Fractures

Question 1

Preclinical Disability

Answer 1

-progressive and detectable but unrecognized decline in physical function in older adults
-decreased task efficiency

Question 2

Phenotypes

Answer 2

-describes how an individual’s characteristics are a result of their genotype interacting with the environment

Question 3

Musculoskeletal system and aging​

Answer 3

-Skeletal muscle of older people is more easily damaged with the loading
-Aging collagen increased cross-links between molecules, increasing the mechanical stability and tissue stiffness
-Tendons exhibit a lower metabolic activity that compromises healing
-joint increased stiffness and decreased flexibility and proprioception

Question 4

Bone Remodeling influences

Answer 4

-mechanical stress
-Calcium and phosphate
-hormonal levels

Question 5

4 types of Fractures

Answer 5

Traumatic, stress, insufficiency, pathologic

Question 6

Traumatic Fractures

Answer 6

-sudden impact
-Transverse, oblique, spiral
-mostly radius and ulna
-most affected 5-14

Question 7

Stress Fractures

Answer 7

-partial break
-rhythmic repeated microtrauma
-most in tibial shaft and metatarsal

1. Compressive: forceful heel strike during prolonged marching
2. Distractive: muscle pull on bone

RF
-increase intensity of training
-females: pelvic and sacral fractures

Question 8

Insufficiency Fracture

Answer 8

-normal stress applied to abnormal bone
-decreased elastic resistance or decreased mineralization
-minor trauma

Question 9

Pathologic Fracture

Answer 9

-abnormally fragile bone by disease

Question 10

Classification of Fractures

Answer 10

Transverse: right angle line, shearing

Oblique/Spiral: twisting force

Comminuted: broken into fragments

Segmented: broken with a segment of free bone is left

Butterfly: separation of a wedge

Greenstick: splintering of bone

Torus: bone bulges out from stress

Hairline/crack: skinny crack

Question 11

Vertebral Compression Fracture

Answer 11

-most common osteoporosis related fracture
-minor
-pain worse with spinal extension
-height loss and respiration dysfunction

Question 12

Fracture Healing

Answer 12

1. Hematoma (6-12h): Blood clot forms and inflammation
2. Proliferation (1-2d): granulation tissue and fibrocartilage
3. Callous Formation (1-3w):
   Soft callous
4. Ossification (6w): Soft callous replaced by bony callous
5. Remodeling (4m-1y): restoration of medullary canal

Question 13

Factors to Hinder Fracture Healing

Answer 13

-inadequate blood supply
-poor nutritional status
-poos apposition
-infection
-corticosteroid

Question 14

Clinical Manifestations of Fractures

Answer 14

-point tenderness
-pain with weight bearing
-swelling and bruising
-loss of mobility

Question 15

Complications of fractures

Answer 15

-malunion
-delayed union
-nonunion: fibrous union or false joint

Question 16

Bone Grafting

Answer 16

-enhance bone repair

Autogenous: taken from self, iliac crest of fibula

Allogeneic: donor bank

Tissue Engineering: Porous scaffolds and biodegradable plastics

Question 17

Bone Healing Prognosis

Answer 17

Children: 4-6w
Adolescents: 6-8w
Adults: 10-18w

Negative Predictors:
-Calcium channel blockers and NSAIDs

Question 18

PT Implications

Answer 18

-can begin rehab within 1 week
-immobilized until callus formation
-treat swelling, pain, and ROM deficits
-Weight bearing limitations

Look for
-compartment syndrome
-fat embolisms
-nerve issues