MS1: Fractures Flashcards
1
Q
what is a fracture
A
break in continuity of bone or cartilage na mag aaffect sa function and strength nila
2
Q
possible causes for fractures
A
TRAUMA
acquired disease - osteoporosis, tumors
congenital disease - osteogenesis imperfecta
3
Q
what is pathologic fracture
A
fracture due to pre-existing bine disease
tumors, cyst, osteoporosis, osteomyelitis
4
Q
what is stress fracture
A
fracture due to repeated loading and weak muscles support
BONE FATIGUE
5
Q
how do we describe fractures
A
open or closed
complete or incomplete
pattern
displacement
location
bone involved
side involved
modifiers
6
Q
what are closed fractures
A
intact skin and mucus membranes
BASTA DI NAG BREAK yuNG SKIN
7
Q
what are open fractures
A
OPEN SKIN - NAEXPOSE SA ENVIRONMENT
8
Q
debridement and irrigation of open fractures should be done within
A
within 8 hrs tas need mag antibiotics
9
Q
what are complete fractures
A
tlagang into 2 or more pieces
both cortices are disrupted
10
Q
what are incomplete fractures
A
cortex is not totally disrupted
11
Q
where in the population does incomplete fracture usually happen
A
children
12
Q
what are kinds of incomplete fractures
A
greenstick - parang tangkay fracture of cortex pero may naka kabit pa
torus - buckling of cortex; nabend tas nag crack medj
bowing - pre greenstick; mag ccurve yung bone
13
Q
pattern of fracture due to tension
A
transverse
14
Q
pattern of fracture due to compression
A
oblique
15
Q
pattern of fracture due to bending
A
comminuted or butterfly
16
Q
pattern of fracture due to torsion
A
spiral
17
Q
diifer comminuted and segmented fracture
A
comminuted - > 2 fragments; bc of rapid and excessive loading
segmental - 4 point bending
18
Q
how is the displacement of a fragment named
A
based in the direction of the distal fragment;
ant, post, med, lat or rotation
19
Q
name of fracture location if on metaphysis
A
proximal or distal
20
Q
name of fracture location if on diaphysis
A
into thirds
upper third, middle third, lower third
21
Q
name of fracture location if on specific parts
A
pwede din kung like sa femoral neck, tibial plateu, lateral epicondyle ganun
22
Q
mechanism of stress fracture
A
NORMAL BONE under continued overuse until failure occurs
23
Q
mechanism of pathologic fracture
A
PATHOLOGICALLY WEAKENED BONE under normal use
24
Q
what are modifiers
A
if there is presence of dislocation
25
difference between displacement and dislocation
displacement - refers to fractured bone segment kung sa napunta
dislocation - if bone goes out of normal joint position ganun
26
what is the optimal condition for fracture healing
adequate vascular supply
minimal necrosis
good reduction
immobilization
physiologic stress - wolf's law
absence of infection
27
most important factor for fracture healing
blood supply
28
response of bone blood flow to fracture
initially mag ddecrease sa fracture site
tas mag ppeak at 2 wks - 1-3x normal
return to normal at 3-5 months
29
when does blood flow peak in fracture healing
2 wks
30
when does blood flow return to normal in fracture healing
3-5 months
31
what are the stages of fracture healing
inflammation - hematoma
repair
- soft callus
- hard callus
remodelling - lamellar bone
32
what happens in the inflammation stage
mga macrophages, growth factors and mesenchymal stem cells iinvade site tas mag cclot
33
what replaces the clot in the inflammation stage
reparative fibrovascular granulation tissue
34
when does primary callus occur
within 2 wks
35
what happens in the soft callus stage
osteoblasts from inner cambium ng uninjured laydown primitive osteoid
nodules of cartilage from cartilaginous tissue around fracture site
36
how much WB in soft callus stage
25% of body weight muna until kaya mag FWB
37
what happens in hard callus stage
enchondral ossification begins - soft callus becomes hard callus
osteoid mineralize sa medullary cana
bridgins callus in fracture site is formed
FWB na
38
what happens in remodeling stage
firm continuity is formed via mature callus tas normal na force transmission
39
how does bone remodel
callus follows along stress dictated lines tas dun mag osteoblast/clast activity
40
internal variables that affect healing
blood supply
head injury that affects pituitary gland can inc
41
mechanical variables that affect healing
affectation of soft tissue
local injury
bone loss
pattern
42
what fracture patter takes longest to heal
comminuted and segmental tas inc chance of non union due to dec blood supply
43
external variables that affect healing
low intensity pulse ultrasound - inc vascularity and strength of callus
COX2 - enzyme promotes healing - inc stem cells - inc osteoblast
high dose radiation - remodelling long term
bone sim - direct current, pulse EMF
44
patient factors that affect fracture healing
low vit D and calcium = non union
diabetes mellitus - 1.6x longer remodeling
nicotine - 79% longer; inhibits growth of new bv and weak callus
infection (HIV) - fragility fracture due to poor blood supp, effect of meds and poor nutrition
45
how does bisphosphonate affect fracture healing
can cause osteoporotiv fractures
46
how does steroids affect fracture healing
weakens muscles and ligs
47
how does NSAID affect fracture healing
if COX2 inhibitor
48
how does quinolones affect fracture healing
toxic to chondrocytes
49
3 types of deformity associated w fractures
angulation
shortening
rotation
50
gold standard of imaging
xray
ct scan pag complex
mri kung may ligament damage
51
what are the 3 phases of management of fractures
fracture reduction
maintenance of reduction
preservation and restoration of function
52
most common from of reduction
manipulation
53
advantages of closed reduction
uses natural repair process
few complications
54
disadvantages of closed reduction
more difficult to perform
slight angulation and rotation commonly occur
55
indications of open reduction
failure of closed reduction
articular fractures bc need accurate reduction
unstable fractures
unite poorly
pathologic - trauma
polytrauma
56
most common method of maintaining reduction
external fixation -
57
type of EF effective where bones are superficial
casts - pag deep kase like femur gagalaw sa dami ng muscles
58
type of EF for comminuted, open fractures nd soft tissue injury
pins, bars and rods
59
used for fractures not adequately immobilized by casts
traction
60
how does traction work
muscles act as internal splint to protect fracture
61
disadvantage of traction
requires patient to be in bed
62
identify if skin or bone traction
applied by means of adhesive or rubber strips and elastic bandage
skin traction
63
identify if skin or bone traction
not more than 5-6 lbs bc causes maceration of skin
skin traction
64
identify if skin or bone traction
bucks and russels traction
skin traction
65
identify if skin or bone traction
wire/pin is drilled through bone
bone traction
66
identify if skin or bone traction
higher forces 20-30 lbs
bone traction
67
identify if skin or bone traction
can be applied to distal areas like ankle
bone traction
68
when is IF used
when other methods of maintaining is unreloable
69
advantage of IF
direct visualization of fracture = anatomic reduction
70
disadvantage of IF
converts closed to open fracture
infection
71
disadvantage of IF
converts closed to open fracture
infection
72
IF used for oblique fractures esp tibia
transfixation screw
73
what are bone plates
IF - fastened to bone fragments above and below the fracture
74
IF used commonly in femoral shaft fracture
intermedullary nails
75
advantages of IM
promotes contact-compression
removes immob of joint
enables PWB - crutches
76
what is fracture disease
from prolonged immob
pain and swelling
stiff joint
contractures and adhesions
atrophy
osteoporosis
77
difference of pediatric bone
thicker periosteum kaya more support and resistance
heal fast bc high vascular
high capacity for remodeling
non union is rare unless ma infect
ligs stronger than bone
lower modulus
78
method of reduction for pediatric
CLOSED
79
weak spot in pediatric bone
physis kaya predispose ma injure - affects growth
80
type 1 salter-harris
physeal fracture
81
type 2 salter-harris
physeal and metaphyseal
82
type 3 salter-harris
physeal until epiphysis
83
type 4 salter-harris
physeal
metaphyseal
epyphyseal
84
type 5 salter-harris
compression fracture of growth plate
85
when is it considered delayed union in LE
20 wks
86
when is it considered delayed union in UE
10 wks
87
causes of delayrd union
inaccurate reduction
kulang or interrupted immob
local trauma
impairment to circulation
infection
bone loss
separation of fragments
88
treatment for delayed union
prolong immob or repeat
control infection
WB in walking boot or wolfs law to accelerate
electrical stim
89
when is it considered non union
6 months and above
90
factors to non union
extensive soft tissue damage
impaired blood supply
infection
91
clinical features of non union
mobility at fracture site
motion of fragments = pain
pain on WB
swelling
if sever atrophy
92
pathology of non union
fracture ends are covered by fibrocartilage and pseudocapsule na may synovial fluid
93
radiographic exam of non union
gap or line
marrow cavity sealed by scelrotic
proliferation of proximal rounding of distal fragment
94
what is atrophic non union
ends are thinned and tapered
95
treatment of non union
brace for stability
bone graft
96
type of bone graft taken from patient
autogenous
97
type of bone graft taken from another person
homogenous
98
treatment that has greatest osteogenic potential
iliac cancellous bone graft
99
15% of non union cases
femoral neck kase anatomically poor blood supply
100
treatment for non union in femoral neck
< 60 - graft
> 70 - thr
101
treatment for non union in femoral shaft
trim fracture end tas IM and graft
102
most common site of non union
lower 1/3 of tibia kase poor din blood supply
103
treatment for non union in tibia
compression plate and screw w bone graft
104
causes of malunion
kulang reduction and immob
105
where is shortening more problematic
LE
106
acceptable shortening
up to 1 inch if more mag surgery na
107
mechanism of rotational malunion
distal fragment heals naka IR or ER
108
mechanism of angulation mal union
angulated so abnormal stress on adjacent joints
varus of femur = pain on medial knee
109
treatment for malunion
if minor usually kaya naman mag adapt
pero pwede surgery if severe or cosmetic
110
most common site for march fracture
2nd metatarsal neck kase less flexible and longest so prone to torsional tas sha pinaka WB
111
occurence of march fracture
more in females
ATHLETES AND MILITARY
112
pathology of march fracture
repetitive impact on metatarsals - osteoblastic lags behind during - WB exercises
113
PE of march fracture
pain improves w rest but inc w activity
pain is dull and aching
bone tenderness
LIMP
114
imaging for march
xray padin pero baka after 2-4 wks pa makita from onser
MRI w in 234 hrs of onser
115
treatment for march
RICE
analgesics
walking boot 4-8 wks
stretch and gradual lng na exercise
116
mechanism of smith
fall on flexed wrist or direct blow to back of wrist
117
wha tis smith fracture
fracture of radius w volang angulation of distal fragment
118
treatment of smith fracture
CR and cast
ORIF if malaki dispalcement
119
what is monteggia fracture
fracture of proximal 1/3 of ulna w radial head dislocation
120
here is monteggia common in population
children 4-10 yo
121
treatment for montiagga
CR pag children - cast in supination
ORIF if acute and open or unstable
- adult at commninued
- if di nag reduce yung radius
122
what is potts fracture
fracture of fibula 2-3 inches above distal tibia w rupture of medial ligament and lateral sublux of talus
FRACTURE OF MEDIAL OR LATERAL MALEOLI W LIG INJURY
ANKLE FRACTURE
123
MECHANISM of potts
twisting of ankle while running or walking
124
imaging for potts
x ray of anke leg in 15-20 deg IR
125
management for potts
nonop if undisplaced and stable
ORIF for falies CR, displaced and unstable
126
most common osteoporotic fracture
vertebral compression fracture
127
clinical features of VCF
pain local to fracture
pain can be dermatomal and around rib cage
kyphosis - from multiple compression
potts disease
lost of vertebral height by 20% or at least 4mm
128
imaging for VCF
xray of entire spine
129
treatment for VCF
non op - brace lng and bisphosphonates
op - vertebroplasty, kyphoplasty, decompress
