Fracture management Flashcards
(24 cards)
Bone healing:
There is first a ___ and cell injury leading to release of ___ and so there is ___. The repair process then begins. ___ tissue is laid down, this is then replaced by ___ tissue i.e. ____. This is then replaced by ___ bone tissue aka ___ callus (week___), which then ___ to form ___ callus. ___ then occurs from about week __.
The process of bone remodelling occurs because mesenchymal precursors differentiate to ___ which then lay down the osteoid (___ callus)
Haematoma Cytokines Inflammation Granulation Connective Cartilage Primitive Soft 2-3 Ossifies Hard Remodelling
Osteoblasts
Soft
Two categories of fracture in abnormal bone? And what causes each?
Insufficiency fracture - osteoporosis
Pathological fracture - tumour/infection/metabolic
What is a callus??
AA mass of new bone at a fracture site
4 factors that promote bone healing
Nutritional status e.g. Vit D
Loading and micro motions
Good blood supply
Local growth hormones
Disease that impairs bone healing?
Diabetes
3 treatments that impair bone healing?
Steroids
NSAIDs
Radiotherapy
When can you get primary bone healing, ie where there is no callou formation?
When the fracture is held rigidly in place
- surgery: rigid internal fixation
- nature: when there is no movement at the fracture site e.g. vertebral disk collapse
While most bone unites correctly, some bone can unite slowly, somee can unite incorrectly and some can not unite. What are the 3 reasons for the latter situation?
Hypertrophic (flared bone end, callus ++)
Atrophic (withered bone end, no callus)
Infected
Rule of thumb for union time:
Most bones? Lower limb? Shaft? High energy? Child?
6 weeks Double Double Double Half
What patient lifestyle factor impairs bone healing?
Smoking
What is each of the following:
Epiphysis
Physis
Metaphysis
Diaphysis
Rounded end of bone at joint with adjacent bones
Growth plate/epiphyseal plate
Wide section of bone beneath the physis
Bone shaft (narrow)
How do small bones grow?
From the centre…?
Which views do you norm xray a fracture from?
Lateral and AP
Fracture desccription
- name bone
- part of bone: into 1/3s, or into 4 diff parts of bone?
- Intra or extra ____?
- Immature vs mature skeleton
- Pattern of fracture (3). When does each occcur.
Epiphysis, physis, metaphysis, diaphysis
Articular
Transverse: bending or tensile force, (>30 degree angle) oblique (compression), spiral (torsion)
When describing displacement, to which bit of a fragment are you referring to?
Distal
4 descriptions of displacement?
Transition, angulation, rotation, shortening
What is a comminuted fracture? What is a greenstick fracture and who is it seen in?
A fracture with 2 or more fragments
Where the bone breaks but the periosteum on one side remains in tact. Occurs in children.
3 principles off the management of any fracture?
Reduce (open/surgical or closed/non surgical)
Stabilise
Rehabilitate
Main methods of non surgical stabilisation?
Plaster
Sling
Traction
2 main categories surgical internal fixation?
Intramedullary (nails)
Cortical - plate/screw/joint
2 main methods (not incl internal fixation) of treating a fracture (surgical)
Replacement
External fixation - eg ilizarov frame, mono axial
What is plaster of paris used? Why?
Black slab, along back of limb to stabilise it, held in place with bandage. Normally used more than full circumferential plaster because doesnt have risk of compartment syndrome
Why is intramedullary fixation (nails) a good method off stabilisation? Which bones is it especially useful for?
Fast stabilisation and early weightbearing
Goood for long bones
What is compartment syndrome? How is it treated? When is (diastolic pressure - compartment pressure) indicative of critical tissue perfusion?
Extreme swelling in confined
