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Fractures Flashcards

1
Q

Fractures in hip occur in which population? Arms/Legs?

A

Hip fractures-> age 65 & older

Arms/Legs-> Under 65

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2
Q

Name 4 signs/symptoms of a fracture

A

1) Visible or palpable deformity
2) Marked pain or local tenderness
3) Ecchymosis or visible bruising
4) Marked functional impairment

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3
Q

Name 3 way fracture classifications

A

1) Etiology
2) Open vs. closed
3) Pattern of the fracture

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4
Q

Name 3 fracture etiology

A

1) Trauma
- Direct or indirect force
2) Stress or fatigue fracture
- Secondary abnormal or reptitive forces on normal bone
3) Pathological fracture
- Normal force on an abnormal or weakened bone, secondary to CA, osteoporosis, Paget’s disease, etc.

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5
Q

Describe the difference between closed vs open fractures

A

1) Closed
- No communication external to body
2) Open
- Communication with fracture site and surface of skin
- Concern re: infection - need antibiotics
- Prophylaxis for tetanus

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6
Q

Classification by pattern of fracture: Name the 2 large categories and all the subcategories within

A

A) Complete

1) Transverse
2) Oblique
3) Avulsion
4) Spiral
5) Comminuted

B) Incomplete

1) Greenstick
2) Compression

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7
Q

Describe a transverse fracture. It’s usually secondary to direct trauma

A
  • Fracture is at right angle to a long portion of the bone

- Usually secondary to direct trauma

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8
Q

Spiral fracture-Secondary to what?

A

twisting injury

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9
Q

Spiral fracture-Stable or unstable? What does it need?

A
  • Very unstable

- needs fixation

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10
Q

Oblique fracture-Common or rare? Confined to how many planes? Stable or unstable (needs this)

A
  • Rarer than the other types
  • Confined to one plane
  • Often unstable-needs fixation
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11
Q

Comminuted fracture-Usually secondary to what?

A

Significant trauma

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12
Q

Comminuted fracture-Has many or few parts? Stable or unstable?

A

Has many parts so unstable and requires fixation

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13
Q

Describe avulsion fracture

A

Fracture caused by excessive pull by a tendon or ligament

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14
Q

Name the 3 types of fractures of 5th metatarsal

A

1) Stress fracture
2) Jones fracture
3) Avulsion fracture

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15
Q

Where does the stress fracture occur?

A

Most distal of the three 5th toe fracture

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16
Q

Where does the Jones fracture occur?

A

At the diaphyseal-metaphyseal junction

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17
Q

Where does the Avulsion fracture occur?

A

At the base of the 5th metatarsal by excessive pull of the peroneus brevis

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18
Q

Which type of 5th metatarsal fracture is most common?

A

Avulsion fracture

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19
Q

Describe a greenstick fracture in children

A

Incomplete fracture of a long bone with cortical disruption on one side – creates a bowing effect

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20
Q

What system is used to classify epiphyseal injuries? How many degrees are there/

A
  • Harris and Salter classification

- 1 through 5

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21
Q

Salter-Harris Type I-What happeens? What does it require? How are the results for healing?

A
  • Epiphyseal slip only
  • Requires casting and sometimes pinning
  • Usually good result unless there is daage to the blood supply
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22
Q

Salter-Harris Type II-What happens? What does it require? How are the results for healing?

A
  • Fracture through epiphyseal plate with part of shaft attached
  • Usually needs fixation
  • Good result for healing
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23
Q

Which Salter-Harris type is most common?

A

Salter-Harris Type II

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24
Q

Salter-Harris Type III-What happens? How are the results for healing?

A
  • Fracture through the epiphysis extending into the plate

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

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25
Salter-Harris III-What can occur prematurely? Why does it occur?
-Could get premature fusion and late deformity because it affects the growth place AND is intraarticular
26
How common is the Salter-Harris Type III fracture?
Rare fracture
27
WHat happens in a Salter-Harris Type IV fracture?
Fracture of the epiphysis and the shaft which crosses the epiphyseal plate
28
What is likely to happen in a salter-harris Type IV fracture?
Likely to have growth deformities because it is an intra articular fracture
29
Salter-harris Type V fracture-What happens?
Damage to the epiphyseal plate, growth plate is crushed
30
Salter-harris Type V fracture-Where does it usually occur?
Usually at the knee or ankle
31
Salter-harris Type V fracture-What is likely too occur?
Deformity likely
32
Premature fusion occurs in which Salter-Harris types?
3 & 4
33
Late deformity occurs in which Salter-Harris types?
Types 3-5
34
Define radiological union
healing at the fracture site
35
When there is radiological union, Name 3 things that occur
Visble callus on radiograph 1) Soft 2) Hard & - Continuity of bone trabeculae across site (bridging)
36
Name the 3 things absent in clinical union
1) Absence of mobility between fracture fragments 2) Absence of tenderness over site on palpation 3) Absence of pain with angulation stress
37
List the average rates of union for UE for callus visible, clinical union, consolidation
1) 2-3 wks 2) 4-6 wks 3) 6-8 wks
38
List the average rates of union for LE for callus visible, clinical union, consolidation
1) 2-3 wks 2) 8-12 wks 3) 12-16 wks
39
Name 6 factors affecting rates of union
1) Age - younger usually heals faster - more bone turnover 2) Type of bone - cortical heals more slowly than cancellous 3) Site - UE often heals faster than LE - bones tend to be smaller 4) Blood supply 5) Apoosition of bone fragments (How close the bone fragments are and how good is the alignment?) 6) Movement between bone fragments (disrupts healing - need good fixation)
40
Name two specific bones that have poor blood supply that have increased healing times
1) Proximal scaphoid | 2) distal shaft of tibia/fibula
41
Name 3 categories for principles of fracture management
1) Reduction 2) Immbolization 3) Preservation of function
42
Fracture management-Reduction-Define
Realignment of the fracture fragments into as close to a normal position as possible
43
Name 2 types of reduction for fracture mangement
1) Closed - non-surgical, casted, or in sling/boot, etc. | 2) Open - surgical and fixed with some device, e.g. ORIF open reduction with internal fixation
44
Name 3 purposes of immobilization after a fracture
1) Prevent displacement or angulation of fragments 2) Prevent movement 3) Relieve pain
45
Name 2 methods of immobilization
1) Cast/Splint/Sling (Passive or active (walking cast) 2) Continuous traction - Bucks traction - Skeletal traction
46
Name 3 types of internal fixation devices
1) Plates and Screws 2) Intermedullary nails or rods 3) Circumferential wires or bands - Tension bands - used where muscles will tend pull fragments apart - e.g. olecranon and patella fractures
47
Name 2 types of external fixation
1) Percutaneous pinning - pins through the skin that are temporary and pulled out when fracture is healed 2) External fixator device - usually when there are numerous fragments or cannot get good fixation internally
48
Define Arthroplasty
Replacement of body part
49
Name two reasons when arthroplasty is used
1) Too deformed or too many pieces to fix | 2) Bone stock too poor to use fixation devices
50
Name 2 types of arthroplasty
1) Total joint arthroplasty - both joint partners are replaced 2) Hemi-arthroplasty - only one joint partner is replaced
51
Name 4 fracture complications
1) Infection! Huge! 2) Non union, delayed union, or mal union 3) Avascular necrosis 4) Injuries to other structures
52
Name a specific type of infection that an occur with a fracture
Post traumatic osteomyelitis Acute -> tends to occur with children Chronic -> more with adults, can occur within weeks to months within an injury
53
Name the 3 problems with union
1) Delayed Union 2) Mal-union 3) Non-union
54
Explain what delayed union is
Longer than expeected for age, site and type of fracture, but no evidence of non-union
55
Explain what mal-union is
Heals with deformity - e.g. shortening
56
Explain what non-union is
- no evidence of healing on 3 CONSECUTIVE RADIOGRAPHS | - often in the presence of abnormal changes at the fracture site - atrophic, hypertrophic, pseudoarthroses
57
What type of fraction will a bone growth stimulator help?
Non-union fracture
58
With a fracture, name 3 other structures that can be injured
1) Major blood vessels 2) Neurological injury 3) Viscera
59
WIth injury to major blood vessels, name 2 things that can occur
1) Ischemia - can lead to bone and other tissue death | 2) Avascular necrosis - death of the bone secondary to lack of blood supply
60
Name 3 common sites of avascular necrosis when dealing with fractures
1) Femoral head 2) Proximal scaphoid 3) Body of talus
61
In neurological injuries, name 2 things that can occur with the nerves
1) Torn/crushed peripheral nerves e.g. radial nerve in humeral spiral groove with humeral shaft fracture 2) Nerve to joints -> Charcot joint (joint injury when there is no sensation or kinsthesia) - Also seen in severe diabetic neuropathy
62
Name 2 viscera that can become injured with a fracture
1) Pelvic organs s/p pelvic fracture | 2) Lungs s/p rib fractures
63
Define Fat Embolism Syndrome
Fat Embolism Syndrome (FES) is a rare but potentially fatal complication of long bone or pelvic fracture. The classic syndrome involves pulmonary, cerebral and cutaneous manifestations and presents 24 hrs to 48 hrs post-injury.
64
What are the incidence rates for FES? Name the % and fracture site
1) 1-3.5% of tibia or fibula | 2) 5-11% bilateral/multiple fracture
65
Name 3 signs/symptoms of FES (generally)
1) Pulmonary 2) Cerebral 3) Cutaneous
66
Name the pulmonary signs/symptoms of FES
Dyspna, basilar crackles - 2-3 days post injuy
67
Name the cerebral signs/symptoms of FES
acute confusional state, can have other focal deficits
68
Name the cutaneous signs/symptoms of FES
petechiae (pinpoint, round spots that appear on the skin as a result of bleeding under the skin) rash - conjuctiva, skinfolds
69
Name 2 categories of joint injuries
1) Acute | 2) Chronic
70
WIth an acute injury of the joint, what are 2 things that can occur?
1) Hemarthrosis - blood in joint | 2) Poor alignment if fracture through joint
71
With a chronic injury of the joint, what is one thing that can occur?
Potential for post-traumatic degenerative joint disease (DJD) - long term effect
72
Name 3 implications of complications for PT and rehab in fractures
1) Monitor and screen for vascular and neurological definicits 2) Longer healing times may require slower rehab progress 3) Consider possiblity of abnormal healing that will affect ultimate recovery

Musculoskeletal PathoPhys (3 decks)

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