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Clinical Medicine - OT > Week 7 - Fracture management > Flashcards

Week 7 - Fracture management Flashcards

1
Q

What is a fracture?

A

A disruption to the structural continuity of bone or cartilage cause by an overloading of the tissue beyond its tolerance levels

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2
Q

What are the most common causes of fracture?

A

Trauma
Repetitive overload (stress fracture)
Abnormal weakening of the bone (osteoporosis etc)

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3
Q

What are the 2 types of trauma?

A

Direct and indirect

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4
Q

What is indirect trauma?

A

Occur further away from the force application

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5
Q

What is direct trauma?

A

At the specific site of force application

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6
Q

What are the signs and symptoms of a fracture?

A 
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
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7
Q

What are the 7 basic principles of describing a fracture?

A

Considered in every fracture:

  1. Anatomical site and extent of #
  2. Type of #
  3. Alignment of # fragments
  4. Direction of the # line

Considered only in certain types of fracture

  1. Special # features
  2. Associated abnormalities
  3. Special aetiological considerations
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8
Q

How do we describe the anatomical site of the fracture?

A
  1. Name the bones involved
  2. Long bones require description of location
  3. Intra or extra articular
  4. Anatomical descriptor
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9
Q

What are the 3 main types of fracture?

A
  1. Complete - # in the full continuity of the bone
  2. Incomplete: Partial disruption in the continuity of the bone
  3. Comminuted: # with more than 2 bony fragments
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10
Q

What is an open fracture?

A

A compound fracture, where the bony fragment pierces the skin and is visible to the naked eye.

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11
Q

What is a closed fracture?

A

A simple fracture, where the skin remains in tact

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12
Q

What is a displaced fracture?

A

Some loss of apposition or contact between the bony fragments

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13
Q

What is a non-displaced fracture?

A

Contact between bony fragments remains

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14
Q

What are the 5 directions of the fracture line?

A 
Transverse
Spiral
Oblique
Comminuted
Segmental
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15
Q

What are the special features of a fracture that need to be noted in a paediatric fracture?

A

If the growth plate is involved

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16
Q

What are the special features of a fracture that need to be noted in an adult fracture?

A

Avulsion

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17
Q

What associated abnormalities should be noted with fractures?

A

Subluxation and/or dislocation of related joints

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18
Q

What is subluxation?

A

A subluxation is an incomplete or partial dislocation of a joint

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19
Q

What is dislocation?

A

An injury where a joint is forced out of normal position.

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20
Q

What aetiological considerations must be noted in a fracture?

A

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

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21
Q

What are complications of fracture?

A 
Infection
Avascular necrosis
Delayed union
Non-union
Mal-union
Shortening
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22
Q

What complications are caused by associated injury from the fracture?

A 
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
23
Q

What complications of fracture are specific to the paediatric population?

A

Healing rate
Diagnosis
Fracture of growth plate

24
Q

What are the 4 steps of fracture healing?

A
  1. Hematoma formation
  2. Fibrocartilaginous callus formation
  3. Bony callus formation
  4. Bone remodelling
25
Q

Which type of fracture takes the longest to heal?

A

Transverse in lower limb, 24 weeks to unite and 48 weeks to consolidate

26
Q

Which fracture heals the fastest?

A

Spiral in upper limb, 6 weeks to unite, 12 weeks to consolidate.

27
Q

How long does a lower limb spiral fracture take to consolidate?

A

24 weeks

28
Q

How long does a lower limb spiral fracture take to unite?

A

12 weeks

29
Q

How long does a spiral fracture in the upper limb take to unite?

A

6 weeks

30
Q

How long does a spiral fracture in the upper limb take to consolidate?

A

12 weeks

31
Q

How long does a transverse fracture in the upper limb take to unite?

A

12 week

32
Q

How long does a transverse fracture in the upper limb take to consolidate?

A

24 weeks

33
Q

How long does a transverse fracture in the lower limb take to unite?

A

24 weeks

34
Q

How long does a transverse fracture in the lower limb take to consolidate?

A

48 weeks

35
Q

What affects rate of fracture healing?

A 
Age
# site
# shape
Blood supply to bony fragments
Amount of displacement
Health and fitness
Type of bone
36
Q

What are the 2 types of fracture management?

A

Reduction and fixation

37
Q

What is reduction of a bone fracture?

A

A procedure to restore bone fragments to their normal anatomical position

38
Q

What is a closed reduction?

A

Procedure is performed without an incision

39
Q

What is an open reduction?

A

procedure involves a surgical incision

40
Q

What is fixation of a bone fracture?

A

Method of maintaining fracture fragments in position after reduction

41
Q

What is internal fixation?

A

Use of orthopaedic appliances such as screws, nails, rods to hold fracture in position

42
Q

What is an external fixation?

A

Support on the outside, plaster of paris, splints

43
Q

What is an ORIF?

A

An Open Reduction Internal Fixation involving a surgical procedure to implant an orthopaedic device to support the fracture site.

44
Q

What is the benefit of an ORIF?

A

It allows a return to normal function much sooner than a traditional closed reduction procedure

45
Q

What is joint derangement?

A

Any injury which causes a loss of joint congruity due to displacement of one or more of the bones which comprise the joint.

46
Q

What injuries are usually associated with joint derangement?

A

Injuries to ligaments, intra-articular discs and other peri-articular structure.

47
Q

What are the 3 types of joint derangement?

A

Subluxation
Dislocation
Intra-articular fracture

48
Q

What is intra-articular fracture?

A

Fracture through one or more of the joint surfaces involved

49
Q

How is joint derangement managed?

A

Reduction
Management of pain, oedema, loss of function and instability
Management of soft tissue damage
Strengthening of secondary support structures
Retraining proprioception

50
Q

What is arthrodesis?

A

A surgical procedure causing artificial induction of joint ossification between two bones (aka joint fusion)

51
Q

When is arthrodesis done?

A

When there is joint pain secondary to OA and RA
Fracture or avascular necrosis
Failed arthroplasty

52
Q

What are the most common sites for arthrodesis?

A

Spine, hand, foot and ankle

53
Q

What is osteotomy?

A

Orthopaedic surgery involving a modification of the bone to lengthen, shorten or alter the alignment

54
Q

What is OT role in #?

A 
AT
Splints
Oedema management
Scar management
ROM and Strength - UL

Clinical Medicine - OT (35 decks)

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