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NMSK1 - physio 1 > intro to fractures > Flashcards

intro to fractures Flashcards

1
Q

what is a fracture?

A

loss of continuity of the substance of bone

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2
Q

what are the different types of fractures?

A
  • open / compound fractures
  • closed/ simple fractures
    -undisplaced fractures
    -displaced fractures
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3
Q

compare complete vs incomplete fracture

A

complete fracture - fracture extends all the way across the bone and breaks it into 2 or more pieces
incomplete fracture - fracture does not involve all the way through and only involves a portion of the bone

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4
Q

what is an open or compound fracture?

A

when the fracture is protruding into the skin, this is common in certain areas of the body when you have less skin coverage and less adipose tissue eg the tibia

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5
Q

what risks can happen as a result of open or compound fractures?

A

as the skin is open, there is more risk for infection and also blood loss

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6
Q

what is a closed or simple fracture?

A

-when the bone does not protrude the skin - ie the skin is intact
- as the skin isn’t broken, there is less risk of infection and bleeding is internal

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7
Q

what is an undisplaced fracture?

A

there is a fracture- but the 2 ends of the bone still remain in alignment - requires conservative treatment rather than surgical

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8
Q

what is a displaced fracture?

A

a fracture where the bone ends do not meet and realignment through surgery (called reduction) is required

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9
Q

what is a traverse fracture?

A

fracture that occurs at a right angle - ie the bone is broken perpendicular to its length (straight line that runs in opposite direction to the bone)

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10
Q

what is an oblique fracture?

A

when the fracture occurs at an angle that is greater than 30 degrees

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11
Q

what is a spiral fracture?

A

-when the line of the fracture curves around
-bone is broken in a twisting motion

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12
Q

what is a comminuted fracture?

A

a fracture involving 3 or more fragments
very unstable
may contain butterfly segment

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13
Q

what is a compression/crush fracture? and give example of where in the body this can happen

A

a fracture involving cancellous or spongy bone eg the vertebrae

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14
Q

what is an impacted fracture?

A

-when one fragment one bone is driven into another
-stable fracture and heals quickly

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15
Q

what is a greenstick fracture?

A

a bend in an immature bone eg in children

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16
Q

what is a hairline fracture?

A

-a fracture without displacement
-caused by trauma

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17
Q

what is an avulsion fracture?

A

-when a bone fragment isn pulled away from its main body by muscle that is attached to it

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18
Q

what is an intra-articular fracture?

A

-a fracture within a joint
-may have bleeding within the joint

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19
Q

what is bleeding within the joint called?

A

haemarthrosis

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20
Q

what is a depressed fracture?

A

Sharp localised blow depresses fragment of cortical bone

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21
Q

how is a bone injured?

A
  • sudden injury
    -fatigue
    -pathological
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22
Q

what is direct trauma?

A

when the stresses exceed the limit of strength of bone
eg falling on the ground or being hit by a moving object

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23
Q

what is indirect trauma?

A

twisting or bending stresses, eg may be sport related

24
Q

what is a fatigue or stress fracture?

A

-repeated minor stresses
-pain increases with activity and decrease with rest
localised bony tenderness, swelling and thickening

25
Q

where are examples of common sites of a stress fracture?

A

tibia and metatarsals (on foot)

26
Q

what imaging is useful for detecting a stress fracture?

A
  • often not visible on x ray initially, but can show healing and callous formation
    -MRI is very good for showing bony oedema
27
Q

what is a pathological fracture?

A

fracture that occurs as a result of bone weakening by disease
eg osteoporosis, cancer

28
Q

what are the 2 main components that bone is composed of?

A
  • cellular component
    -extra cellular matter
29
Q

what are osteoblasts?

A

bone forming cells

30
Q

what are osteoclasts?

A

primary bone re-absorbing cells

31
Q

what are osteocytes?

A

highly specialised cells which maintain the bony matrix

32
Q

what is primary bone healing?

A

the bony fragments are fixed together through reduction fixation- there is no formation of a callus

33
Q

what is secondary bone healing?

A

-occurs when there is slight movement at the fracture site, there is formation of a callus and subsequent remodelling takes place
- braces, bridging plates, IM nailing - non rigid fixation modalities are used

34
Q

what are the 4 stages of bone healing?

A

1- haematoma formation
2- granulation tissue formation
3- bony callous formation
4- bone remodelling

35
Q

what does haematoma formation in bone healing involve?

A
  • blood vessels are disrupted when the fracture occurs, then there is a formation of a haematoma at the fracture site
  • this haematoma clots and forms the temporary frame for subsequent healing
36
Q

what does the granulation tissue formation stage of bone healing involve?

A
  • inflammatory cells appear in haematoma
    -proliferation of cells in the deep surface of the periosteum
    -angiogenesis occurs - ie the development of new blood vessels
37
Q

what does the bony callous formation stage of bone healing involve?

A
  • involves osteoblast and osteoclast activity
    the intracellular matrix is laid down
    -dead bone is removed
  • hard callous forms - weaker than normal bone but is able to withstand forces
38
Q

what does the remodelling phase involve?

A
  • longest phase
    woven bone is replaced by lamellar bone
  • the newly formed bone is remodelled to resemble normal bone
39
Q

what is the union of bone?

A

-the partial repair of bone
- there is minimal movement at the fracture site
-may give way easily

40
Q

what is consolidation of bone?

A

-full repair of bone
-no movement at fracture site
- full function

41
Q

what is the malunion of bone?

A

when the bone has united but in the wrong position

42
Q

what is non-union of bone?

A

when the bone ends do not unite and remain separate (may require internal fixation)

43
Q

what is delayed union of bone?

A

when the bone takes longer to unite than normal, but eventually does so

44
Q

what are examples of factors that influence healing?

A
  • type of bone involved
    -type of fracture
    -mobility at fracture site
    -blood supply
    -age
    -infection
    -nutrition
45
Q

what are the main principles of fracture management ?

A
  • obtain bony union (bone repair) without deformity
    -restore function
    -prevent falls
  • address bone health
46
Q

Describe the symptoms of the clinical examination of fracture

A

-palpable and visible deformity
-localised swelling
-visible bruising
-impaired function
-marked bony tenderness

47
Q

what are the 3 stages in fracture management?

A

1- reduction - manipulation of bone to correct anatomical position
2- immobilisation - holding bond in correct reduced position
3- rehab - return to full function post trauma

48
Q

what is the external fixation method?

A

when the bony fragments are held with external device and pins

49
Q

what are the indications that external fixation is needed?

A
  • severe soft tissue damage
    -nerve or blood vessel damage
    -pelvic fractures that can’t be internal fixated
    -infected fractures
50
Q

what does ORIF stand for?

A

Open reduction internal fixation
eg with pins, plates, screws

51
Q

what are the indications that ORIF is necessary?

A
  • unstable fracture
    -displaced fractures
    -the fracture cannot be otherwise controlled
  • fractures that unite poorly
52
Q

what are the advantages of ORIF?

A
  • good reduction and union
    -early mobilisation
53
Q

what are the disadvantages of ORIF?

A
  • risk of infection
    -additional trauma
54
Q

what is the role of a physio with inpatient fractures?

A
  • swelling management
    -gentle exercise
    -gait education
    -safety
    -education/advice
55
Q

what is the role of a physio with outpatient fractures?

A
  • at a later stage
    -once fracture is healed or cast is removed
    -exercise - strengthening, ROM etc
    -manual therapy as indicate
    -aim to return to function
56
Q

what are examples of urgent complications of fractures?

A
  • visceral injury]
    -vascular injury
    infection
    -compartment syndrome (pressure of muscles builds up which can decrease blood flow)
57
Q

what are the complications of prolonged immobilisation? eg bed rest

A
  • resp tract infections
    -UTI’s
    -risk of pressure areas
    -muscle atrophy from disuse

NMSK1 - physio 1 (36 decks)

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