Fractures

Question 1

Types of Fractures (10)

Answer 1

• Closed: doesn’t break the skin
• Open: penetrates the skin (risk for infection-osteomyletis)
• Comminuted: two or more bony fragments have separated
• Non comminuted- bone in two fragments only
• Alvusion: tearing away from the pophysis due to a forceful muscular or ligamentous pull
• Impaction: a portion of bone is driven to its adjacent segment. Subtle radio opaque white line is seen in the region of impaction
• Incomplete: broken down one side leaving a buckling or bending
• Chip: a form of avulsion fracture where a chip of the bone is pulled off
• Pathologic: A # in a bone that has been weakened by a local or systemic disease. Often transverse and appear quite smooth
• Stress: caused by repetitive stress causing gradual formation of micro fractures and eventually an interruption in the bone structure

Question 2

Fracture Orientation (3)

Answer 2

• Oblique
• Spiral
• Transverse

Question 3

Traumatic Articular Lesions (4)

Answer 3

• Subluxation: partial loss of contact
• Dislocation: Complete loss of contact
• Diastasis: Displacement or separation of a slightly movable joint (usually pubic symphysis)
• Chondral and osteochondral: fracture through a joint surface from shearing, rotary or impaction fractures

Question 4

Fracture Repair

Answer 4

1. Circulatory (inflammatory) phase:
   Haematoma and clot forms, Vascular network develops around fracture, Primary callus forms. Osteoclasts clear so that osteoblasts can build the callus
2. Reparative (metabolic) phase:
   bridging of the callus and remodelling.
3. Remodelling (mechanical) phase:
   bone deposition in areas of stress, restoration of medullary cavity and bone marrow

Question 5

Immediate Fracture Complications

Answer 5

• Vascular Injury
• Compartment syndrome (inc. pressure due to oedema or hemorrhage
• Fat embolism
• Thromboembolism

Question 6

Intermediate Fracture Complications

Answer 6

• Osteomyelitis
• Hardware failure
• Re-fracture
• Synostosis
• Delayed Union

Question 7

Delayed Fracture Complications

Answer 7

• Osteonecrosis (avascular necrosis)
• DJD- interarticular fracture damages articular cartilage, frequent in the hip, knee and ankle
• Osteoporosis- when functional weight bearing is delayed
• Malunion- union occurs in the wrong position
• Nonunion- failure to full osseous fusion at fracture site