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Musculoskeletal pathophysiology > Fractures cards > Flashcards

Fractures cards Flashcards

1
Q

Signs & Sx of Fx

A

Visible or palpable deformity
Pain, tenderness
Ecchymosis or visible bruising
Functional impairment

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2
Q

Fx classification systems

A

Etiology
Open vs. closed
Pattern of fx

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3
Q

Fx Etiology

A

Trauma
Stress or fatigue
Pathological fx

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4
Q

Trauma

A

Direct or indirect force

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5
Q

Stress or Fatigue

A

2º abnormal or repetitive forces on normal bone
“March Fx”
Often don’t show radiologically right away, after it starts to recede.

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6
Q

Pathological fx

A

Normal foce on an abnormal or weakened bone 2º CA, osteoarthritis, Paget’s disease, etc.

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7
Q

Closed Fx

A

No communication external to body

Surgery might not be necessary

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8
Q

Open Fx

A

Communication with fx site and surface of skin
Concern re: infection, need antibiotics
Prophylaxis for tetanus

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9
Q

Fx Patterns

A 
Complete
   * Transverse
   * Oblique
   * Avulsion
   * Spiral
   * Comminuted
Incomplete
   * Greenstick
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10
Q

Transverse Fx

A

at right angle to la long portion o f the bone.

Usually 2º to direct trauma

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11
Q

Oblique Fx

A

Rarer
Only in 1 plane
Often unstable, must be fixed

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12
Q

Avulsion Fx

A

Fx caused by excessive pull by a tendon or ligament.

Muscle-tendon pulls off part of bone

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13
Q

Spiral Fx

A

3 dimensional
unstable, needs fixation.
2º twisting injury.
Looks like corkscrew on long axis.

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14
Q

Comminuted Fx

A

many pieces, unstable, fixation

Usually 2º significant trauma

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15
Q

Greenstick (children)

A

Cortical disruption on one side; bowing effect

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16
Q

Fx’s of 5th Metatarsal

A 
Stress Fx
   * Most distal of the 3 5th toe fx’s
Jones Fx
   * At diaphyseal-metaphyseal junction
Avulsion Fx
   * At base of 5th metatarsal by excessive pull of peron Brevis, most common
17
Q

How many categories in the Harris & Salter epiphyseal injury classification system?

A

Five

18
Q

Harris & Salter I

A

Epiphyseal slip only

  • Requires casting, sometimes pinning
  • Usually good results unless vascular damage
  • Ex. Slipped Capital Femoral Epiphysis (SCFE – “sciffee”)
19
Q

Harris & Salter II

A

Fx through epiphyseal plate with triangle of shaft attached

  • Most common type
  • Usually needs fixation, but good results
20
Q

Harris & Salter III

A

Fx through the epiphysis extending into epiphyseal plate

  • Rare
  • Outlook good only if blood supply is intact and it is not displaced
  • Could get premature fusion and late deformity because it affects the growth plate AND is intra- articular
21
Q

Harris & Salter IV

A

Fx of epiphysis and shaft, crossing the epiphyseal plate

  • Fx of epiphysis, metaphysis through growth plate
  • Needs surgical stabilization and joint realignment
  • Likely to have growth deformities, is an intra articular fx
22
Q

Harris & Salter V

A

Damage to epiphyseal plate

  • Growth plate crushed
  • Deformity likely
  • Usually at knee or ankle
23
Q

Complications of physeal injuries

A
  • Premature fusion – types III and IV
  • Late deformity: III - V
    • Limb shortening
    • Abnormal joint alignment
24
Q

Signs & Sx of Radiological Union

A
  • Visible callus on radiograph
    * Soft hard
  • Continuity of bone trabeculae across site (bridgine)
  • Blunting → Widening → Callus → Bridging, Incorporation → Remodelling
25
Q

Signs & Sx of Clinical Union

A

Absence of mobility between fx fragments
Absence of tenderness with palpation
Absence of pain with angulation stress

26
Q

Rates of union affected by

A

Age
Type of bone (cortical < cancellous)
Site (LE < UE)
Blood supply
Apposition: How close, and well aligned, are bone fragments?
Movement betw fragments: disrupts healing

27
Q

Reduction

A

Realignment of fx fragments into as close to normal position as possible
Closed: non-surgical, casted or in sling/boot
Open: surgical and fixed with some device (e.g. ORIF)

28
Q

Immobilization

A

Prevents displacement, angulation, movement. Relieves pain.

Methods: Cast, splint, sling, Continuous traction

29
Q

Internal Fixation devices

A
  • Plates and screws
    • Dynamic/compression
      • In hip, sliding screw can prevent penetration of acetabulum
  • Intermedullary nails or rods
  • Circumferential wires or bands
    * Tension bands: used where muscles will tend to pull fragments apart (e.g. olecranon and patella fx’s)
30
Q

External fixation

A

Percutaneous pinning: through skin, pulled out when Fx is healed.
External fixator device: used when there are numerous fragments, or cannot fixate internally

31
Q

Arthroplasty

A

Replacement of body part

  • Used when:
    • Too deformed, too many pieces to fix
    • Bone stock too poor for fixation devices
  • Types:
    • Total joint arthroplasty – both joint partners are replaced
    • Hemi-arthroplasty – only one joint partner is replaced (Austin-Moore femoral prosthesis)
32
Q

Post traumatic osteomyelitis

A

infection of bone and marrow

Hard to get rid of, prevention is best

33
Q

Non union

A

no evidence of healing with 3 consecutive radiographs
Often with abnormal changes at Fx site (atrophic, hypertrophic, pseudoarthroses- movement, must break)
Bone growth stimulators via electric stimulation

34
Q

Delayed union

A

taking longer than expected to heal

35
Q

Mal union

A

heals with deformity

36
Q

Avascular necrosis

A

death of bone 2º to lack of blood supply

37
Q

Charcot joint

A

joint injury w/ no sensation or kinesthesia

38
Q

Fat Embolism Syndrome (FES)

A

Rare, but potentially fatal from long or pelvic bone Fx.

Involve pulmonary, cerebral & cutaneous manifestations 1-2 days s/p Fx.

39
Q

Joint Injuries

A

Acute
* Hemarthrosis: blood in joint
* Poor alignment if Fx through joint
Chronic
* Potential for post-traumatic Degenerative Joint Disease (DJD) – long term effect

Musculoskeletal pathophysiology (3 decks)

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