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INTRO TO ORTHO > fractures > Flashcards

fractures Flashcards

(55 cards)

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1
Q

what is a fracture?

A

a break in the continuity of a bone

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2
Q

if skin is intact - classification

A

closed/ simple fracture

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3
Q

if ends of bones have broken through skin / into one of body cavities - classifications

A

open/ compound fracture

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4
Q

when bone is broken in two pieces or more/ when bone is bent/ cracked & periosteum remains intact

A

two pieces = complete
bent/ cracked = incomplete

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5
Q

TRANSVERSE - complete fractures

A

usually stay in place after reduction, but they take longer to heal

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6
Q

OBLIQUE - complete fractures

A

difficult to keep in place but they heal more rapidly

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7
Q

SPIRAL - complete fractures

A

difficult to keep in place but they heal more rapidly

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8
Q

COMMINUTED - complete fractures

A

often unstable because it consists of two or fragments, making healing difficult

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9
Q

AVULSION - complete fractures

A

occurs when a ligament pulls portion of bone that it is attached to away from bone

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10
Q

OSTEOCHONDRAL - complete fractures

A

occurs when fragments of articular cartilage are sheared from joint surface often during a dislocation/ sprain

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11
Q

COMPRESSION - incomplete fractures

A

bone is crushed & usually occurs in cancellous bone (vertebral body)

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12
Q

GREENSTICK - incomplete fractures

A

bone is bent/ partially broken, as when breaking a green twig
-usually found in children younger than 10 yrs when bones are more pliable

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13
Q

PERFORATION - incomplete fractures

A

result of a missile wound, such as a bullet

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14
Q

STRESS - incomplete fractures

A

cracks in bone due to overuse / repetitive actions

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15
Q

COLLE’S - common fractures

A

-fracture of wrist where transverse fracture of radius just proximal to wrist allows fragment to rotate & displace dorsally
-gives wrist “dinner fork” deformity before it is reduced
*most common in older people
*usual mechanism = FOOSH
*can be difficult to reduce successfully

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16
Q

GALEAZZI - common fractures

A

-involves break of radial shaft & dislocation of inferior radioulnar joint
*mechanism = fall on hand with some rotational component

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17
Q

POTT’S - common fractures

A

-ankle fracture: affects one/ both malleoli
-distal fibula breaks close to lateral malleolus
*deltoid ligament may also rupture / avulse medial malleoli
*mechanism = eversion with some external rotation

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18
Q

DUPUYTREN’S - common fractures

A

-fibula fractures higher up, medial malleolus avulses & talus is pushed superiorly between tibia & fibula
*mechanism = eversion with some external rotation
*screws/ wires often used to reduce & stabilize ankle

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19
Q

common stress fracture sites

A

tibia
metatarsals
navicular
femur
pelvis

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20
Q

causes of a fracture

A

-trauma/ sudden force which creates more stress than bone can absorb
*direct force: bone breaks at point of contact
*indirect force: bone breaks at distance from site of force
-overuse/ repetitive wear, bone cracks
-pathologies: osteoporosis, tumours, local infections, bone cysts

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21
Q

FIRST stage of healing

A

-hematoma forms around ends of fractured bone within 72 hrs of initial trauma
-mesh of fibrin forms around injury site
-ends of bone die back several millimeters

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22
Q

SECOND stage of healing

A

-inflammatory reaction & a proliferation of osteoblasts at periosteum
-cells create fibrocartilaginous bridge between fragment ends

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23
Q

THIRD stage of healing

Study These Flashcards
A

-soft callus/ point is formed from mass of proliferating osteoblasts
-osteoclasts also present, cleaning up dead bone & debris
-as fibrous, immature bone is gradually calcified, movement at fracture ends gradually increases
-union of fracture ends occur at about 4 wks
-repair is incomplete because callus is merely calcified & not yet mature bone

24
Q

FOURTH stage of healing

Study These Flashcards
A

-consolidation occurs as immature woven bone is changed into mature lamellar bone
-consolidation is a complete repair -> callus now ossified
-may be several months before bone is capable of bearing normal loads
-no tenderness at fracture site

25
FIFTH stage of healing
-remodelling of irregular outer surface & reshaping of space inside bone takes place through osteoclastic & osteoblastic activity -process governed by WOLFF'S LAW: bone responds to mechanical stress by becoming stronger & thicker the more strenuous its function
26
closed reduction - medical treatment of fractures
-manual traction applied & bone ends are realigned -fracture held in place until fracture repair occurs
27
open reduction - medical treatment of fractures
bone/ bone fragments are stabilized by devices such as screws, nails, wire, metal plates
28
early complications
include: torn muscles & tendons, ligament damage, compartment syndromes, nerve injuries, vascular injuries, joint hemarthrosis, bone & soft tissue infections, DVT & problems caused by poorly fitting casts
29
compartment syndrome - early complications
-can occur in forearm / leg following a fracture -swelling that accompanies marked edema, hematoma / inflammation increases pressure within fascial compartment
30
nerve compression - early complications
may be indicated by paresthesia in tissues under cast
31
vascular damage - early complications
untreated vascular damage may be indicated by an increase in observable distal red, black or blue bruising
32
bone & soft tissue infection - early complications
can occur with external fixation or skeletal traction along pin tract if proper wound care is not observed
33
deep vein thrombosis (DVT) - early complications
may occur after a lower limb fracture indicated by pain, an increase in swelling local to calf & a slight increase in temperature
34
pressure/ plaster sore - early complications
-occurs where cast chemically compresses skin over a bony prominence -client initially feels a local burning pain under cast
35
cast dermatitis - early complications
-may result from poor ventilation & hygiene of skin under cast -allergic reactions to chemicals present in fibreglass casts are also possible
36
loose cast syndrome - early complications
occurs when cast that is too loose rubs on bony prominence, causing skin abrasions
37
late complications
include delayed union & non-union of fracture, malunion, myositis ossificans, nerve compression, nerve entrapment, bone necrosis, Volkmann’s ischemic contracture, joint stiffness & disuse atrophy
38
delayed union - late complications
-occurs if bone does not unite within expected time frame -may be due to inadequate circulation, insufficient splinting, excessive traction or infection
39
non-union - late complications
-failure of bone to heal before repair process finishes -may be caused by an overly large gap between bone ends whether due to bone destruction, bone less, excessive tractioning, inadequate fracture reduction, bone infection or soft tissue
40
malunion - late complications
-unacceptable joining of bone ends so that a deformity occurs -may be due to improper alignment of bone ends when fracture was reduced or displacement of bone ends while limb was casted
41
myositis ossificans - late complications
-bone formation within muscle, which occurs weeks after intial trauma -may also result from muscle injury -heterotopic ossification is bone formation within soft tissue
42
Volkmann's ischemic contracture - late complications
-may eventually result after compartment syndrome or injury to an artery causes ischemic contracture of affected mm -while over time ischemic mm in compartment are replaced by inelastic fibrous tissue, ischemic nerve may be able to recover partial function
43
disuse osteoporosis - late complications
-may occur with prolonged immobilization -reversible once full use of limb is regained
44
symptom picture
-immediately after fracture occurs & before reduction is performed, unnatural mobility & deformity are present at fracture site -shock, pain, bleeding, inflammation, swelling, loss of function, mm splinting & edema are present -soft tissue also injured -with stress fractures, fracture is painful upon compression
45
symptom picture - during immobilization
-following closed/ open reduction, limb may be casted or immobilized -pain present locally & possibly at a distance from fracture -tissue repair & callus formation occurring at fracture site -adhesions are developing around injury -due to immobilization reduced circulation, edema, disuse atrophy & CT contracture occur in tissues under cast -HT & TPs present in compensating structures -short-term complications may occur
46
symptom picture - immobilization removed
-fracture site is healing & remodelling -decreased tissue health in tissue that has been under cast -adhesions have matured around injury -with open reduction, scars present -HT & TPs present in mm crossing fracture site & in compensating structures -mm weakness / disuse atrophy is likely present in mm crossing fracture site -occasionally, pocket of chronic edema may remain local to injury -long-term complications may occur
47
observations - during immobilization
-antalgic gait if fracture is in lower limb -affected limb may be casted or external fixation device may be used -client may have crutches, cane / walking cast -antalgic posture may be present -edema present at fracture site & distal -red, black or purple bruising may be visible at fracture site / distal to it -pained / medicated facial expression
48
observations - immobilization removed
-habituated antalgic gait & posture may be observed -chronic edema may remain at fracture site & distal -when cast is initially removed, skin that was under is likely dry, scaly or flaky -disuse atrophy may be visible -bruising should resolve to brown, yellow & green, then disappear -if surgery was performed, scars present
49
palpation - during immobilization
-heat & edema present at fracture site, although not palpable due to casting -pain present local to fracture site & refers into nearby tissue -protective mm spasm present in mm crossing fracture site -HT & TPs present in compensating mm
50
palpation - immobilization removed
-health of tissues that were under cast assessed in first few days following cast removal -conditions may include disuse atrophy, dry or flaky skin, local paresthesia, reduced vasomotor control, signs of inflammation or tissue ischemia -after one week, as tissue health returns, adhesions associated with fracture site are palpated -HT & TPs present in compensating mm
51
CI's - during immobilization
-limb must not be tractioned before union occurrs -hot hydro not placed distal or immediately proximal to cast -if fracture was at site of mm attachment or if there was laceration or severance of tendon crossing fracture site, to avoid further soft tissue damage, AF & AR isometrics only performed with physician’s approval -with open reduction, on-site work is avoided until skin has healed -local techniques avoided until skin is fully healed if fracture was treated by open reduction & stabilized without cast
52
CI's - immobilization removed
-overpressure testing of involved joints is CI’d before union has occurred -hydro temp extremes avoided on tissues that were under cast -until tissue health & mm tone regained in mm that were under cast, it is CI’d to use deep longitudinal techniques on these mm -if metal implants such as pins or plates have been used to repair fracture, avoid local hot hydro applications
53
treatment - during immobilization
-do NOT interfere with healing process -refer client to physician if complications are suspected -positioning depends on location of fracture & client’s comfort -limb elevated & secured so no stress is placed on fracture site -hydro is cold application to limb, distal to cast -reduce edema proximal to cast -maintain local circulation proximal to injury -maintain ROM with mid-range pain-free PR ROM to proximal & distal joints -vibrations through cast over fracture site may help to decrease SNS -work distal to cast is restricted
54
treatment - immobilization removed
-positioning for comfort & accessibility to structures being treated -mild contrast hydro used on tissues that were under cast, helps to normalize circulation & vasomotor tone -once tone has returned, deep moist heat to increase flexibility of CT contractures & adhesions prior to treatment -reduce edema proximally to injury site -reduce HT & TPs proximal to injury -in area that was under cast, textured mitten can be used to gently remove any dead, flaky skin & increase local circulation -stimulating light techniques used on mm with disuse atrophy
55
treatment reduction without casting
-with fracture that was medically treated by open reduction without cast, care must be taken to avoid interfering with healing process until union occurs -with stress fracture that is not casted, on-site massage CI’d while fracture site is tender -proximally, limb treated using techniques described in immobilization treatment -once external fixation devices removed & pin tracks healed, work is done to decrease adhesion & scar formation -after union, techniques focus on circulation, drainage & reducing adhesions indicated -once consolidation has occurred, passive forced range & joint play as listed in immobilization removed section can be used to increase ROM

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