Bone Morphogenic Proteins - Cytokines and metabologens which induce bone and cartilage development - Can be produced with recombinant DNA technology to treat spinal fusions and fracture non-union

Fractures Flashcards by Sare Bear

What inflammatory mediators are released following a fracture?

Interleukins 1 and 6 (attract inflammatory cells)
BMP and FGF (cell differentiation and proliferation)
IFF-2 and TGF-B (lay down collagen matrix)

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Where are the inflammatory mediators released from?

PLatelets

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Describe the process of fracture healing

Periosteal tear causes bleeding and a haematoma formation
Fibroblasts enter and capillaries sprout into the haematoma
Cytokine release causes granulation tissue to form
Granulation tissue develops into a callus (adding type 2 collagen)
Continued microfractures increase the size of the callus
Callus is replaced by lamellar bone by osteoblasts and clasts

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What factors help with remodelling of the callus?

Osteoclasts

Movement of surrounding tendons and muscles

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Give some factors which affect bone healing

Smoking
NSAIDS
Age
Hormones
Functional activity (movement aids osteogenesis)
Nerve function
Nutrition (Vit D deficiency)
Local blood supply (periosteal stripping)
Degree of immobilisation (more movement means greater blood supply)
Local pathology

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Define bone non-union

The permanent failure of healing following a broken bone

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What are the different types of non-union?

Hypertrophic non-union

Atrophic non-union

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Describe hypertrophic non-unopn

Callus forms but bony ends do not join together

- treat by rigidly immobilising fracture

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Describe atrophic non-union

Callus does not form

improve fixation
expose raw ends of bone
bone grafts

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How can ultrasound be used in bone healing?

Causes micro-mechanical stress fractures which helps to induce callus formation

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What are BMPs?

Bone Morphogenic Proteins

Cytokines and metabologens which induce bone and cartilage development
Can be produced with recombinant DNA technology to treat spinal fusions and fracture non-union

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Define a fracture

A discontinuity in the bone cortex

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Describe a transverse fracture

At riht angle to shaft

Due to side force

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Describe an oblique fracture

At an oblique angle to shaft

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Describe a spiral fracture

Curving or twisting along the bone

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Describe a butterfly fracture

One fragment in the shape of a butterfly wing

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Describe a comminuted fracture

More than two fragments

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Describe an impacted fracture

One fragment has been driven into the other

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Describe displaced fractures

The bone ends shift in relation to each other

Is described in relation to the distal fragment

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What are the main symptoms of fractures?

Pain
Deformity
Decreased movement

When do you use the Salter-Harris classification?

Fractures that occur through the growth plate in children

Describe the components of the Salter Harris Classification

SALTRA
1 = S = Straight across the physis
2 = A = above the physis
3 = L = lower than the physis
4 = T = through the metaphysis, physis and epiphysis
5 = R = rammed physis which ahs been crushed
6 = A = avulsion of physis by ligament

Give your initial management for a fracture

ABCDE
Control haemmorhage w/ pressure and splinting
Fluid resuscitation
Pain control
Immobilisation
Cover with sterile dressing

What would you assess when sassessing a fracture?

Mechanism of injury
Blood supply (colour, tempt, cap refill, pulses)
Nerve supply
- movement, sensation
Soft tissue injury
- open wounds, swelling, tenderness
Bone injury
- deformity, crepitus
Movement
- active movement will be decreased with pain
- passive allows assessment of joint stability

What x-rays do you need to get for a fracture?

Two views at rigth angles to each other | Joint above and joint below

What are the radiographical signs of a fracture?

Soft tissue swelling Lipohaemarthrosis Loss of continuity of cortex Angulation of the bone

What are the signs which indicate the severity of a fracture?

``` Damage to soft tissues Impairment of circulation to distal limb Compartment syndrome Comminution Wide displacement ```

How much blood can be lost from certain fractures?

``` Pelvis = 5L Humerus = 1L Femur = 2L ```

When would you operate on fractures?

Open fractures | Displaced intra-articular fractures

Give an example of percutaneous fixation

K-wires | - are driven into the bone through the skin in order to reduce fractures and hold fragments together

Give an example of internal fixation

Plates and screw | - allows for early mobilisation

What is important to emphasize to patients if htey have a fracture?

Mobilisation is important as there is an increase in the flow of synovial fluid, therefore the cartilage receives more nutrients.

Give some life threatening complications of fractures

Haemmorhage - pelvi fractures especially Arterial injury Crush injury - release of breakdown products (Ca2+, K+, myoglobin) Treat with alkaline diuresis

Give some lib threatening complications

``` Open fractures Dislocation Vascular injury Compartment syndrome Neurological injury Intra-articular fractures - risk of subluxation or dislocation ```

Give some late complication of fractures

``` Non-union Mal-union Avascular necrosis Traumatic arthropathy Growth disturbance Contractures e.g. Volkmann's ischaemic contractures ```

Describe what happens in greenstick fractures

Children with flexible bones | Bone bends but the cortex only breaks on one side, causing an incomplete fracture

Describe a Colles fracture

Distal radius fracture Get dorsal angulation Get dorsal and radial displacement (dinnerfork) Commonly due to FOOSH Can get an associated ulnar styloid fracture

Describe a Smiths fracture

Distal radius fracture Volar Angulation and displacement Fall on flexed hand More unstable than Colles as flexors are stronger

Describe a scaphoid fracture

FOOSH | Tenderness in anatomical snuff box - put in scaphoid cast and xray at one week

Give some complication that can occur with scaphoid fractures

- Avascular necrosis of the proximal part of the scaphoid - palmar carpal artery - Non-union or delayed union - Reduced grip strength and reduced range of motion

What metacarpals tend to be fractured in punch injuries?

5th metacarpal

Which metacarpals tend to be fractures in boxers?

1st and 2nd metacarpals

Describe a Bennet's fracture

Fall to teh thumb which causes a fracture subluxation of the metocarpalphalangeal joint Need manipulation and plaster or internal fixation

What must you ensure when assessing a fractured phalanx?

Make sure there is no rotational deformity | Splint it to the adjacent finger

Management and complications for a surgical neck of humerus fracture

Needs fixation Risk of avascular necrosis and fracture dislocation Sling Hemiarthroplasty if necrosis occurs

What must you check in humeral fractures?

Integrity of the radial nerve as it runs posteriorly in the radial groove - Triceps extension - Wrist extension Manage with traction and hanging cast May need an intramedullary nail

How will someone present with a fractured neck of femur?

Shortened and externally rotated leg

What treatment would you given an elderly patient who had a fractured NOF and why?

Hemiarthroplasty | Risk of avascular necrosis