Extremity Fracture Flashcards Preview

PTRS 746 Exam 1 > Extremity Fracture > Flashcards

Flashcards in Extremity Fracture Deck (59):
1

Content: 3 phases of bone healing (with time frame)

1. Inflammatory phase, 1-2 wkls

2. Reparative phase, months

3. Remodeling phase, mo-yrs

2

Q: What occurs during the inflammatory phase?

Increased vascularity and formation of fracture hematoma

3

Q: What is the cellular response during the inflammatory phase? (4)

1. Neutrophils 2. Macrophages 3. Phagocytes 4. Osteoclasts

4

Q: What occurs during the reparative phase?

Cell differentiation - chondroblasts are mineralized by osteoblasts to form a soft callus

5

Q: What can be seen radiographically during the reparative phase?

Fracture line diminishes

6

Q: What is the risk during the reparative phase?

Delayed union or non-union

7

Q: What occurs during the remodeling phase?

Reformation of the medullary canal

8

Diagram: Fill in the following table

Q image thumb

A image thumb
9

Content: 4 factors of bone healing

1. Age

2. Location and configuration

3. Extent of initial displacement

4. Blood supply

10

Q: Remodeling is _____ ________ in children and _____________ _____________ after early adulthood.

Very, rapid, relatively, constant

11

Q: What is the femoral shaft healing time for the following ages? Birth, 8 yo, 12 yo, 20 yo

3 wks, 8 wks, 12 wks, 20 wks

12

Q: Fractures surrounded by __________ heal faster

Muscle

13

T/F: Cortical bone heals faster than cancellous bone

False, flip it

14

T/F: Long oblique and spiral fractures heal faster than transverse fractures

True

15

Q: Non-displaced fractures with ________ periosteal sleave heal _______ as fast as displaced fractures.

Intact, twice

16

Q: Greater initial displacement = ?

More extensive

17

Q: Periosteal sleeve disruption = ?

Prolonged healing time

18

Q: What is the healing prognosis is all fracture fragments have blood supply?

Excellent

19

Q: If only some fragments have blood supply, what is the course of action?

Rigid immoblization to allow for vascularized fragments to serve as "hosts" to unvascularized fragments

20

Content: Initial complications due to local injuries to... (5)

1. Skin

2. Vascular

3. Neurologic

4. Muscular

5. Visceral

21

Content: Early complications - local (3)

1. Infection, gangrene, septic arthritis

2. Compartment syndrome

3. Osteomyelitis, avascular necrosis

22

Content: Early complications - remote (3)

1. Thrombus/embolus formation

2. Pneumonia

3. Tetanus

23

Content: Late complications - joint (2)

1. Persistent pain or stiffness

2. Post-traumatic DJD

24

Content: Late complications - bony (5)

1. Abnormal healing

2. Growth disturbance

3. Persistent ostemyelitis

4. Osteoporosis

5. Complex regional pain syndrome (CRPS)

25

Content: Late complications - muscular (2)

1. Myositis ossificans

2. tendon rupture

26

Defn: Increased pressure with fasical compartment (esp. anterior LE) due to edema or hematoma within closed space

Acute Compartment syndrome

27

Q: What are the 3 signs of acute compartment syndrome?

1. Painful

2. Edematous, tight

3. Absent or significantly diminished pulse

28

Q: How is chronic compartment syndrome different than acute?

Chronic is due to muscular expansion or decreased size of anatomical compartment

29

Content: Heterotropic ossification (3)

1. Soft tissue ossification, usually periarticular

2. most commonly involves hip or knee

3. unknown etiology

30

Content: 5 risk factors for heterotropic ossification

1. Neurologic involvement

2. Open wounds/burns

3. Sepsis

4. Prolonged critical illness

5. Aggressive ROM

31

Content: 6 ways fractures are described

1. Anatomic location

2. Fracture location

3. Direction

4. Alignment

5. Articular involvement

6. Open/Closed

32

Diagram: Identify the type of fracture

Q image thumb

Transverse

33

Diagram: Identify the type of fracture

Q image thumb

Oblique

34

Diagram: Identify the type of fracture

Q image thumb

Spiral

35

Diagram: Identify the type of fracture

Q image thumb

Longitudinal

36

Diagram: Identify the type of fracture

Q image thumb

Comminuted

37

Diagram: Identify the type of fracture

Q image thumb

Impacted

38

Diagram: Identify the type of fracture

Q image thumb

Depressed

39

Diagram: Identify the type of fracture

Q image thumb

Avulsion

40

T/F: Avulsion fractures are more common in children, esp. at growth plates.

True

41

Content: Fracture mechanics - cortical bone (2)

1. Tolerant to compression and shear forces

2. Fractures due ot tension - bending, twisting, pulling

 

42

Q: Who is cortical bone more flexible in?

Children

43

Q: A cortical bone fracture caused by an angulatory tension force (in children) is called a?

Greenstick fracture

44

Q: What type of forces are cancellous bone susceptible to?

Compression forces

45

Diagram: Salter-harris classificaiton of growth plate injuries

A image thumb
46

Content: Salter Harris Classification - Type 1 (Description, Tx, Px)

D: run directly along the growth plates, vital portions of growth plate remain attached to the epiphysis

Tx: Rarely reduced, immobilization to fully heal

Px: Excellent if blood supply is intact

47

Content: Salter Harris Classification - Type 2 (Description, Tx, Px)

D: Runs along the grwoth plate and includes a triangular metaphyseal fragment

Tx: Reduction and immobilization

Px: Good

48

Q: Which type of Salter-Harris classification is most common?

Type 2

49

Content: Salter Harris Classification - Type 3 (Description, Tx, Px)

D: Run along part of growth plate and turn perpendicularly into the joint

Tx: Surgery to restore joint surface

Px: Good if blood supply to separated portion is intact

50

Content: Salter Harris Classification - Type 4 (Description, Tx, Px)

D: Run from epiphysis across the growth plate and into the metaphysis

Tx: Surgery to restore joint surface and align growth plate

Px: May cause premature focal fusion and joint deformity 

51

Content: Salter Harris Classification - Type 5 (Description, Px)

D: Compression of growth plate results in a growth disturbance

Px: Poor

52

Q: What type of Salter-Harris Classification is not often recognized at the time of injury?

Type 5

53

Q: What Salter-Harris classification is an injury to perichondrial ring may cause physis to tether to bone, hindering growth?

Type 6

54

Q: What are the two main types of fracture management?

Reduction and immobilization 

55

Content: 2 types of fracture reduction

1. Open

2. Closed

56

Content: 4 types of immobilization

1. Casting

2. Splinting

3. External fixation

4. Internal fixation 

57

Q: What 4 things should be considered for a PT fracture intervention?

1. MOI

2. Age

3. Functional needs/demands

4. Type of immobilizaiton/orthopedic plan of care

58

Q: What 5 things does a PT fracture intervention entail?

1. Preserve/Improve ROM

2. Increase mobility

3. ADL training

4. Education

5. Wound care

59

Q: What can cause an avulsion fracture?

Musculature is stronger than the developing bone can handle