Fractures, bone healing and imaging of MSK / Flashcards
Fractures vs break
They are the same thing
Fracture is a break in the continuity of the cortex of the bone
What are the different types of fracture due to cause?
Traumatic
Pathological e.g. cancer
Atypical e.g. ligaments breaking bone off
Physeal e.g. unfused bones in kids
Iatrogenic e.g. due to surgery
Peri-prosthetic e.g. around a prosthesis - knee replacement
How may fractures be treated?
Try to leave to heal by themselves e.g use a sling - majority treated without surgery
Internal fixation - intramedullary nailing
External fixation
What is the aim to achieve when treating a fracture?
Pain relief
Restore anatomy: length, alignment, rotation
Retain anatomy while bone unite
Rehabilitate the joint
What are the classifications of fractures, and how are they caused?
Spiral fractures (torsion)
Oblique/transverse (bending)
Transverse (avulsion)
Crush (compression)
What are the two main types of hip fractures?
Intracapsular: fractures within the joint capsule
Extracapsular: fractures distal to the joint capsule
What are the phases of fracture healing?
Haematoma formation: inflammatory or granulation phase
Soft callus formation: proliferative phase
Hard callus formation: maturing or modelling phase
Remodelling phase
What are the two forms of bone healing?
Direct/primary bone healing - in perfect anatomical position
- No motion at fracture site
- No callus formation
Indirect/secondary bone healing
- Motion at fracture site
- Callus formation (bridging periosteal soft callus, medullary hard callus re-establish structural conitnuity
- Osteons traverse the gap
- Endochondral ossification
What are the stages in the healing cascade? what time scales, what features?
Inflammation 0-5 days
- Haematoma, necrotic material, phagocytosis
Repair 5-42 days
- Granulation tissue, acid environment, periosteum-osteogenic cells, cortical osteoclasis
Late repair:
- Fibrous tissue replaced by cartilage, endochondral ossification, periosteal healing > membranous ossification
Regeneration and remodelling:
- Replacement of callus, continued osteoclasis, mechanical strain
What significance does timing have on fracture treatment?
Immediate ‘debridement’ - removal of dead tissue/foreign body if
- Gross contamination (agricultural, marine, sewage
- Compartment syndrome
- Avascular limb
- Multi injured patient
What can’t xrays tell us?
Soft tissue injury
Subtle fractures
Type or grade of malignancies
How should radiographs be taken if there is a fractured bone?
Obtain two views
Evaluation of two adjacent joints to injured bone
Obtain radiograph of unaffected limb for children for comparison
Consider further imaging - CT/MRI - for occult fractures or soft tissue injury
What are the different types of fracture?
Spiral
Oblique
Transverse
Complex
Wedge
Impacted
Displaced
Open/compound
How should an x-ray be explained?
Whose is it?
What the view is
What does it show e.g. fracture/arthritis
Type of fracture’
Where is the fracture
Intraarticular/extra articular
Displaced or not displaced
What are direct signs of a fracture on xray?
Subtle lucent or sclerotic lines through bone, deformity or separated fragements
