Language Of Fractures Flashcards
(101 cards)
1
Q
Both cortices of bone have been fractured
A
Complete Fx
2
Q
Only 1 cortex has been fractured
A
Incomplete Fx
3
Q
What is an open fx?
A
Fx site communicates with the outside environment
4
Q
Skin and soft tissues overlying the fx are intact
A
Closed Fx
5
Q
A fx that has more than 2 fragments?
A
Comminuted
6
Q
What are the directions of fracture lines?
A
Transverse
Oblique
Spiral
NOTE: the steeper the angle the more unstable the fx
7
Q
Fracture line is perpendicular to the cortical bone or long axis?
A
Transverse fx
8
Q
Fracture line runs obliquely to the cortical bone or long axis?
A
oblique fx
9
Q
Caused by torsional force that encircles the shaft of the long bone?
A
Spiral fx
10
Q
What are some descriptive terms of fractures?
A
Distraction Impaction Compression Avulsion Segmental
11
Q
Opposing ends of fx fragments are kept apart?
A
Distraction
12
Q
One fragment is forcibly driven or telescoped into an adjacent fragment, or kept pressed against each other?
A
Impaction
13
Q
A form of impaction, where a flat surface of one bone forces the adjacent flat surface to compress (i.e. vertebral body)
A
Compression
14
Q
Fragments of bone are pulled away from their original position by soft tissue attachments (usually tendon or ligament) causing displacement of the fx fragment?
A
Avulsion
15
Q
What are some examples of avulsion fractures?
A
Mallet Finger
5th metatarsal fx
Sigone Fx (lateral plateau of knee)?
16
Q
Fx of long bone at different levels creating at least 3 distinct segments?
A
Segmental
17
Q
What is position?
A
Relationship of fragments to their normal anatomical structure
18
Q
What is displacement?
A
Loss of position
19
Q
Alignment
A
Relationship of the longitudinal axis of one fragment to another
20
Q
What is angulation
A
Result of mal-alignment
21
Q
NOTE
A
Use anatomical description to describe displacement and angulation (Volar, dorsal, medial, lateral)
22
Q
NOTE
A
For position and alignment describe the distal fragment in relation to the proximal segment
23
Q
What is a pathologic fracture?
A
Fracture that occurs through abnormal or weakened bone
24
Q
What are the causes of pathologic fractures?
A
- Local bony changes secondary to infection, benign or malignant tumors, diffuse osteopenia, or systemic disease such as osteogenesis
- Stress fracture
25
What is a stress fracture?
Fracture resulting from repeated micro-trauma to otherwise normal bone (March fx, Tibia fx)
26
What are some clinical features of fractures? 5
1. Pain & tenderness: Subjective, variable, may be only sx
2. Loss of function: 2˚ to pain or loss of structural integrity
3. Deformity: 2˚ to swelling, loss of tissue integrity, angulation, displacement of fx
4. Abnormal mobility or crepitus
5. Neurovascular injury: May exist without fx-Examine & document with any injury
27
What is the test of choice for dx of fx?
Radiographs
28
What is the minimum number of x-rays needed for fx dx?
Minimum of 2 views
90˚ apart (AP/Lateral)
Consider stress views/comparison views (pediatric elbow fx)
29
When would a CT scan be used for fx dx?
When x-ray is negative, but fx still suspected
CT allows cross-sectional imaging from a series of x-ray beams. The x-ray tube is rotated 360˚ around the pt, and the computer converts it into a 2 dimensional axial image
30
What 3 planes is the CT capable of imaging in?
Coronal, Sagital, Oblique
31
What is CT particularly useful in?
Very useful in evaluating fx and bone tumors
32
What is a Bone Scan?
| What will the lesion look like?
Radioisotope technique indicative of blood flow and thereby of bone formation and destruction.
Lesion will show increased uptake of radioisotope and appear as a dark area in the bone.
NOTE: sensitive but not always specific. Helps if high probability dx prior to study
33
What are bone scans used to identify?
Lesions such as fx, infections, or tumor
| Also used to assess for prosthetic loosening
34
What is an Arthrogram?
Technique of injecting contrast material into the joint to evaluate joint capsule and articular surface integrity. Radiologist uses fluoroscopy or ultrasound to guide needle placement into the joint.
35
When is an arthrogram useful?
Shoulders and hips to assess the labrum
| Wrists to show any tear of small ligaments
36
What is an MRI?
Uses radio frequency in the presence of high magnetic field to produce high quality images of the body in any plane.
37
When is MRI useful?
Dx soft tissue injuries, tumors, stress fractures, and infection
Hip fx not showing on x-ray
38
What are the 4 terms related to fracture union?
1. Delayed Union
2. Nonunion
3. Pseudoarthrosis
4. Malunion
39
Fracture fails to unite in the expected time for healing. Fracture repair is occurring just slowly
Delayed Union
40
Failure of fracture fragments to unite with processes of bone repair having ceased
Non union
41
"False-joint"
Pseudoarthrosis
42
When may pseudoarthrosis occur?
In a nonunion, when fragments are connected by dense fibrous tissue which allows motion
43
What is a malunion?
Fracture has healed in less than optimal position (angulatory or rotary deformity)
44
What are the stages of Fracture Healing? 5
1. Periosteal/endosteal bleeding
2. Hematoma formation
3. Maturation of hematoma/ infiltration of osteoblasts and fibroblasts
4. Formation of periosteal new bone and callous creation of vessels, progressive mineralization of new bone
5. Remodeling
45
What are the objectives of fracture mgmt?
1. Restore function
2. Achieve bony union
3. Minimize or prevent deformity
46
What are the closed treatment options?
1. Reduction: Positioning the fx fragments back into anatomical position
2. Immobilization: Holds the position of the fx whether it needed reduction or not
47
What are some complications of immobilization? 3
Tissue atrophy
Arthrofibrosis (joint stiffness)
Dermal Irritation
48
What are some examples of immobilization options?
Fiberglass/plaster casts
Braces
Splints
49
What is a closed reduction? Describe process.
Procedure performed under local, regional, or general anesthetic.
Fx reduced then appropriate immobilization applied
50
How are open fractures treated?
Open (operative) treatment
1. Plates/screws/pins (stainless steel, titanium, cobalt chrome)
2. Wire/cable (same material as above)
3. External fixation (stainless steel)
4. Intra-medulary nail/rod (stainless, titanium)
5. Bioabsorbable screws/pins (poly-lactic acid derivatives)
51
What are the indications for open (operative) treatment
Unstable fx not held by closed measures
When immobilization is impractical
Neurovascular compromise (depends on severity)
52
What are 4 main fracture complications?
1. Neurovascular injury/shock
2. Compartment Syndrome
3. Infection
4. Malunion, Delayed Union, Non-union
53
What can neuromuscular injury/shock cause?
* Significant blood loss to induce shock, which can lead to death
* Severe dysfunction of extremities and vital organ functions
* Severe vessel injury may require vascular repair or amputation
54
What is compartment syndrome?
Increased inter-compartmental pressure caused by tissue injury, bleeding, etc.
Compartment pressure> capillary pressure=ischemia
55
If left untreated what does compartment syndrome result in?
Tissue ischemia and eventual tissue necrosis
| Occurs within 4-8 hrs
56
How does compartment syndrome present? 4
1. Pain disproportionate to injury
2. Pain with passive motion
3. Tense muscle compartment
4. May have numbness, tingling
57
What Sx of compartment syndrome is a very late finding?
Pulselessness
| Primary arterial injury should be 1st suspected and emergently treated if pulseless limb is identified
58
How is compartment syndrome dx?
Clinical dx but if unsure, document compartment pressure measurements
Measured using a pressure needle (>30 mmHg or the difference b/t DBP and compartment pressure <30)
59
How is compartment syndrome treated?
Urgent Fasciotomy
60
When is an infection more likely and what other disease can develop from this?
2˚ to open fx
| May have significant soft tissue infx or develop osteomyelitis
61
How are a malunion, delayed union, and a nonunion corrected?
Often requires bone grafting procedure or bone stimulation to aid in healing or to correct deformity or dysfunction from malalignment
62
How are Pediatric Epiphyseal Fractures Classified?
Salter/Harris Classification of Epiphyseal Fractures
| There are 5 types (I, II, III, IV, V)
63
Type I
```
S=Straight
Complete separation from metaphysis
Non-displaced
Usually only immobilization is needed
Good prognosis
```
64
Type II
```
A=Above
Transverses physis, exits into metaphysis
Thurston-Holland Fragment
Most Common of all Physeal Fx
Patient usually 10 or older
Good Prognosis
```
65
Type III
L=Lower
Intra-articular, transverses physis, exits into epiphysis
Less common than I, II
Anatomic reduction Critical
Growth arrest, healing usually not a problem
66
Type IV
T-Through
Fracture line crosses physis, extends into both metaphysics, epiphysis
Usually requires surgery for anatomical reduction
May use bioabsorbable or metal fixation devices
67
Type V
```
R=Ram
Sever crush injury to physis
May be dismissed as sprain
Growth arrest common, poor prognosis
Often difficult to differentiate b/t type I
```
68
What is the most common of all physeal fractures?
Type II
69
What is another name for a Type II epiphyseal fx?
Thurston-Holland Fragment
70
This type of epiphyseal fx has complete separation from metaphysis?
Type I
71
The fracture line crosses physis, extends into both metaphysis and epiphysis
Type IV
72
This type of epiphyseal fx results from a severe crush injury to physis
Type V
73
This type of epiphyseal fx may be dismissed as a sprain?
Type V
74
Which type of epiphyseal fx has a poor prognosis and growth arrest is common?
Type V
75
This type of epiphyseal fx is intra-articular, transverses physis, and exits into epiphysis?
Type III
76
In which type of epiphysis fx is anatomic reduction critical?
Type III it's critical
| Type IV usually requires surgery for anatomical reduction
77
In which type of epiphyseal fx may bioabsorbable metal fixation devices be used?
Type IV
78
What 2 types of epiphyseal fx are often difficult to differentiate?
Type I and V
79
Which types of epiphyseal fxs have a good prognosis?
Type I, II, III (growth arrest, healing usually not a problem)
80
What are the general treatment principles of epiphyseal fractures?
Reduce Early
Reduce adequately
Strive for anatomic reduction
81
What should be done if pt presents late with a Type I-III epiphyseal fx?
Consider leaving it alone
allow it to heal
Fx deformity with osteotomy later
82
What should be done if pt presents late with a Type III-V
Late Open Reduction and Internal Fixation (ORIF) is better than allowing to develop a deformed joint
83
T/F Most epiphyseal fxs result in growth disturbance
False only 5-10% result in any growth disturbance
84
What x-rays are helpful in the dx of epiphyseal fxs?
Stress films and/or comparison view are often helpful
85
When should follow up radiographs be done in epiphyseal fxs?
6 mo and possible 1 yr
| Comparison films may again be helpful
86
What are some other common pediatric fractures?
Torus or Buckle Fx
Supracondylar Elbow Fx
Greenstick Fx
87
Which fat pad is always pathologic? Anterior or Posterior?
Posterior
88
What are some characteristics of a non-accidental skeletal trauma in a child?
1. Must have Clinical Suspicion
2. Unusual Behavior
3. Inconsistent Hx
4. Multiple fractures and different stages of healing
5. Specific Fracture Patterns
6. Family Stress Fratures
85% of fx under age 3 are non-accidental
89
What is a Galeazzi fx?
Displaced fx of the distal radius with dislocation or fx of the distal ulna
OR
Fx of the distal ulnar physis
90
What is a Monteggia Fx?
Fx of the proximal ulna and dislocation of the radial head
91
What is a Segond Fx?
Avulsion fx of the knee, lateral tibial plateau
92
What are 75% of Segond fxs associated with
ACL ruptures
93
What is a Jones Fx?
Base of 5th metatarsal (MT) in zone 2
94
What is a Boxer's Fx?
5 metacarpal (MC) neck fx
95
What is a torus fx?
Least complicated
| has buckling of cortex on one side only
96
What is a Greenstick fx?
Has disrupted cortex on one side, with intact or buckled cortex on the other side
97
Which type of fx discussed so far is the most complicated?
Galeazzi fx
98
Where is the most common location for fxs in children?
Distal 1/3 of forearm
99
What is a Colles Fx?
Distal end of radius fx and angulated dorsally aka Fork Fx (the wrist tilts upward)
Extension fx of radius
Usually from fall on outstretched wrist
100
What is a Smith Fx?
Reverse Colles Fx distal end of radius fx angulated toward volar surface
Flexion fx of radius
101
What site is the most common site for fx in adults?
Fracture of the distal radius
