Session 10 Flashcards
What are the Signs and Symptoms of a Fracture?
Pain
Swelling
Deformity
Crepitus
Loss of function
‘Bony’ tenderness
Abnormal movement
What to consider when describing fractures?
Location
Configuration e.g. spiral
Parts
Articular (joint surface)
Displacement (of distal fragment)
~Angulation (the younger the child is the more angulation you can accept because bones grow so fast)
~Displacement
~Axial
~Rotation
Clinical Assessment
How would you describe the Mechanism of a Fracture?
Fracture pattern
Energy
Soft tissue envelope
Skeletal maturity
What is meant by a Pathological Fracture?
Fracture occurring through abnormal bone under physiological load
- local
- systemic
E.g. osteoporosis ‘normal bone but less of it’, osteomalacia ‘abnormal bone’ , tumour
What does Fracture Healing depend on, and name the 3 phases
Fracture Healing is a balance between stability and biology
3 Phases:
Inflammatory 1-5 days
Reparative 4-40 days
Remodelling 25-200 days (can go for more much longer)
Healing by Callus
What are the Local Factors influencing Fracture Healing?
Injury – configuration/soft tissue injury
Bone – cancellous v cortical
Treatment – reduction (restore anatomy)/ stability (e.g. plaster, frame, screws, rod) / infection
What are the Regional and Systemic Fractures influencing Fracture Healing?
Regional
Blood supply / muscle cover
Systemic
Age/co-morbidity (e.g. renal failure)/ bone pathology / head injury (healing speeds up due to the response to the head injury)
What is Pearson’s Rule?
What happens when fracture healing goes wrong?
Malunion (healed in the wrong position) –> deformity, late arthrosis (degeneration of articular cartilage with a subsequent change in the bony articular surfaces, development of osteophyte, deformation of the joint and the development of moderate synovitis)
Non-Union: hypertrophic (extra callus has been laid due to lots of movement causing instability – hypertrophy is body’s response to try to achieve stability), atrophic (no healing potential)
What are Early Local Fracture Complications?
Nerve injury
Vascular injury
Compartment syndrome
Avascular necrosis
Infection
Surgical
What are Early Systemic Fracture Complications?
Hypovolaemia (due to blood loss) / shock
Fat embolism –> due to fat being released from bone fracture (yellow marrow) –> same effect as pulmonary embolism
Acute respiratory distress syndrome
Disseminated intravascular coagulation (all clotting factors have been used up –> continuous bleeding)
What are Late Local Fracture Complications?
Delayed union
Non-union
Malunion
Myositis ossificans
Re-fracture (muscle doesn’t heal properly – becomes calcified –> joint stiffens)
What are Late Regional Fracture Complications?
Osteoporosis
Joint stiffness
Chronic regional pain syndrome
Abnormal biomechanics
Osteoarthrosis
What is Compartment Syndrome?
raised pressure within an enclosed fascial space leading to localised tissue ischaemia
Pain – excessive/progressive/not relieved by analgesia / ‘passive stretch pain’
Neurovascular changes are late – by the time the pulses have disappeared an amputation is required
If in doubt, perform surgical decompression
Check for puncture wounds when looking at Open v Closed Fractures. How do you assess Open Injuries?
- (After surgical removal of dead tissue)*
- Gustillo and Anderson*
I: <1cm, clean
II: >1cm, mod contamination (most common)
III: high velocity, farmyard (including neurovascular damage)
A: adequate skin cover
B: bone exposed
C: circulatory compromise
What do you consider when looking at Children’s Fractures?
Incomplete Fractures:
- Buckle (Torus) fractures – compression (the topmost layer of bone on side of the bone is compressed causing the other side to bend away from the growth plate)
- Greenstick fractures - Tension
Rapid healing
Growth plate (Epiphyseal) fractures
Non-accidental injury
What do you need to consider when looking at Epiphyseal Fractures?
What are Stress Fractures?
Repetitive, non-violent ‘subtle’ stresses
‘Fatigue’ v ‘Insufficiency’ – bone hasn’t had time to develop e.g. suddenly running a marathon
Female > men
Predispositions: osteoporosis, sports, eating disorders
