Fractures

Question 1

Fracture?

Answer 1

Disrupted continuity of the bone

Question 2

Does the bone have to be broken in order to have a fracture?

Answer 2

No, it can be a small chip or break down he side fo the bone

Question 3

List the classifications.

Answer 3

• cause
• appearance
• location (not where in the skeleton but where on the bone)
• pattern
• type

Question 4

Name 2 type of fractures.

Answer 4

• simple (closed) fracture

- compound (open) fracture

Question 5

Simple (closed) fracture?

Answer 5

closed = integument intact

Question 6

Compound (open) fracture?

Answer 6

open = integument is broken (bone may be protruding out)

Question 7

Types of fractures?

Answer 7

1. greenstick fracture
2. comminuted fracture
3. pathologic fracture
4. segmental
5. butterfly
6. impacted

Question 8

greenstick fracture?

Answer 8

“greenstick” referring to a freshly fallen tree branch/ twig that is difficult to snap because it is flexible. An older twig would be dry and snap very easily. in younger children because the bone is still developing and is very pliable

Question 9

Comminuted fracture?

Answer 9

bone breaks into multiple pieces under excessive force . Multiple breaks at one site; difficult to treat -> pt will most likely need surgery.

Question 10

Segmental fracture?

Answer 10

large bone fragments separate from the main body of the bone

Question 11

Butterfly fracture?

Answer 11

2 oblique fracture lines meeting to create a large triangular or wedge-shaped fragment that resembles a butterfly

Question 12

Impacted fracture?

Answer 12

parts of the broken bone are driven toward or into each other by force (eg. head of the femur driven into the acetabulum on extreme impact)

Question 13

Pathologic fracture?

Answer 13

d/t bone disorder eg. osteoporosis , bone cancer etc (simple things like standing or walking may break the bone)

Question 14

List the patterns.

Answer 14

based on the direction of the fracture line:

1. longitudinal
2. oblique
3. spiral
4. transverse/horizontal

Question 15

Oblique?

Answer 15

usually d/t a twisting force; breaks at 45 degrees.

Question 16

List the appearances.

Answer 16

1. Burst
2. chip
3. displaced

Question 17

Burst?

Answer 17

multiple bone pieces @ break (same as comminuted fracture, but that is the type and burst is the appearance). usually at the end of the bone.

Question 18

Chip?

Answer 18

small fragment of the bone is chipped away near the joint

Question 19

Displaced?

Answer 19

bone separated at fracture line

Question 20

Etiology/patho?

Answer 20

• more force is applied to the bone than it can withstand = force overload
• bone is extremely strong and can handle a great amount of force provided that the force is applied in the same direction that the bone is equipped to handle
• 3 categories:
  1. trauma
  2. fatigue/stress
  3. pathologic

Question 21

example of a fatigue/stress fracture?

Answer 21

someone running a marathon is persistently applying force, the bone previously would have been able to handle this but now that is fatigued it will break

Question 22

Manifestations of fractures?

Answer 22

• pain
• soft tissue injury d/t inflammation
• hemorrhage
• deformity
• loss of function

Question 23

Dx?

Answer 23

• hx, px

- xray

Question 24

Treatment?

Answer 24

• reduce (ensure that the bone is aligned so that it heals properly)
• stabilize (immobile the affected bone to allow the body to do the healing)
• healing will take a long time
• restore function (PT+OT)

Question 25

How long does healing of a fracture take?

Answer 25

Complex and lengthy process that takes 3-6 months but can take longer, up to 2 yrs depending on pt and underlying cause

Question 26

Name the 4 stages that occurring in healing of a fracture.

Answer 26

1. Hematoma and cell proliferation 2. Soft callus formation 3. bony callus formation stage 4. remodelling stage

Question 27

Hematoma?

Answer 27

blood clot; gel-like material that retain bones in proximity to each other

Question 28

Hematoma and cell proliferation stage?

Answer 28

bone is richly vascularized; when you break bone -> vessels are severed and you will have bleeding. -> hematoma (forms bc blood is clotting) and forms within 48-72 hrs. Cellular activity occurs within the hematoma mediated by molecular signalling. Hematoma facilitates the formation of a fibrin mesh that seals off the fracture site an serves as a framework for the influx of inflammatory cells, ingrowth of fibroblasts and development of capillary buds (angiogenesis). Inflammation occurs -> to defend against any microbes entering the break in the skin/bone integrity. Bone necrosis begins d/t ischemia from the severed vessels -> necrotic bone tissue must be removed.

Question 29

What does optimal healing require?

Answer 29

Blood/oxygen/nutrient supply and the ability to remove waste products

Question 30

Soft callus formation?

Answer 30

(appearance of fibrocartilage) New capillaries/vessels forming (angiogenesis) -> forms into granulation tissue. Fibroblasts from the periosteum, endosperm and red bone marrow proliferate and invade the granulation tissues -> produce fibrocartilaginous CT -> cartilage must form before new bone can -> necrotic bone becomes visible in this stage -> bone is still not weight-bearing

Question 31

Bony Callus Formation Stage?

Answer 31

osteogenic cells develop into osteoblasts once new vessels are present in tissue -> form thin projections of spongy bone (referred to as trabeculae). Fibrocartilaginous callus is converted into bony callus (bone is initially deposited on the outer surface of the bone and progresses towards the fracture site until a new bony sheath cover the fibrocartilaginous callus. 3-4 weeks after injury, the bony callus calcifies and is replaced by mature bone

Question 32

How does the remodelling stage differ from the physiologic process of bone remodelling?

Answer 32

The physiologic process of bone remodelling occurs continuously, while this process refers to reshaping the bone and finalizing its form.

Question 33

Remodelling stage?

Answer 33

Osteoclasts remove inessential material, including any remaining necrotic bone and excess material on the outside of the bone shaft and within the medullar cavity. Compact bone replaces spongy bone around the periphery of the fracture. Bone begins to resemble original bone prior to the break. At the end of this stage, the bone will have healed completely.

Question 34

In which stages is the bone weight-bearing?

Answer 34

Only in the remodelling stage