that need to be noted in a paediatric fracture?
If the growth plate is involved
What are the special features of a fracture that need to be noted in an adult fracture?
Avulsion
What associated abnormalities should be noted with fractures?
Subluxation and/or dislocation of related joints
What is subluxation?
A subluxation is an incomplete or partial dislocation of a joint
What is dislocation?
An injury where a joint is forced out of normal position.
What aetiological considerations must be noted in a fracture?
Pathological processes that can affect the structural integrity and predispose bone to a fracture, eg. osteoporosis, radiation therapy, infection
Periprosthetic (fractures around joint replacements)
Stress fractures
What are complications of fracture?
Infection Avascular necrosis Delayed union Non-union Mal-union Shortening
What complications are caused by associated injury from the fracture?
Injury to major vessels Injury to major nerves Injury is viscera Injury to tendons Fat embolism Dislocation Subluxation Ligamentous strain Intra-articular and peri-articular adhesions Post traumatic Ossification Osteoarthritis
What complications of fracture are specific to the paediatric population?
Healing rate
Diagnosis
Fracture of growth plate
What are the 4 steps of fracture healing?
- Hematoma formation
- Fibrocartilaginous callus formation
- Bony callus formation
- Bone remodelling
Which type of fracture takes the longest to heal?
Transverse in lower limb, 24 weeks to unite and 48 weeks to consolidate
Which fracture heals the fastest?
Spiral in upper limb, 6 weeks to unite, 12 weeks to consolidate.
How long does a lower limb spiral fracture take to consolidate?
24 weeks
How long does a lower limb spiral fracture take to unite?
12 weeks
How long does a spiral fracture in the upper limb take to unite?
6 weeks
How long does a spiral fracture in the upper limb take to consolidate?
12 weeks
How long does a transverse fracture in the upper limb take to unite?
12 week
How long does a transverse fracture in the upper limb take to consolidate?
24 weeks
How long does a transverse fracture in the lower limb take to unite?
24 weeks
How long does a transverse fracture in the lower limb take to consolidate?
48 weeks
What affects rate of fracture healing?
Age # site # shape Blood supply to bony fragments Amount of displacement Health and fitness Type of bone
What are the 2 types of fracture management?
Reduction and fixation
What is reduction of a bone fracture?
A procedure to restore bone fragments to their normal anatomical position
What is a closed reduction?
Procedure is performed without an incision
What is an open reduction?
procedure involves a surgical incision
What is fixation of a bone fracture?
Method of maintaining fracture fragments in position after reduction
What is internal fixation?
Use of orthopaedic appliances such as screws, nails, rods to hold fracture in position
What is an external fixation?
Support on the outside, plaster of paris, splints
What is an ORIF?
An Open Reduction Internal Fixation involving a surgical procedure to implant an orthopaedic device to support the fracture site.
What is the benefit of an ORIF?
It allows a return to normal function much sooner than a traditional closed reduction procedure
What is joint derangement?
Any injury which causes a loss of joint congruity due to displacement of one or more of the bones which comprise the joint.
What injuries are usually associated with joint derangement?
Injuries to ligaments, intra-articular discs and other peri-articular structure.
What are the 3 types of joint derangement?
Subluxation
Dislocation
Intra-articular fracture
What is intra-articular fracture?
Fracture through one or more of the joint surfaces involved
How is joint derangement managed?
Reduction
Management of pain, oedema, loss of function and instability
Management of soft tissue damage
Strengthening of secondary support structures
Retraining proprioception
What is arthrodesis?
A surgical procedure causing artificial induction of joint ossification between two bones (aka joint fusion)
When is arthrodesis done?
When there is joint pain secondary to OA and RA
Fracture or avascular necrosis
Failed arthroplasty
What are the most common sites for arthrodesis?
Spine, hand, foot and ankle
What is osteotomy?
Orthopaedic surgery involving a modification of the bone to lengthen, shorten or alter the alignment
What is OT role in #?
AT Splints Oedema management Scar management ROM and Strength - UL
