fractures

Question 1

what is the most common bone lesion

Answer 1

fracture

Question 2

what is a fx

a few ways it can be classified

Answer 2

• Most common bone lesion
• Break in continuity of bone–A fracture does not need to involve a break across the entire bone. (he drew what look like little cracks)
• Many classifications—too many for us
o Cause, location, pattern, type

Question 3

what is a simple fx

Answer 3

Simple (closed)—dividing the fx into simple or compound is simple step. The closed or open refers to whether the integument is broken or not. Skin is closed still

Question 4

what is compound fx

Answer 4

• Compound (open)—where the skin is broken

Question 5

terms we learned for classifying by type of fx

Answer 5

greenstick
pathologic
comminuted

Question 6

fractures by pattern

Answer 6

oblique

longitudinal

Question 7

names for fractures by appearance

Answer 7

burst
chip
displaced

Question 8

pt gets fx due to bone disorder like osteopososis what kind of fx is this

Answer 8

pathologic (way of classifying by type)

Question 9

what kind of fx occurs in kids only. why in kids

how do you desribe this

Answer 9

Greenstick—this is a fx that is encountered in kids only
• 1 broken and 1 bent surface
• In children (why?) –in kids bone is still forming and is pliable and flexible, it is less likely to break. The bone in the kid is like a green stick that isn’t dry

Question 10

comminuted fx

which other type can be used to describe this

Answer 10

Comminuted
• multiple breaks at primary site—at the point of break the bone splits into multiple pieces. 1 of difficulties with htis is that other terminology is used for this type

burst

Question 11

oblique fx

Answer 11

• break at approx 45 degrees—
• D/T twisting force– (this is also called a spiral break)
• –this is the least informative type. There must be additional info added to this

Question 12

longitudinal fx

Answer 12

Longitudinal

• Longitudinal break line—up and down along length of bone

Question 13

burst fx

where does this occur

Answer 13

Burst—same as a comminuted fx
• Bone breaks into multiple pieces
• Usually at end of bone

Question 14

where does chip fx usually occur

Answer 14

Chip

• Small fragment near joint—at end of bone

Question 15

displaced fx

Answer 15

Displaced
• Bone separates at fracture line—the pieces move apart but are still aligned. He drew another pic in which the fx pieces were displaced laterally

Question 16

the following types are from a figure 57.1

decribe a segmented fx

impacted fx…where does this usually occur

Answer 16

Segmented there are two break lines with a piece of broken bone in between two fx bone (3 pcs total).

Impacted fx is v serious the head of the femur (in example) the head of femur has dislocated from acetabulum and the force has been so strong that it has pushed the head of the femur into the opposing bone…this can happen anywhere but more often in joint.

Question 17

colles fx how does this gen occur and where

Answer 17

Colles fracture is fx of wris distal part of wristt (more than one of them would most liley break) often occurs when they fall forwards or backwards and catch themselves. Needs to be reduced surgically.

Question 18

potts fx

compression fx

Answer 18

Pott’s fracture is in distal fibula at ankle

Compression fx of vertebra occurs when pt falls and lands on butt

Question 19

et and patho of fx

Answer 19

• Force overload on bone
-• 1=more force than it can withstand
• 2=that additional force that is applied is applied in direction that bone cant withstand

-where stress is applied to bone in the direction that force should be applied o the bone the bone is stronger than concrete. More imp is application of force to bone in direction in which it cant be applied.

Question 20

mnfts of fx

Answer 20

• Pain—quite severe and is major issue
• Deformity—in arthritis the subchondral bone deforms (which is normal). In fx this deformity is not physiologic.
• Loss of function
• Hemorrhage-
• Soft tissue injury—this may be diff to detect.

Question 21

is there always hemorrhage with fx

is this good or bad

Answer 21

Bone is considered to be hard tissue (like cartilage). The soft tissue adjoining the bon is likely to be damaged. The hemmorgahe that you see is likely to be soft tissue. But when a bone breaks there will always be hemmorhaging. Bone is richly vascularised…the severed blood vessels may be lg or sm.

The hemorrhage that occurs with fx is imp requirement of healing process. Just because youd ont see it doesn’t mean there isn’t any hem. Just means that soft tissue isn’t damaged. Particularly if there is closed fx.

Question 22

tx of fx

Answer 22

• Reduction (re align bones)
• Immobilization (healing)—usually involves a cast. Youll have atrophy of the muscle. The atrophy should reverse once cast is off.
• Preserve and restore function—you are NOT healing the fx youre simply putting in place steps to help facilitate healing

Question 23

now stages of healing fx

titles of 4 stages

Answer 23

hematoma
soft callus stage
bony callus stage
remodelling

Question 24

what is a hematoma

how long does hematoma stage last (although the stages are overlapping)

Answer 24

 Hematoma is a blood clot. The initial clot happens within minutes This stage requires 48-72 hrs

Question 25

2 functions of hematoma...where is it

Answer 25

 1=Hematoma prevents further misalignment. (iti is a gel surrounding the whole fx)  2=provides medium for cellular activity/cellular interaction through molecular signalling of WBC, RBC, platelet etc. This process continues throughout (the cell signalling)

Question 26

what occurs in hematoma and sevred area

Answer 26

 There are cap buds appearing at the point of where the vessel is severed. This will give rise to blood vessels (angiogenesis) angiogenesis doesn’t begin at this stage but the mech are put in place for it  The fibrin serves several imp purposes • It tends to seal the fx site (with the mesh) • It is source of inflm cells (inflm is part of healing process) • It is framework/medium for dev of new vessels

Question 27

is the bone wt bearing in soft callus stage what occurs

Answer 27

not yet wt bearing  During this stage the hematoma is replaced by cartilage (fibroblasts deposit fibrocartilage at site of break. )  There is now angiogenesis (from cap buds). In order for this to occur you need granulation tissue.  During this time the bone isn’t wt bearing (the glue hasn’t hardened yet)  There is broken blood vesselischemianecrosis. If there is necrotic bone you need to remove it and form new bone

Question 28

what ocurs in bony callus stage

Answer 28

 where bone begins to form  there are proliferating osteogeneic cells (osteoblasts) and trabeculae of forming bone  ossification is occurring. The bone that forms here is SPONGY...in ossificationt he bone turns to spongy before compact bone.

Question 29

what occurs in remodelling stage

Answer 29

 the spongy bone now becomes compact bone (like in ossification)  the break is now completely repaired. This bone now becomes wt bearing  there was necrosis of bone in preceding stages which cant remain, there was multitude of healing cells/inflm cells and need to leave or be removed. The remodelling speaks of *reshshaping the bone and the break back to what it was. Youre removing extraneous material*  with any fx it is rare to achieve the reg shape of the bone. In majority of cases the bone will work as before, but, if healing inappropriate and its not aligned then youll see deformity