1
Q
Fracture healing stages
A
- Tissue damage and haematoma formation
- Inflammation and cellular proliferation
- Callus (woven bone) formation
- Consolidation
- Remodelling
1
Q
Stage 1 - Tissue damage and haematoma formation
A
- Haematoma is immediate result of fracture
- Blood vessels are damaged and bleeding occurs between ends of fractured bone
- An area of avascular necrotic bone results
- The size of the haematoma influences the rate of healing
2
Q
Stage 2 - Inflammation and cellular proliferation
A
- Up to 2 weeks post fracture
- Acute inflammatory reaction - within 8 hours of fracture occurring
- Osteoclasts remove the necrotic bone
- Osteoblasts begin to lay down a matric of collagen which bridges the fracture site, providing a scaffolding on which new bone can be laid and new bone formation can take place
- The clotted haematoma is slowly absorbed and fine new capillaries grow into the area
3
Q
Stage 3 - Callus (woven bone) formation
A
- 2 to 4 weeks post fracture
- Callus formation starts at approximately 2 weeks post fracture
- Main bolus of callus is formed at about 4 weeks - when fracture may be ‘united’
- Callus does not increase in size but undergoes substantial reorganisation, gradually increases stability
4
Q
Stage 4 - Consolidation
A
- 8 weeks post fracture
- Transformation of callus into lamellar bone
- Osteoclasts migrate through debris at the fracture line and resorb the callus
- Osteoblasts lay down new bone in the gaps behind them
5
Q
Stage 5 - Remodelling
A
- 2 months to 2 years post fracture
- Continuous process of bone resorption and formation which occurs at a relatively rapid rate
- Thicker lamellae are laid down where the stresses are high
- Unwanted bone is resorbed and the medullary canal is reformed as the bone approximates its normal shape
6
Q
Fracture classification
A
- Skin damage
- Displacement
- Shape or line
- Anatomical location
7
Q
Skin damage
A
- Open (compound) - broken bone contacts skin surface
- Closed (simple) - overlying tissues intact
8
Q
Displacement
A
- Undisplaced - both ends still in apposition, although clear break
- Displaced - both ends do not meet (direction of displacement)
- Impacted - both ends have been firmly stunted together, forming stable but shortened bone
- Stable - both ends held firmly
9
Q
Shape or line
A
- Transverse - fracture line is 90 degrees to longitudinal axis
- Oblique - fracture line is usually angled by 30 to 45 degrees to longitudinal axis
- Spiral - fracture line is oblique and encircles portion of shaft
- Comminuted - multiple bone fragments
- Compression/crush - cancellous bone is compacted
- Greenstick - bend in immature bone with break in one of cortices
10
Q
Anatomical location
A
- Left or right
- Proximal, middle, distal
- Bone involved
11
Q
Other fraction descriptions
A
- Avulsion fractures - produced by a sudden contraction of a muscle or overstretching of a ligament which pulls off a portion of bone which it is attached to (e.g. lesser trochanter - iliopsoas)
- Specific name - ‘non-generic’ fracture terms, advanced fracture classifications (e.g. Colle’s fracture of radius)
- Pathological fractures - associated with an underlying disease process which has resulted in weak bone and a resultant fracture (e.g. osteoporosis - femoral neck fracture)
- Stress or fatigue fracture - disruption in cortex of bone over time, repeated stress weakens bone and causes pain (e.g. tibial stress fracture)
12
Q
General complications of fractures
A
- Shock
- Infection
- Gas gangrene
- Respiratory conditions
- Thrombo-embolic complications
- Metabolic response to trauma (rhabdomyolosis)
- Crush syndrome
- Pressure areas
- Falls
13
Q
Local early complications of fractures
A
- Vascular complications
- Neural complications
- Necrosis
- Joint complications
- Visceral
14
Q
Late local complications of fractures
A
- Union
- Avascular necrosis
- Myotosis ossificans
- Joint complications
15
Q
Orthopaedic fracture management
A
- Conservative management - auto-fixation, traction, casting/bracing
- Surgical management - open reduction internal fixation, external fixation
16
Q
Auto-fixation
A
- When fractures immobilise themselves and require no additional fixation
- Example - clavicle fracture, where sling is preferred fixation
17
Q
Casting/bracing
A
- Plaster of paris, fibreglass casts, thermoplastic splinting, and removable splints can be used to immobilise fractures not requiring surgical fixation
- Fracture should be anatomically reduced and the cast should immobilise the fracture site whilst allowing other joints not related to move freely
- Example - radius fracture
18
Q
Traction
A
- Maintains bone fragments in anatomical alignment while healing occurs
- Primarily used for cervical spine and lower limb fractures
19
Q
Open reduction internal fixation (ORIF)
A
- Broad term used to describe surgical fixation using pins, nails, wires, plates, or screws
20
Q
External fixation
A
- Indication - soft tissue damage associated with some fractures that prevents immobilisation by casting and ORIF
21
Q
Role of physiotherapy systems management
A
- Respiratory and circulatory systems
- Circulation exercises
- Musculoskeletal maintenance exercises
- Neurovascular observations
22
Q
Respiratory and circulatory systems
A
Assessment immediately postoperatively with appropriate exercises initiated until the patient is returning to their previous mobility level
22
Q
Circulation exercises
A
Routine circulation exercises are static exercises (glutes, quads, foot, ankle) repeated in large volumes initially and reducing as mobility improves
23
Musculoskeletal maintenance exercises
For unaffected joints and muscles which are issued where appropriate
24
Neurovascular observation
Include peripheral light touch and capillary refill at the nail bed, and should be regularly checked for patients fitted with a cast
PS1002
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