Lab: Fracture Flashcards by Hannah Brule

What are the organic to inorganic ratios for the following?
Children:
Adults:
Elderly:

Children: 1:1
Adults: 1:4
Elderly: 1:7

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More organic material means more ___

elasticity

children have more elastic bones

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Less organic material means less ___

elasticity

increased risk of fracture

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What is elasticity?

Ability of bone to bend and return shape

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What is the term for bone’s ability to bend and return shape?

Elasticity

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What is plasticity?

Yield point surpassed; permanent deformity without fracture

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stress strain curve

What is yield point?

Permanent physical changes begin

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stress strain curve

What is the term for the point where permanent physical changes begin?

Yield point

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stress strain curve

What is the ultimate yield point?

Point of failure/fracture

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stress strain curve

What is the term for the point of failure/fracture?

Ultimate yield point

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stress strain curve

What types of fractures are more common in children because of these differences in elasticity and plasticity?

Salter-Harris (fracture of growth plate)
Greenstick
Torus

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View:
Anatomy:
Mature/immature:

View: AP ankle
Anatomy: tibia and fibula
Mature/immature: mature

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What notes can be made about the bone in this ankle?

Black areas in bone; cortical disruption (fracture) and necrosis

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What stage of fracture repair is shown in this ankle specimen?

Inflammatory stage (necrosis is present)

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What cellular events occur during the inflammatory phase of fracture repair shown in this ankle specimen?

Blood vessel rupture
Hematoma fills gap
Periosteum tears
Necrosis
Fibrin mesh develops
Procallus

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View:
Anatomy:
Mature/immature:

View: AP diaphysis of long bone
Anatomy: diaphysis
Mature/immature: unknown (growth plate not visualized)

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What observations can be made about the bone in this specimen?

Complete closed fracture through diaphysis

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What stage of fracture repair is shown in this long bone?

Reparative stage (rounding of broken edges)

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What cellular events occur during the reparative stage of fracture repair shown in this long bone?

Osteoclasts and macrophages clean up debris
Extensive neovascularization/angiogenesis
Callus formation (chondrocytes)
Significant osteoblastic activity

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View:
Anatomy:
Mature/immature:

View: lateral ulna
Anatomy: proximal ulna, olecranon, diaphysis, metaphysis
Mature/immature: mature

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What notes can be made about this ulna?

Dilated mid diaphysis

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What stage of fracture repair is shown in this ulna?

Remodeling stage (callus has sealed bone and bone has adjusted strength and shape)

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What cells are involved in the remodeling stage of fracture shown in this ulna?

Osteoblasts, osteocytes, and osteoclasts

Anatomy:

Anatomy: clavicle, head of humerus, scapula, sternum

What stage of fracture repair is shown?

Redomeling stage

What has not occured in this fracture repair to lead to pseudoarthrosis?

No formation of procallus; non-union fracture led to pseudojoint

What terminology describes the outcome of fracture in this image?

Pseudoarthrosis

What cellular changes or events explain this pseudoarthrosis?

Lack of debris clean up by osteoclasts and mononuclear cells

View: Anatomy: Mature/immature:

View: medial oblique forearm (left), lateral forearm (right) Anatomy: radius, ulna (accounted for but broken) Mature/immature: mature

Is this lesion local or systemic?

Local

What notes can be made about the alignment in this forearm?

Medial superior dislocation of proximal radioulnar joint (ulna) and lateral superior dislocation of proximal radiohumeral joint (radius)

What notes can be made about the bones of this forearm?

Complete open fracture of proximal ulnar diaphysis

What notes can be made about the connective tissue and soft tissue in this forearm?

Whiter (radiodense) soft tissue

What stage of fracture repair is shown in this forearm?

Inflammatory stage; radiopacity in soft tissue can be debris or hemorrhage with swelling

What cellular events would explain the radiographic findings in this forearm?

Neutrophils and macrophages present

What specific names apply to this type of fracture?

Complete, transverse, open, noncomminuted

View: Anatomy: Mature/immature:

View: AP foot (left), medial oblique foot (right) Anatomy: accounted for Mature/immature: mature

Is this foot lesion local or systemic?

Local

What can be noted about the aligment of this foot? What about connective and soft tissue?

Bunion Connective and soft tissue are normal

What notes can be made about the bones in this foot?

Cloudy, hazy patch around 3rd metatarsal

What stage of fracture repair is shown in this foot?

Reparative stage | callus forming

What cellular events would explain the radiographic findings in this foot?

* Osteoclasts and mononuclear cells cleaning up debris * PMNs present * Neovascularization/angiogenesis * Osteoblastic activity * Chondrocytes making callus | reparative stage of fracture repair

What specific names apply to this type of foot fracture?

March fracture (fatigue stress fracture), closed fracture

View: Anatomy: Mature/immature:

View: AP knee Anatomy: accounted for, no patella yet Mature/immature: immature/young

Is this knee lesion local or systemic?

Local

What can be noted about the alignment of this knee? What about connective and soft tissue?

Normal alignment Soft tissue swelling that is radiopaque

What stage of fracture repair is shown in this knee?

Inflammatory stage | hematoma visible, blood vessels ruptured

What cellular events would explain your radiographic findings in this knee?

PMNs/neutrophils and macrophages present with necrosis | inflammatory stage of fracture repair

What specific names apply to this type of knee fracture?

Salter-Harris fracture A (type II) (A for above) Complete, open, noncomminuted fracture

A 71 year-old woman reported to the emergency room with pain in her hip and thigh after stumbling while in the grocery store. The patient had a previous history of breast cancer that was treated and went into remission 40 years prior. She has also been receiving drug therapy for high blood pressure for the past 8 years. This is her radiograph. How would you treat this patient?

Passive care and reference to orthopedic

View: Anatomy: Alignment:

View: AP pelvis Anatomy: all present Alignment: antalgic lean, superior lateral femur in relation to acetabulum

What notes can be made about the bones in this radiograph?

Thinning of cortical bone, fracture of femoral neck, radiolucent medullary cavity | osteoporosis

Additional tests confirm that this patient suffered from osteoporosis Given this information, what type of fracture is this?

Pathological insufficiency (stress) fracture due to diseased bone

View: Anatomy: Alignment:

View: AP pelvis Anatomy: all present Alignment: normal

What is another name for a fracture that isn't initially visible radiographically?

Occult fracture