Fractures- Intro

Question 1

What is a fracture?

Answer 1

Discontinuity in structure of a bone

Question 2

What are the 3 main types?

Answer 2

Traumatic- high force in a non weakened bone causes fracture

Pathological- non traumatic force due to weakened bone

Stress fracture- repetitive sub maximal force causing fracture in non-weakened bone

Question 3

What are the risk factors?

Answer 3

Osteoporosis
Osteomalacia
Pagets
Primary/metastatic neoplasia
Bine cysts
Congenital disease e.g. osteogenesis imperfecta

Question 4

What are important assessment points?

Answer 4

History of injury
Pain
-sharp esp at time of injury
-worsened on bending, compression, weight bearing
-LoC from pain

Cannot use affected limb
Physical deformity
Bruising
Swelling
Tenderness
Crepitus

Distal neurovascular status
-if impaired= emergency

Look for associated injuries

Question 5

What is the mechanism of fracture repair?

Answer 5

1) Inflammation
- days 1-7
- Fracture ends bleed
- leads to haematoma formation around fracture site and inflammatory response creating a fibrin and capillary network

2) Soft callus
- 1-3wks
- as movement at fracture ends reduce the vascular network expands
- fibrous tissue replaces haematoma
- subperiosteal new bone formation begins

3) Hard callus
- 1-4months
- calcification of soft callus forms rigid calcified tissue

4) Remodelling
- once fracture is solidly united
- remodelling takes place over following months/yrs
- new woven bone replaced by lamella bone and medullary canal restored

This is if it is an unstable condition i.e. fracture is in plaster

If surgery has happened then the fracture is stable and can heal without callus formation