Fractures Flashcards
(29 cards)
Major fracture sites are the hip, limbs and skull. Where do people 65 have the majority of fractures?
65: hip (osteoporosis)
What is the difference between a stress/fatigue fracture and a pathological fracture in etiology? Name a common type of each.
A stress or fatigue fracture is caused by abnormal forces on a normal, healthy bone. Pathological fractures occur secondary to a bone pathology, such as OA. A common stress fracture is a march fracture to the metatarsal (doesn’t show on XRAY until 2/3rd week, but is painful to vibration). A common pathological fracture is a femoral neck fall fracture.
How are recent bone changes shown on an XRAY?
As darkened objects.
What’s the major concern with open fractures?
They penetrate the skin and usually need antibiotics soon after injury.
Describe the 3 types of complete fracture.
- Transverse (occurs at a right angle to the shaft).
- Oblique (occurs at a 45 degree angle to the shaft; unstable, needs fixation).
- Avulsion (excessive pull of a tendon or ligament, pulling bone off; happens frequently at base of 5th met by peronious brevis). Occurs in young people before full bone strength.
Describe the 4 types of incomplete fracture.
- Greenstick (bending; no true break because of bone flexibility; cortical disruption).
- Compression
- Spiral (twisting injury, very unstable).
- Comminuted (multiple pieces, significant trauma; typically uses external fixaters).
On the Harris and Salter Classification, types ___ and ___ are non-interarticular fractures, where types ___ and ___ are interarticular. This level indicates damage to the epiphyseal plate.
I and II
III and IV
V
Describe a Salter-Harris type I injury.
Epiphyseal slip only. Requires some casting or pinning. No damage to epiphyseal plate.
Describe a Salter-Harris type II injury.
Most common. Fx through part of shaft. Usually needs fixation.
Describe a Salter-Harris type III injury.
Rare. Fx extends through epiphyseal plate. Outlook good only if adequate blood supply. Could have growth defects.
Describe a Salter-Harris type IV injury.
Fracture of epiphysis and shaft that crosses growth plate. Requires surgical realignment. Likely to have growth deformities (increases if intra-articular).
Describe a Salter-Harris type V injury.
Severe crushing, usually knee or ankle. Growth plate destroyed.
What are the signs of radiological union? What is the difference between blunting and bridging?
Visible callus (soft or hard), continuous bone tribeculae across site (bridging). Blunting is the disappearance of the fracture line while bridging is the physiological joining.
What types of complications can occur with physeal injuries?
Premature fusion (III, IV) Late deformity (III - V): length discrepancies
Once a bone has healed where it can be walked on there is a clinical union. What are the signs of this? Can you now apply resistance?
- Absence of mobility between fracture fragments
- Absence of tenderness over site on palpation
- Absence of pain with angulation stress
No resistance.
In both the UE and LE, the soft callus becomes visible in 2-3 weeks. How long does it take to develop a clinical union?
UE: 4-6 wks
LE: 8-12 wks
Plus 2-4 wks for consolidation
What are examples of cortical and cancellous bone?
Cortical: shaft
Cancellous: vertebra
Blood supply is a key element of healing time after bone trauma. Give 2 examples of bones in the body that suffer from extended healing times due to poor blood flow.
- Proximal scaphoid (6-8 wks casting)
2. Distal shaft of fib/tib
What makes a femoral neck fracture dangerous and difficult to heal?
Disruption of blood supply. The medial circumflex artery forms an anastomosis around the femoral neck and into the head. This can cause avascular necrosis.
Fracture management involves 3 key categories: reduction, immobilization and preservation of function. Describe all three.
- Reduction: realignment of the fracture into a close approximation. Open (ORIF) or closed (cast).
- Immobilization: prevent displacement, reduce pain, aid union. Can also utilize traction (eg. femur condyloid fx).
- Just do it.
Name 3 internal fixation devices.
- Plates and screws.
- Intermedullary nails or rods.
- Circumferential wires and bands. Used in patella and olecranon fx.
Name 2 types of external fixation devices.
- Percutaneous pins. Through the skin, pulled out.
2. External fixator. Used for multiple fragments.
Athroplasty is joint replacement surgery. When it’s hemi (vs total), what does it signify?
That only half of the joint is replaced (eg. femoral head).
In a THA, you can have an implant cemented or pressed. In which cases would you use either?
Cemented for older population. Less secure, but can move on device earlier.
