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Musculoskeletal Pathophysiology > Fractures > Flashcards

Flashcards in Fractures Deck (80):
1

What is the most common type of fx in adults above 65?

hip

2

What is the most common types of fx's in its under 65?

arm and leg

3

What are the signs/symptoms of a fracture?

Visible or palpable deformity (except in case of stress fx)
Marked pain or local tenderness
ecchymosis or visible bruising
Functional impairment

4

What is the etiology of the fx?

How it happened (trauma, stress, pathological etc)

5

What is a stress fx?

Fx 2ndary to abnormal or repetitive forces on normal bone

6

When do stres fx's start to show up on X-rays?

not until the 2nd or 3rd week

7

What is a pathological fx?

When a normal force on an abnormal or weakened bone causes a fx.

8

What are pathological fx's usually 2ndary to?

Cancer/metastasis, osteoporosis, Paget's disease

9

What are some common sites for pathological fxs?

Vertebrae
proximal femur
ribs
wrist

10

What is a closed fx? Open fx?

closed-no communication external to body
Open-Connumication with fractures site and surface of skin

11

What are the concerns with an open fx?

Infection

12

What are you given if you have an open fx?

Antibiotics and prophylaxis for teatnus

13

What is the pattern of fx?

Classification of how the bone broke (transverse, oblique, Avulsion)

14

What is a complete fx?

The bone is broken completely (Transverse, oblique, Avulsion), spiral, comminuted

15

What is an incomplete fx?

Bone doesn't completely brake (greenstick, compression)

16

Where do you most often see greenstick fx's?

IN children due to lack of strength of bone

17

What type of injury are spiral fx's usually 2ndary to?

Twisting injuries

18

Are spiral fx's stable or unstable?

Very unstable-needs fixation

19

What does a spiral fx look like?

Looks like a corkscrew on the long axis

20

How many planes is the spiral fx in?

Multiple planes

21

How many planes is the oblique fx in?

One plane

22

Are oblique fx's stable or unstable?

Often unstable, needs fixation

23

What is a comminuted fx?

Serious fx where the bone is broken into many pieces, usually 2ndary to significant trauma

24

What is an avulsion fx caused by?

Caused by an excessive pull by a tendon or ligament

25

What is the most proximal fx of the 5th metatarsal?

Avulsion fx due to excessive pull of the peronius brevis. This is the MOST common

26

What is a fx in the middle portion of the 5th metatarsal?

A jones fx, at the diaphyseal-metaphyseal junction

27

What is the most distal fx of the 5th metatarsal?

A stress fx

28

What is a greenstick fx?

Incomplete fx of a long bone with cortical disruption on ONE side. Creates a bowing effect

29

How do you classify epiphyseal injuries?

The Harris and Salter classification which consists of a I-V rating scale

30

What is a Type I epiphyseal fx?

Epiphyseal slip only
Requires casting and sometimes pinning

31

What is the outcome for a Type I epiphyseal fx?

Usually good unless the blood supply is damaged

32

What is a Type II epiphyseal fx?

Fx through epiphyseal plate with part of shaft attached
Usually needs fixation but has good results

33


Ih a Type II fx, is the articular surface intact or damaged?



Intact


34

What is the most common type of epiphyseal fx?

Type II

35

What is a type III epiphyseal fx?

A rare fx through the epiphysis extending into the plate

36

What is the outlook for a type III epiphyseal fx?

Outlook is good only if the blood supply is intact and it is not displaced

37

What is a Type IV epiphyseal fx?

Fx of epiphysis, metaphysics and through the growth plate

38

What do you need for a Type IV epiphyseal fx to heal?

Surgical stabilization and joint realignment

39

What is a Type V epiphyseal fx?

The growth plate is crushed usually at the ankle or knee

40

IN which types of fx's is premature fusion likely to occur?

Types III and IV

41

In which types of fx's is late deformity likely to occur?

Types III-V

42

What are some examples of late deformity in epiphyseal injuries?

Limb shortening
abnormal joint alignment

43

What is radiological union?

When there is a visible callus on a radiograph (soft and hard)
There will also be bridging, or continuity of bone trabeculae across the fx site

44

When is there clinical union?

Absence of mobility between fx fragments
Absence of tenderness over site on palpation
Absence of pain with angulation stress

45

When is a callus visible in the UE? LE?

UE- 2-3 weeks
LE- 2-3 weeks

46

When is clinical union in the UE? LE?

UE- 4-6 weeks
LE 8-12 weeks

47

When does consolidation happen in the UE? LE?

UE- 6-8 weeks
LE- 12-16 weeks

48

Why does union take longer in the LE than the UE?

larger bones in the LE

49

What affect does age have on bone healing?

The younger you are the quicker it takes for your bone to heal

50

What is the difference in healing times for different types of bone (cortical/cancellous)?

Cortical bone heals more slowly than cancellous bone

51

What effect does blood supply after trauma have on rate of union?

If the blood supply is impacted after trauma this may severely slow healing or stop it altogether (avascular necrosis)

52

How does the normal blood supply affect union?

If an area does not have a good blood supply, like the proximal scaphoid and distal shaft of tibia/fibula, you will have increased healing times

53

What does the apposition of bone fragments affect healing time?

How far the fragments are and how aligned they are will affect the rate and quality of healing

54

What affect does movement of bone fragments have on healing?

Movement disrupts healing so requires fixation

55

What is reduction?

The realignment of the fx fragments into as close to a normal position as possible

56

What is a closed reduction?

Non-surgical, casted or in a boot

57

What is an open reduction?

Surgical and fixed with some device (ORIF)

58

What is the purpose of immobilization?

Prevents displacement or angulation of fragments
Prevents movement
Relieves pain

59

What are some methods of immobilization?

Cast/sling/splint
Continuous traction (bucks traction, skeletal traction)

60

What is the purpose of a dynamic/compression screw in a hip fx?

Gives a little when weight is put through it so it does not get rammed through the acetabulum

61

Where are tension bands used?

Used where muscles will tend to pull fragments apart (olecranon and patella fxs)

62

What type of fixation is Percutaneous pinning and what is it?

External fixation where pins are put through the skin temporary and pulled out when fx is healed

63

When do you use and external fixator device?

When there are numerous fragments or you cannot get a good fixation internally

64

What is an Arthoplasty and when do you use it?

Joint replacement. Used when there are too many fragments or the bone stock is too poor to use fixation devices

65

What is a Total joint arthoplasty?

Both joint partners are replaced

66

What is a Hemi-arthoplasty?

Only one joint partner is replaced

67

What is the biggest complication with a fx? What are some other complications that can happen?

Infection is a huge complication. Can also have:
Nonunion, delayed union or mal union
Avascualr necrosis
Injuries to other structures

68

What is avascular necrosis?

Loss of bone due to loss of blood supply

69

What is post traumatic osteomyelitis?

Infection of bone and marrow

70

What is delayed union?

Takes longer than expected for age, site and type of fx, BUT NO EVIDENCE OF NON-UNION

71

What is mal-union?

Heals with a deformity (e.g. shortening)

72

What is non union?

NO evidence of healing on 3 CONSECUTIVE RADIOGRAPHS
Often in the presence of abnormal changes at the fx site

73

What is atrophic non-union?

No bone growth at fx site

74

What is hypertrophic non-union?

There is bone growth but no union

75

What is pseudoarthroses?

There is movement, need to re-break and reset

76

What type of device can you use for a non-union fracture?

Bone Growth Stimulator

77

Where are common sites of avascular necrosis?

Femoral head
Proximal scaphoid
Body of talus

78

What is Charcot's joint?

Joint injury when there is no sensation of kinesthesia. See in DM neuropathy

79

What is FES?

Fat embolism Syndrome, a rare but potentially fatal complication of long bone or pelvic fx involving pulmonary, cerebral and cutaneous manifestations

80

When does FES usually present?

24-48 hrs "post-injury"