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PTRS 746 Musculoskeletal > Extremity Fractures > Flashcards

Extremity Fractures Flashcards

1
Q

Healing Factors (4)

A
  1. Age
  2. Location & Configuration
  3. Extent of Displacement
  4. Blood Supply
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2
Q

Initial Fracture Complications

A
  • Local Injuries to skin, blood vessels, nerves, muscles and visceral structures (internal organs)
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3
Q

Early Fracture Complications - Local (3)

A
  • Infection, gangrene, septic arthritis
  • Compartment syndrome
  • Osteomyelitis, AVN
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4
Q

Early Fracture Complications - Remote (3)

A
  • Thrombus, embolus formation
  • Pneumonia
  • Tetanus
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5
Q

Late Fracture Complications - Joint (2)

A
  • Persistent pain or stiffness
  • Post-traumatic DJD
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6
Q

Late Fracture Complications - Bone (5)

A
  • Abnormal healing
  • Growth disturbances
  • Persistent osteomyelitis
  • Osteoporosis
  • Complex regional pain syndrome (CRPS)
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7
Q

Late Fracture Complications - Muscular (2)

A
  • Myositis ossificans
  • Tendon rupture
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8
Q

Compartment Syndrome

A

Caused by swelling or other causes of decreased space within the fascial compartment resulting in reduced blood flow.

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9
Q

Acute Compartment Syndrome (3)

A
  • Caused by edema or hematoma
  • Signs include pain, edema (shiny, tight skin), blue color in distal limb, absent or diminished pulse
  • EMERGENCY
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10
Q

Chronic Compartment Syndrome

A
  • Usually due to increased muscle size or decrease in size of the anatomical compartment
  • Not considered a medical emergency
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11
Q

Heterotropic Ossification

A
  • Bone deposits in soft tissue areas
  • Common sites are around knees and hips
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12
Q

Heterotropic Ossification Risk Factors (5)

A
  • Neurological Injuries (SCI)
  • Open wounds
  • Sepsis
  • Prolonged critical illness
  • ** Aggressive ROM
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13
Q

Fracture Classification Areas (6)

A
  • Anatomic location
  • Fracture location on the bone (proximal, distal)
  • Direction (transverse, longitudinal)
  • Alignment (varus, valgus, displaced)
  • Articular involvement
  • Open/Closed
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14
Q

Transverse Fracture

A

Horizontal fracture across the bone

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15
Q

Oblique Fracture

A
  • Diagonal fracture
  • Usually caused by sharp angled blow
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16
Q

Spiral Fracture

A
  • AKA torsion fracture
  • Fracture “wraps” or spirals around the bone
  • Commonly due to sports injury or child abuse
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17
Q

Longitudinal Fracture

A
  • Fracture occurs vertically
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18
Q

Comminuted Fracture

A
  • Fracture occurs in multiple directions, results in fragments
  • Commonly caused by trauma and aging
  • Often treated with ORIF or external fixation
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19
Q

Impacted Fracture

A
  • Occurs when two bone surfaces are jammed together
  • Often seen in hips of children
20
Q

Depressed Fracture

A
  • Fracture that causes bones to cave inwards
  • Most commonly seen in the skull
  • Commonly due to blunt force trauma
21
Q

Avulsion Fracture

A
  • Piece of bone is pulled off, usually due to repeated pulling on the bone by muscles
  • More common in children, especially at growth plate
22
Q

Salter Harris Fractures

A
  • Fracture of the growth plate, can result in growth deficits
  • Types I-VI
23
Q

Salter Harris Type 1

A
  • Fracture occurs along the growth plate on either side but does not cross growth plate
  • Immobilized until fracture fully heals
  • Excellent prognosis w/ good blood supply
24
Q

Salter Harris Type 2

A
  • Fracture occurs along the growth plate and extends up into metaphysis creating a triangular shaped fragment
  • Requires reduction/immobilization
  • Good prognosis
25
Q

Salter Harris Type 3

A
  • Fracture runs along growth plate and then crosses into the growth plate
  • Surgery is required to rejoin joint surfaces
  • Good prognosis if good blood supply
26
Q

Salter Harris Type 4

A
  • Fracture runs from metaphysis through the growth plate into the epiphysis
  • Surgery required
  • May cause growth deformity
27
Q

Salter Harris Type 5

A
  • Compression fracture of growth plate between metaphysis and epiphysis
  • Poor prognosis
28
Q

Salter Harris Type 6

A
  • Compression fracture of growth plate results in bone tethering
  • Poor prognosis
29
Q

Reduction Fracture Management

A
  • Realignment of fractured joint surfaces
  • Closed (non-invasive)
  • Open (surgical)
30
Q

Immobilization Fracture Management

A
  • Keeps realigned fracture site in the correct position
  • Casting
  • Splinting
  • External/internal fixation (pins, screws, rods, prosthetics)
31
Q

Ilizarov Procedure

A
  • Type of external fixation of a fracture where micro fractures are created throughout the healing process to allow bone growth during fixation
  • Allows for gradual bone lengthening
32
Q

Describe a varus fracture.

A

The distal end of the fractured bone deviates medially.

33
Q

Describe a valgus fracture.

A

The distal end of the fractured bone deviates laterally.

34
Q

What should the PT consider before implementing a fracture management plan? (4)

A
  • Patient’s age
  • MOI
  • Patient’s functional needs/demands
  • Type of immobilization and orthopedist’s plan of care
35
Q

What PT interventions are associated with fracture rehab? (5)

A
  • Preserve and improve ROM
  • Increase mobility
  • ADL training
  • Patient education
  • Wound care
36
Q

What is going on during the inflammatory stage of bone healing? (3)

A
  • Increased blood flow to the area
  • Formation of a fracture hematoma
  • Infiltration of neutrophils, macrophages, phagocytes, and osteoclasts
37
Q

What is going on during the reparative (subacute) phase of healing? (2)

A
  • Bone callus is formed by chondroblasts/fibroblasts that is mineralized by osteoblasts
  • Fracture diminishes but is still susceptible to delayed union/non-union
38
Q

What is going on during the remodeling (chronic) phase of bone healing? (2)

A
  • Medullary cavity is reformed
  • Delayed remodeling can be caused by low blood flow, periosteal stripping, highly comminuted fractures, and extensive soft tissue damage
39
Q

What are the functional limitations associated with the inflammatory phase? (2)

A
  • Patient it totally restricted
  • NWB, immobilization
40
Q

What are the functional limitations associated with the early stages of the reparative phase?

A

PWB, PROM, and limited AROM

41
Q

What are the functional limitations associated with the late stages of the reparative phase?

A

WBAT, increase AROM

42
Q

What are the functional limitations during the remodeling phase?

A
  • Patient is nearly back to normal
  • FWB, full AROM, and RROM
43
Q

T/F: Cortical bone heals faster than cancellous bone.

A

False, cancellous bone heals faster due to higher blood supply

44
Q

___________ and _____________ fractures heal faster than _________ fractures.

A

Longitudinal, spiral, transverse

45
Q

Prolonged healing time of displaced fractures is influenced by what 2 things?

A
  1. Greater amount of initial displacement
  2. Periosteal sleeve disruption
46
Q

T/F: All bone fragments have to be vascularized or the fracture will not heal (non-union).

A

False, some of the bone fragments need blood flow and can then act as hosts for the fragments lacking blood flow.

  • If all fragments lack blood flow then the fracture will NOT heal.

PTRS 746 Musculoskeletal (9 decks)

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