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Year 2 Loco > 9. Fractures and bone healing (Robson) > Flashcards

9. Fractures and bone healing (Robson) Flashcards

1
Q

When are men and when are women more at risk of bone fractures and why?

A

Men - younger age bracket - take part in mores stress related conditions e.g. contact sport

Women - older age bracket - OP - lack of oestrogen - bone becomes thinner and weaker

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2
Q

What is a Colles fracture?

A

Fracture of the distal part of the radius, within 2cm of the most distal end

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3
Q

What is a Colles like fracture?

A

Colles fracture of the radius also involving the ulnar

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4
Q

What is the most common presentation of a fracture to the neck of the femur (hip fracture)?

A

The leg shortens (compared to other) and is externally rotated

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5
Q

What are the two main groups of fractures?

A

Closed - the bone fragments do not pierce the skin

Open/compound - the bone fragments pierce the skin - tend to be due to higher force

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6
Q

What is the difference between a displaced and undisplaced fracture?

A

Displaced - there is some movement of the bone pieces relative to each other - no longer in their normal anatomical alignment

Undisplaced - the fractured bone has not moved too far out of normal alignment

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7
Q

SO how are bone fractures classified?

A

Either open or closed and then either displaced or undisplaced

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8
Q

What is a transverse fracture?

A

Horizontal fracture through the bone

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9
Q

What are spiral/oblique fractures and how do these occur?

A

(Don’t need to differentiate between these two)
Almost diagonal fracture

These are created by twisting movements of the bone e.g. by trauma

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10
Q

Why are spiral/oblique fractures particularly dangerous?

A

Can create sharp edges - nerve or blood supply damage - oedema

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11
Q

What is a crush/compression fracture?

A

When WEAKENED vertebral bone is crushed from force

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12
Q

In what bone do crush/compression fractures occur?

A

Cancellous bone due to compression

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13
Q

In what condition are crush/compression fractures common?

A

Osteoporosis as a result of compression - bone cannot carry the weight

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14
Q

How do crush/compression fractures typically present on an x-ray?

A

Wedging of the bone

Biconcave structure of the vertebrae

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15
Q

How do crush/compression fractures present on a CT or bone scan and why?

A

Whiter bone - there will be an increased density in the central part of the bone e.g. the vertebra

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16
Q

What type of investigation can be used to see whether a crush/compression fracture is old or new?

A

MRI - to visualise the bone marrow

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17
Q

Which fracture type can result in oedema in a muscle compartment?

A

Spiral fracture - sharp edges - can damage nerves or blood vessels

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18
Q

Why do crush/compression fractures occur?

A

Due to reduced bone mass e.g. as seen in osteoporosis

Thin trabeculae bone loses elasticity, strength and toughness

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19
Q

Between 30-80 years of age, by what percentage does the elasticity of trabeculae bone decrease?

A

64%

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20
Q

Between 30-80 years of age, by what percentage does the strength of trabeculae bone decrease?

A

68%

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21
Q

Between 30-80 years of age, by what percentage does the toughness of trabeculae bone decrease?

A

70%

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22
Q

Between 30-80 years of age, by what percentage does the strength of cortical bone decrease?

A

10%

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23
Q

What is a burst fracture?

A

This is a crush/compression fracture of healthy vertebrae

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24
Q

What causes a burst fracture?

A

When there is a heavy force on the IV disc that is stronger than the strength of the bone

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25
Q

What is the main concern with burst fractures?

A

Burst of the IV disc can result in compression of the spinal cord from compressed bone

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26
Q

What part of the vertebrae can most commonly impinge on the spinal cord from a burst fracture? (posterior or anterior)

A

The posterior region

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27
Q

What is an avulsion fracture?

A

This is caused by traction i.e. something pulling on the bone causing the attachment point to break off

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28
Q

What can pull on the bone in a traction fracture?

A

Ligament or tendon - ligament/tendon attachment point breaks off

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29
Q

What is a fracture dislocation/subluxation and when can this occur?

A

This occurs if a fracture occurs very close to a joint

This results in a malalignment of the joint surfaces - results in disruption and instability of the joint

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30
Q

What is an impact fracture?

A

This is when bone fragments are forced/pushed/impacted into each other

31
Q

Are impact fractures typically displaced or undisplaced and why?

A

Tend to be undisplaced - stable fractures - bones are just pushed into each other rather than out of place

32
Q

How can you identify an impact fracture from a scan?

A

Look for a white line where the bone is overlapping - more slerotic/white

33
Q

What type of scan is useful to identify an impact fracture and why?

A

MRI scan - bleeding may occur and this will show the bone marrow

34
Q

What is a comminuted fracture?

A

This is where a fracture results in two or more bone pieces due to high energy trauma

These can be other fractures e.g. spiral/transverse but then become a comminuted if there are two or more bone pieces

35
Q

What is the main concern with comminuted fractures?

A

These can disrupt the blood supply to the bone - osteonecrosis

36
Q

How can comminuted fractures be fixed?

A

Will require internal fixation to reapply the bone together and to reestablish the blood supply

37
Q

What is a stress fracture?

What are the two different types?

A

When stress on the bone results in it to fracture

Fatigue fracture - when abnormal stress on normal bone causes a fracture

Insufficiency fracture - where normal stress on abnormal bone causes a fracture

38
Q

How can you identify a stress fracture on a scan?

A

Will see a white haziness around the fracture - this is the periosteal reaction forming a bone callous during healing

39
Q

What is the periosteal reaction in a stress fracture?

A

This is a white haziness that will be visible on a bone scan
This is where the bone attempts to heal itself - cells of the bone differentiate and heal the bone - results in bone callous formation

40
Q

What conditions are insufficiency fractures common seen in?

A

Osteomalacia

Paget’s disease

41
Q

What is Paget’s disease?

A

Where the bone is soft and bends and may potentially break

42
Q

Why are stress fractures difficult to pick up on scans?

A

Because it is the internal trabeculae network that is affected rather than the outer cortical bone

43
Q

How does a stress fracture heal generally?

A

Most of these will heal on their own - will not require any intervention

44
Q

How does a high intensity stress fracture heal?

A

Should tell the patient to rest and not put much pressure on the fracture

45
Q

What type of scan can be used to see stress fractures?

A

Bone scintigraphy - becomes positive sooner than plain film

46
Q

What is a greenstick fracture?

A

Where there is a bending force on the bone - the bone bends but does not fracture completely

47
Q

In whom does a green stick fracture occur and why?

A

In children - more woven bone - soft and bending bone

48
Q

In whom does a fracture of the epiphyseal growth plate occur?

A

Children

49
Q

What is the most adverse effect of a fracture of the epiphyseal growth plate?

A

Can interfere with bone

50
Q

Why do fractures of the epiphyseal growth plate occur?

A

Mainly cartilage here - this is soft and is not designed to take the same forces as bone can

51
Q

How can epiphyseal growth plate fractures affect growth?

A

Can cause the growth plate to close prematurely and to stop producing new bone eg. may close at the radius but not at the ulnar - pushes hand towards the raidal side

52
Q

Why is a fracture to the pelvis so clinically significant?

A

There are so many important organs being protected by the pelvis - so this fracture has a very high complication rate

There is very important blood supply passing through the pelvis which all run very close to the bone

53
Q

What is the mortality rate from pelvic fractures?

A

10-12%

54
Q

What is a fracture haematoma and when does this occur?

A

This is the first thing that occurs when a bone fractures

Fracture results in a leak of blood from the blood vessels in the Haversian canals - clot formation occurs - this is a fracture haematoma

55
Q

How long after a fracture foes a fracture haematoma occur?

A

6-8 hours following fracture

56
Q

Why does it take so long for a fracture haematoma to form?

A

Hypoxic tissue with low pH

57
Q

What occurs at the site of the fracture immediately after the fracture?

A

Swelling and inflammation will occur to the dead bone cells at the fracture site

58
Q

What is the second stage of bone healing?

A

Fibrocartilaginous callus formation

59
Q

How long does the fibrocartilaginous callus last for?

A

About three weeks

60
Q

How does the fibrocartilaginous callus form?

A

The clot tissue is remodelled into granulation tissue - new capillaries reorganise and grow and there is hypoxia induced angiogensis

61
Q

What cells produce the tissue in the fibrocartilaginous callus and why?

A

Fibroblasts - these differentiate quickly to act temporarily in the time space that it takes for the osteoblasts to differentiate

Also chondroblasts

62
Q

What collagen type forms the fibrocartilaginous callus?

A

Collagen type 1 (fibroblasts)

63
Q

What is the role of the collagen in the fibrocartilaginous callus?

A

Used to glue the ends of the bone together

64
Q

Why are fibroblasts and chondroblasts producing the fibrocartilaginous callus rather than osteoblasts?

A

Because it takes a while for osteoblasts to differentiate

65
Q

What other cells appear at the site of the fibrocartilaginous callus?

A

Inflammatory cells

66
Q

What do the fibroblasts differentiate into in the fibrocartilaginous callus?

A

Chondrocytes

67
Q

What is the purpose of the chondrocytes in the fibrocartilaginous callus?

A

The chondrocytes produce type I collagen - this acts to bridge the fracture site cartilage and the laid down trabeculae bone

68
Q

What is the third stage of bone healing?

A

Bony callus

69
Q

How long does the bony callus last for?

A

3-4 months

70
Q

What cell is responsible for the production of the bony callus?

A

Osteobolasts - these have now fully differentiated

71
Q

What is the bony callus composed of?

A

Woven bone - remember this is the first form of bone that is formed

72
Q

What is the fourth stage of bone healing?

A

Bone remodelling

73
Q

What is involved in the process of bone remodelling?

A

Osteoclasts are present - remodel the woven bone into compact and trabeculae bone

74
Q

In what order do the stages of bone healing occur?

A

All of these stages are all overlapping with each other all at the same time - do not have one and then move onto the other - instead they are all together

Year 2 Loco (31 decks)

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