Fractures

Question 1

what are common consequences of fracture injuries?

Answer 1

(Low Mortality, High Morbidity)
Physical Suffering
Mental Distress
Loss of Time

Question 2

why are fractures more likely to happen to the elderly?

Answer 2

Decreasing coordination causes falls

Weakened bones more susceptible to injuries

Question 3

what is the OT definition for fracture?

Answer 3

A severe soft tissue injury with an underlying bony defect

Question 4

what is direct trauma?

Answer 4

bone fractures at the point of contact (application) of the force

i.e. fracture of femur at point of contact with moving car

Question 5

what is indirect trauma?

Answer 5

bone fractures at a distance from point of contact (application) of the force

i.e. fracture of clavicle from fall on outstretched hand

Question 6

what are ways that bone pathology can cause fracture?

Answer 6

1. Pathological fx. caused by disease of bone
2. Pathological fx. caused by metastasis of a tumor
3. Force is not sufficient to break normal bone but weakened bone is susceptible to even slight stress

Question 7

if there is no evidence that force was applied to fracture a bone, what should be investigated?

Answer 7

1) did the fracture occur through normal or abnormal bone

2) is there normal or decreased amount of bone present

Question 8

what are stress fractures?

Answer 8

Bone is subjected to repetitive forces
very common and easy to tx
not life threatening

Question 9

what are common sites of stress fracture?

Answer 9

Tibia**
Metatarsals
Navicular
Femur
Fibula
Calcaneus

Question 10

what are common causes of stress fxs?

Answer 10

Training errors (too much, often, soon, fast)
Equipment errors (shoe support important)
Other factors (bone health, nutritional intake, collagen disorders)

Question 11

what are different sites (anatomical location) for fractures?

Answer 11

Diaphysis, metaphysis, epiphysis, intra-articular, fracture dislocation

Upper, middle, lower

Question 12

what are the levels of extent for fractures?

Answer 12

Complete: one side of bone to other
Incomplete: one side remains intact

Question 13

what is an example of incomplete fx? who do they affect?

Answer 13

Greenstick, Buckle, Crack

Usually in children due to “softer” nature of bone
Bone “bends” on one side, breaks on the other

Question 14

what is configuration?

Answer 14

pattern of fx on x-ray

Question 15

what is transverse configuration?

Answer 15

one side to bone to the other

Direct trauma

Question 16

what is oblique configuration?

Answer 16

lies oblique on bone

Indirect trauma

Question 17

what is spiral configuration?

Answer 17

bone is twisted on long axis

Indirect trauma

Question 18

what is comminuted configuration?

Answer 18

more than 1 fx. line, more than 2 fragments

Indirect or direct

Question 19

what is impacted configuration?

Answer 19

fragments are driven into each other, remain locked

direct trauma

Question 20

what is crush configuration?

Answer 20

usually involves cancellous bone from
direct or indirect trauma
(i.e. calcaneum from landing on heels from height)

Question 21

what is avulsion configuration?

Answer 21

excessive stress applied to tendon or ligament that, as it rips off bone, pulls off piece of bone

Question 22

what are relationships of fx fragments to each other?

Answer 22

Non-displaced vs. Displaced

Question 23

what are types of displaced fxs?

Answer 23

Angulation
Rotated
Partial displacement
Overlap/overriding

Question 24

what are the 3 factors that affect fx stability?

Answer 24

1. Direction of line of fx. 
  Stable: transverse, greenstick. Impacted
  Unstable: spiral, oblique, comminuted
2. Forces applied by muscle pull
3. Integrity of ligaments

Question 25

what are the Relationships of fx. fragments to their external environment?

Answer 25

closed (skin intact) vs. open

Question 26

what can cause an open fx?

Answer 26

Fx. Fragment has penetrated skin from within Sharp object has penetrated skin to fx. bone from without

Question 27

what are fx complication classification?

Answer 27

Un-complicated (immobilized, short rehab) Complicated (Local, systemic)

Question 28

what is primary fx shock?

Answer 28

occurs immediately Vaso-constricting nerves are inhibited Peripheral blood vessels dilate, BP drops, pt. becomes pale, faint Spontaneous recovery in few mins

Question 29

what is secondary fx shock?

Answer 29

brought on by hemorrhage common in long bone fxs. Reduction of blood volume Skin pale, cold, moist, heart beats faster Recovery with blood transfusion

Question 30

what are fx associated injuries?

Answer 30

1. ischemia 2. visceral injuries 3. joints 4. nerves 5. muscles

Question 31

what are 4 signs of ischemia?

Answer 31

Temperature | 4 “Ps”: paresthesia, pallor, pain, paralysis

Question 32

how do visceral injuries after fx occur?

Answer 32

fractured bone goes into organ | Bladder, spleen, pleurae

Question 33

what are the symptoms of fracture?

Answer 33

``` Tenderness/pain over bone Swelling Deformity (Visible, Palpable) Loss of function Visible bruising ```

Question 34

how does rate of healing vary?

Answer 34

Rate varies by age (quicker in children) | Cancellous heals faster then cortical bone

Question 35

what are some requirements for fx healing?

Answer 35

Slight movement at fx. Site | Uninterrupted blood supply

Question 36

what is stage 1 of healing?

Answer 36

Hematoma forms Bone ends bleed Periosteum is stripped, varies in length Surrounding soft tissue may be damaged

Question 37

what is stage 2 of healing?

Answer 37

Acute inflammation Cell division Cell proliferation seen within periosteum

Question 38

what is stage 3 of healing?

Answer 38

Callus formation Dead bone is reabsorbed Immature woven bone is laid down

Question 39

what is stage 4 of healing?

Answer 39

bony callus formation

Question 40

what is stage 5 of healing?

Answer 40

Remodeling Medullary cavity restored Bone returns to normal shape

Question 41

what are the 3 principles of tx of fx?

Answer 41

1. reduction of fx 2. immobilization 3. rehab

Question 42

how do you immobilize the healing fx?

Answer 42

maintain position of fx fragment Prevent movement across fx site Joint above & below usually immobilized

Question 43

what is reduction?

Answer 43

restore bone parts to normal alignment

Question 44

what is the difference btwn closed and open reduction?

Answer 44

Closed = Manual manipulation, no surgery (Held with cast, splint, sling, fracture brace) Open = surgery when fracture cant be held together by other means (after Failed closed reduction, To avoid long bed rest)

Question 45

what is the difference btwn external and internal methods of immobilization?

Answer 45

External Methods (Plaster/fiberglass cast, Traction, External fixation) Internal Methods (Plates, screws, Intramedullary rods, K-wires)

Question 46

what are methods of open reduction?

Answer 46

Open reduction internal fixation (ORIF) External fixation Combination Joint arthroplasty

Question 47

what does exercise promote?

Answer 47

edema absorption

Question 48

what does exercise prevent?

Answer 48

Org. of blood clots Loss of elasticity of muscle Formation of unnecessary scar in muscle

Question 49

what does exercise maintain?

Answer 49

Movements in joints not immobilized Strength by isometric exercise circulation

Question 50

what are different types of orthopedic technologies that help with bone healing and growth?

Answer 50

Continuous Passive Motion (CPM) Electrical Bone Growth Stimulator Limb Lengthening (Illizoroff Technique)