Fracture description and radiographic assessment of fracture healing

Question 1

Describe articular fractures

Answer 1

fracture involves the joint surface
all require rigid internal fixation to maintain articular surface to try and prevent severe OA

Question 2

what is the diaphysis

Answer 2

Diaphysis is the shaft of the bone- the cortex is thick and bone strong

Question 3

what is the metaphysis

Answer 3

Metaphysis is the transition from the physis or growth plate to the diaphysis
generally the bone is softer here

Question 4

what is the epiphysis

Answer 4

the ends of the bons - are covered with articular cartilage making up the joint

Question 5

what system do we use to treat physeal fractures

Answer 5

Salter Harris system - there are 5 fracture types described

Question 6

Describe the aims of management of Salter Harris fractures

Answer 6

aim to maintain normal bone growth of the bone resulting in a limb of normal length without angular limb deformities

Question 7

what are closed fractures

Answer 7

the skin is intact

Question 8

what are open fractures

Answer 8

the skin overlying the fracture is broken

Question 9

Describe a type 1 open fractures

Answer 9

small wound <1cm
little contamination
treat as a closed fracture

Question 10

Describe a type 2 open fracture

Answer 10

extensive wound >1cm
communicating with the fracture

Question 11

Describe a type 3 open fracture

Answer 11

very extensive soft tissue damage and fractured bones are seen protruding through the skin

Question 12

Describe comminuted fracture

Answer 12

consists of at least 3 fragments

Question 13

what may you need to use to fix a comminuted fracture

Answer 13

if not re-constructable- use buttress plate or external fixator to bridge the area of comminution

Question 14

Describe a avulsion fracture

Answer 14

when a distractive force results in the fracture and also tends to bring about a loss of reduction

Question 15

Describe how to repair avulsion fractures

Answer 15

need to overcome the distractive forces can use a lag screw or tension band to do this
this converts the distractive forces into compressive ones

Question 16

what do pathological fractures originate from

Answer 16

from weakening of the bone by a pathological process e.g. neoplasia

Question 17

List 5 factors that affect bone healing

Answer 17

age of patient
comorbidities
nature of fracture
stability and appropriateness of the repair
post-op management

Question 18

what is primary bone healing

Answer 18

when there is bone to bone healing

Question 19

what is secondary bone healing

Answer 19

where there is intervening callus formation

Question 20

What does primary bone healing need

Answer 20

intimate contact of the bone ends under compression
needs application of bone plate and extensive dissection and manipulation of soft tissue

Question 21

describe how secondary bone healing works

Answer 21

does not require accurate reduction of the fracture
could just use an external fixator