Intro and Fracture Lecture

Question 1

What are the three primary influences affecting the remodeling process of bones?

Answer 1

1) mechanical stress
2) calcium and phosphate levels in extracellular fluid
3) hormones (parathyroid hormone, calcitonin, vitamin D, cortisol, growth hormone etc)

Question 2

What is a traumatic fracture?

Answer 2

a fracture that happens by sudden impact (commonly transverse, oblique, and spiral)

Question 3

In the general population, where do traumatic fractures in the upper extremity most often occur? (which bone(s)

Answer 3

radius and/ulna

Question 4

Which age group is most effected by accidental falls at home that result in traumatic fx?

Answer 4

5 to 14 years

Question 5

What is a stress fracture? Where in the body do they most commonly occur (what bones)?

Answer 5

a partial break (reaction) or complete break (fracture) caused by bone’s inability to withstand stress applied in rhythmic, repeated, microtraumatic fashion
- most common in the tibial shaft and metatarsal bones

Question 6

What are the risk factors of a stress fracture?

Answer 6

• female (because of valgus hips, hormones, and nutrition)
• abrupt increase in intensity of training

Question 7

What are the two types of stress fractures?

Answer 7

• compressive
• distractive

Question 8

What is an insufficiency fracture?

Answer 8

• occurs if normal stress is applied to abnormal bone (bone has deficient elastic resistance or weakened by decreased mineralization)

Question 9

List two possible reasons for reduced bone integrity (there are more than 2 fyi)

Answer 9

• metabolic bone disease (hyperparathyroidism, osteomalacia)
• corticosteroid-induced osteoporosis

Question 10

Out of transverse, oblique / spiral, comminuted, and butterfly fractures which has the worst prognosis? Are these fractures complete or incomplete fractures?

Answer 10

• comminuted fractures have the worst prognosis
• complete fractures (meaning they go all the way through the bone)

Question 11

What is a comminuted fracture?

Answer 11

when a bone breaks into more than 2 fragments

Question 12

What is a butterfly fracture? (think of the wing)

Answer 12

when a curved chunk is taken out the side (shaped like a wing)

Question 13

What is a greenstick fracture? Complete or incomplete fx?

Answer 13

when the bone is bent enough to crack one side, but not snap it completely (incomplete fx); think about trying to break a young green twig vs an older drier tree branch

Question 14

What is a torus (or buckle) fracture? Complete or incomplete fx?

Answer 14

when the bone bulges outwards; incomplete fx

Question 15

What is an articular fracture?

Answer 15

a fracture that occurs on or near the joint line; described by the course of the fracture line

Question 16

Only _______% to ________% of people who sustain a vertebral compression fracture develop symptoms severe enough to seek medical help

Answer 16

20 to 25

Question 17

When does bone mass reach its maximum size and density?

Answer 17

age 30

Question 18

Do men or women lose bone mass sooner in age?

Answer 18

women lose bone mass sooner

Question 19

Which of the following is NOT a risk factor for fractures?
A) prostate cancer
B) coronary artery disease
C) residence in a long term care facility
D) advanced age
E) trauma
F) alcohol and/or substance abuse

Answer 19

B) coronary artery disease

Question 20

What are the 5 stages in fracture healing?

Answer 20

1) hematoma
2) cellular proliferation
3) callus formation
4) ossification
5) consolidation and remodeling

Question 21

How long after a fracture is there continuity of the external callus?

Answer 21

6 weeks

Question 22

What happens during the initial 6-12 hours of getting a fracture? (healing phases)

Answer 22

inflammation and clotting

Question 23

How long after obtaining a fracture does it take for there to be remodeling of the medullary canal and organized lamellar bone?

Answer 23

4 months to 1 year

Question 24

Which of the following does NOT hinder proper fracture healing?
A) height
B) presence of foreign bodies, infection, or necrotic tissue
C) inadequate blood supply
D) poor general nutritional status
E) corticosteroid therapy

Answer 24

A) height

Question 25

True or false: In the presence of a fatigue fracture (stress reaction), active movement is typically painless

Answer 25

true

Question 26

True or false: vertebral compression fractures are often extremely painful for patients

Answer 26

false; VCF's are often painless

Question 27

Upon examination, how is the pain usually reproduced in someone with a vertebral compression fx?

Answer 27

pushing on the spinous process of the vertebrae where the fracture is

Question 28

What position or action tends to makes the pain worse in someone with a vertebral compression fx?

Answer 28

pain tends to be postural so spinal extension or even standing up straight

Question 29

If a bone heals with a malunion what does that mean? (break down the word)

Answer 29

if the bone heals in an unsatisfactory position (misaligned); may result in residual bone deformity

Question 30

What is the risk factor for developing a fat embolism?

Answer 30

fracture of long bones and bony pelvis because they have the most marrow

Question 31

What is a fat embolism?

Answer 31

A fat embolism is when a piece of fat from the bone marrow or subcutaneous tissue at the site goes into the lungs and disrupts breathing

Question 32

What is arthrodesis?

Answer 32

joint fusion

Question 33

T/F: Stress fx's are complicated to treat and require patients to continue activity to increase bone strength

Answer 33

false; stress fx are uncomplicated to treat and can be managed by rest and restriction from activity

Question 34

Vertebroplasty and kyphoplasty are two minimally invasive procedures for vertebral compression fractures. What do they do in each of these procedures?

Answer 34

_-vertebroplasty: insert bone cement into vertebrae - kyphoplasty: insert balloon to expand collapsed vertebrae followed by bone cement

Question 35

During the usual period of immobilization that occurs after a fracture, what is taking place inside the body?

Answer 35

removal of necrotic bone and initial formation of fibrocartilaginous callus (soft callus)

Question 36

Where does an allogenic bone graft come from?

Answer 36

from a donor (bone bank)

Question 37

Which bones do autogenous bone grafts most often come from?

Answer 37

iliac crust or fibula

Question 38

In general, fractures in children heal in _____ to ______ weeks

Answer 38

4 to 6 weeks

Question 39

In general, fractures in adolescents heal in _____ to ______ weeks

Answer 39

6 to 8 weeks

Question 40

In general, fractures in adults heal in _____ to ______ weeks

Answer 40

10 to 18 weeks

Question 41

T/F: Mortality after a fracture is higher among men than women

Answer 41

true

Question 42

Less than _____% of older adults with a hip fracture will regain their prior level of function, with approximately half experiencing at least one fall in the year after their fracture.

Answer 42

50%

Question 43

Why are NSAID's a negative predictor for healing?

Answer 43

because they are an anti-inflammatory medication

Question 44

If you are a treating a patient for a fracture in their femur and they start experiencing dyspnea and chest pain, pallor, or a rash on the anterior chest wall (or neck, axillae, or shoulders) you must call the physician because they could possibly have a.....................

Answer 44

fat embolism

Question 45

Other than a fat embolism, what are two other reasons a physical therapist should contact a fracture patients physician?

Answer 45

- compartment syndrome (swelling contained within a closed soft tissue compartment) - skin changes, burning, paresthesia, diminished reflexes