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NMSKI > Intro to fractures > Flashcards

Intro to fractures Flashcards

1
Q

definition of a fracture

A

A fracture is described as a loss of continuity of the substance of bone
Can range from hairline to comminuted

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2
Q

is there a difference between break and fracture

A

no

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3
Q

How are fractures classified?

A

skin damage
displacement
pattern/shape

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4
Q

skin damage

A

open/compound

closed/simple

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5
Q

displacement

A

displaced

undisplaced

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6
Q

pattern/shape

A

oblique
transverse
spiral

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7
Q

open fracture

A

broken skin
risk of infection
blood loss

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8
Q

closed fracture

A

Skin intact
no communication to site of fracture
Less risk infection
Bleeding is internal

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9
Q

undisplaced fracture

A

Bone ends still in apposition

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10
Q

displaced fracture

A

Bone ends do not meet, reduction necessary

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11
Q

pattern of fracture i

A 
Transverse
Oblique
Spiral
Simple
Comminuted
Compression / crush
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12
Q

pattern of fracture ii

A 
Greenstick
Hairline
Impacted
Avulsion
Articular
Depressed
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13
Q

transverse fracture

A

Fracture at right angle
Obliquity < 30 degrees
Direct or indirect violence

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14
Q

oblique fracture

A

Angle of fracture > 30 degrees

Direct / indirect or torsional force

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15
Q

spiral fracture

A

Line of fracture curves around

Rapid union - large area in contact

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16
Q

comminuted fracture

A

More than 2 fragments
Unstable
Greater violence
+/- butterfly segment

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17
Q

compression/crush

A

on Cancellous bone

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18
Q

impacted fracture

A

One fragment driven into another

Stable, heals quickly

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19
Q

greenstick fracture

A

Bend in immature bone

children

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20
Q

hairline fracture

A

Trauma - fracture without displacement

Stress fracture

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21
Q

avulsion fracture

A

Sudden forceful muscle contraction - high force pulls off portion of bone

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22
Q

intra-articular fracture

A

Articular joint surfaces

May have associated haemarthrosis (bleeding within joint)

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23
Q

depressed fracture

A

Sharply localised blow depresses fragment of cortical bone

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24
Q

causes of fractures

A 
Sudden injury 
Direct trauma 
indirect trauma
Fatigue 
Repeated stresses 
No evidence of disease
Pathological –
Abnormal or diseased bone
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25
Q

2 types of trauma

A

direct violence

indirect violence

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26
Q

direct violence

A

Most common
Stresses exceed limit of strength of bone
Fall on ground
Hit by moving object

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27
Q

indirect violence

A

Twisting or bending stresses

Sports-related
Common in ankle fractures

28
Q

fatigue/stress fracture

A

Repeated minor stresses rather than one specific incident

Pain increases with activity / decreases with rest

29
Q

common sites of fatiure fracture

A

2nd MT, tibia

30
Q

physical examination of fatigue fracture

A

localised bony tenderness / swelling / thickening/unable to WB

31
Q

x ray findings of fatigue fracture

A

may need bone/CT scan
Nothing detectable initially / 2 - 4 weeks changes
+/- faint hairline crack / rarely displaced
Zone of callus formation

32
Q

pathological fracture

A

Fracture occurs in bone weakened by disease

Fractures occurs with trivial trauma or spontaneously

33
Q

causes of pathological fracture

A 
Tumours: Bone is a common secondary site for cancer 
Bone disease (e.g. Osteoporosis)
34
Q

stages of fracture healing

A 
Haematoma
Subperiosteal & endosteal cellular proliferation
Callus
Consolidation
Remodelling
35
Q

initial damage that occurs in fracutre

A

Periosteum - complete or partial tear
Disruption of Haversian systems
Death of adjacent bone cells
+/- Damage to muscle/nerve and blood vessels

36
Q

haematoma

A

Tissue damage & bleeding
Haematoma between & around fracture segments
Haematoma clots

37
Q

Subperiosteal & endosteal cellular proliferation

A

Inflammatory cells appear in haematoma
Proliferation of cells deep surface of periosteum
‘Collar’ of active tissue around fragments
Blood clot ‘pushed aside’
Cellular activity medullary canal

38
Q
  • Callus formation
A 
Maturation cellular tissue
Osteoblast & osteoclast activity
Intracellular matrix laid down
Removal of dead bone
‘Woven bone’ appears: Callus
Palpable as hard mass
Visible on X Rays
39
Q

stage 4 consolidation

A 
Woven bone replaced by lamellar (cortical) bone
Solid union
full bone repair
no movement in fracture site
full function can commence
40
Q

remodelling

A

Newly formed bone remodelled to resemble normal bone

Bone strengthened along lines of stress

41
Q

rate of union - how fast a bone heals in the young

A

Rapid callus formation 2 weeks

Consolidation 4 / 6 weeks

42
Q

rate of union - how fast a bone heals in the adults

A 
Callus 2 weeks
Consolidation 3 months
Occasionally 4 / 5 months long bones
More rapid in slender bones UL vs LL
Cancellous bone quicker
43
Q

condition of bone during initial union

A 
Partial repair of bone
Initial callus around bone ends
Minimal movement at fracture site
May give way easily
Visible fracture line on X- Ray
Immature bone
44
Q

malunion meaning and where is it most common

A

Bone has united soundly but in wrong position.

Common in clavicle fractures

45
Q

non union and what is required to fix the problem

A

Bone ends do not unite and remain separate.

May require bone grafting and internal fixation

46
Q

delayed union

A

Takes longer to unite than normal

But eventually does so

47
Q

factors influencing healing

A 
Type of bone 
Type of fracture
Mobility at fracture site
Blood supply
Separation of bone ends
48
Q

typical findings on clinical examinations

A 
Visible / palpable deformity
Localised swelling
Visible bruising
Marked bony tenderness
Impaired function
49
Q

principles of fracture management

A 
Obtain sound bony union without deformity 
Restore function (work/social/ADLs etc) 
Without risk of complications
50
Q

reduction aim

A

Adequate apposition and alignment of bone fragments

51
Q

closed reduction

A

For minimally displaced fractures - no surgery required
get traction - disengage fragments
+/- Manipulation under anaesthesia (MUA) - reduce risk of infection
Usually immobilised in some form of splint/cast

52
Q

open reduction

A

Requires Surgery for unstable/displaced fractures

+/- Internal or external fixation

53
Q

conservative immobilisation

A

Non-rigid method of support e.g. collar / cuff / brace
Scotch-cast
Continuous traction (rarely used now)
Skin traction or Skeletal traction

54
Q

external fixation

A

Bony fragments held with external device & pins

55
Q

indications of external fixation

A

Severe soft tissue damage
Nerve or blood vessel damage
Pelvic fractures that cannot be internally fixated
Infected fractures

56
Q

ORIF and examples

A

= Open Reduction Internal Fixation

E.g. Pins, plates, screws, wiring, IM - Inter Medullary nails

57
Q

Indications of ORIF

A 
Inherently unstable fracture
Displaced fractures 
# cannot be otherwise controlled 
# of > 1 bone
Pathological with bone disease 
Fractures that unite poorly
58
Q

Advantages of ORIF

A

Likelihood of good reduction and union

Early mobilisation

59
Q

Disadvantages of ORIF

A

Risk of infection

Additional trauma

60
Q

Role of inpatient physio

A 
Post fixation e.g. ORIF
Early mobilisation 
Gentle exercise to maintain 
Gait education/aids 
 education/advice
61
Q

role of outpatient physio

A 
At a later stage 
Once fracture healed or cast removed 
Exercise  e.g.
ROM
Strengthening 
Pain Management
62
Q

physiotherapy during immobilisation e.g. cast

A 
reduce oedema
Maintenance of circulation
Maintain muscle function - active / static contractions
Maintain joint range
Maintain function
63
Q

physiotherapy on removal of fixation/cast

A

Decrease swelling
Regain full ROM
Regain full muscle power
Restore full function e.g hand function (UL)/walking (LL)

64
Q

complications of surgery

A 
Pneumonia
Blood loss -anaemia
Shock
Wound infection
Delirium (Acute confusion)
65
Q

complications of prolonged immobilisation

A

Respiratory tract infections
Urinary tract infections
Risk of pressure areas
Disuse muscle atrophy

66
Q

immobilisation POP precautions

A

wound care
nerve compression
compression of blood vessel
hygience

NMSKI (38 decks)

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