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comeback szn > MS1: Fractures > Flashcards

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

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2
Q

possible causes for fractures

A

TRAUMA

acquired disease - osteoporosis, tumors

congenital disease - osteogenesis imperfecta

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3
Q

what is pathologic fracture

A

fracture due to pre-existing bine disease

tumors, cyst, osteoporosis, osteomyelitis

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4
Q

what is stress fracture

A

fracture due to repeated loading and weak muscles support

BONE FATIGUE

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5
Q

how do we describe fractures

A

open or closed
complete or incomplete
pattern
displacement
location
bone involved
side involved
modifiers

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6
Q

what are closed fractures

A

intact skin and mucus membranes

BASTA DI NAG BREAK yuNG SKIN

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7
Q

what are open fractures

A

OPEN SKIN - NAEXPOSE SA ENVIRONMENT

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8
Q

debridement and irrigation of open fractures should be done within

A

within 8 hrs tas need mag antibiotics

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9
Q

what are complete fractures

A

tlagang into 2 or more pieces

both cortices are disrupted

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10
Q

what are incomplete fractures

A

cortex is not totally disrupted

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11
Q

where in the population does incomplete fracture usually happen

A

children

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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

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13
Q

pattern of fracture due to tension

A

transverse

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14
Q

pattern of fracture due to compression

A

oblique

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15
Q

pattern of fracture due to bending

A

comminuted or butterfly

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16
Q

pattern of fracture due to torsion

A

spiral

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17
Q

diifer comminuted and segmented fracture

A

comminuted - > 2 fragments; bc of rapid and excessive loading

segmental - 4 point bending

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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

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19
Q

name of fracture location if on metaphysis

A

proximal or distal

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20
Q

name of fracture location if on diaphysis

A

into thirds

upper third, middle third, lower third

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21
Q

name of fracture location if on specific parts

A

pwede din kung like sa femoral neck, tibial plateu, lateral epicondyle ganun

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22
Q

mechanism of stress fracture

A

NORMAL BONE under continued overuse until failure occurs

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23
Q

mechanism of pathologic fracture

A

PATHOLOGICALLY WEAKENED BONE under normal use

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24
Q

what are modifiers

A

if there is presence of dislocation

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25
Q

difference between displacement and dislocation

A

displacement - refers to fractured bone segment kung sa napunta

dislocation - if bone goes out of normal joint position ganun

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26
Q

what is the optimal condition for fracture healing

A

adequate vascular supply
minimal necrosis
good reduction
immobilization
physiologic stress - wolf’s law
absence of infection

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27
Q

most important factor for fracture healing

A

blood supply

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28
Q

response of bone blood flow to fracture

A

initially mag ddecrease sa fracture site

tas mag ppeak at 2 wks - 1-3x normal

return to normal at 3-5 months

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29
Q

when does blood flow peak in fracture healing

A

2 wks

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30
Q

when does blood flow return to normal in fracture healing

A

3-5 months

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31
Q

what are the stages of fracture healing

A

inflammation - hematoma

repair
- soft callus
- hard callus

remodelling - lamellar bone

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32
Q

what happens in the inflammation stage

A

mga macrophages, growth factors and mesenchymal stem cells iinvade site tas mag cclot

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33
Q

what replaces the clot in the inflammation stage

A

reparative fibrovascular granulation tissue

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34
Q

when does primary callus occur

A

within 2 wks

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35
Q

what happens in the soft callus stage

A

osteoblasts from inner cambium ng uninjured laydown primitive osteoid

nodules of cartilage from cartilaginous tissue around fracture site

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36
Q

how much WB in soft callus stage

A

25% of body weight muna until kaya mag FWB

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37
Q

what happens in hard callus stage

A

enchondral ossification begins - soft callus becomes hard callus

osteoid mineralize sa medullary cana

bridgins callus in fracture site is formed

FWB na

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38
Q

what happens in remodeling stage

A

firm continuity is formed via mature callus tas normal na force transmission

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39
Q

how does bone remodel

A

callus follows along stress dictated lines tas dun mag osteoblast/clast activity

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40
Q

internal variables that affect healing

A

blood supply
head injury that affects pituitary gland can inc

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41
Q

mechanical variables that affect healing

A

affectation of soft tissue
local injury
bone loss
pattern

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42
Q

what fracture patter takes longest to heal

A

comminuted and segmental tas inc chance of non union due to dec blood supply

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43
Q

external variables that affect healing

A

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

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44
Q

patient factors that affect fracture healing

A

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

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45
Q

how does bisphosphonate affect fracture healing

A

can cause osteoporotiv fractures

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46
Q

how does steroids affect fracture healing

A

weakens muscles and ligs

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47
Q

how does NSAID affect fracture healing

A

if COX2 inhibitor

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48
Q

how does quinolones affect fracture healing

A

toxic to chondrocytes

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49
Q

3 types of deformity associated w fractures

A

angulation
shortening
rotation

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50
Q

gold standard of imaging

A

xray

ct scan pag complex
mri kung may ligament damage

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51
Q

what are the 3 phases of management of fractures

A

fracture reduction

maintenance of reduction

preservation and restoration of function

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52
Q

most common from of reduction

A

manipulation

53
Q

advantages of closed reduction

A

uses natural repair process
few complications

54
Q

disadvantages of closed reduction

A

more difficult to perform
slight angulation and rotation commonly occur

55
Q

indications of open reduction

A

failure of closed reduction

articular fractures bc need accurate reduction

unstable fractures

unite poorly

pathologic - trauma

polytrauma

56
Q

most common method of maintaining reduction

A

external fixation -

57
Q

type of EF effective where bones are superficial

A

casts - pag deep kase like femur gagalaw sa dami ng muscles

58
Q

type of EF for comminuted, open fractures nd soft tissue injury

A

pins, bars and rods

59
Q

used for fractures not adequately immobilized by casts

A

traction

60
Q

how does traction work

A

muscles act as internal splint to protect fracture

61
Q

disadvantage of traction

A

requires patient to be in bed

62
Q

identify if skin or bone traction

applied by means of adhesive or rubber strips and elastic bandage

A

skin traction

63
Q

identify if skin or bone traction

not more than 5-6 lbs bc causes maceration of skin

A

skin traction

64
Q

identify if skin or bone traction

bucks and russels traction

A

skin traction

65
Q

identify if skin or bone traction

wire/pin is drilled through bone

A

bone traction

66
Q

identify if skin or bone traction

higher forces 20-30 lbs

A

bone traction

67
Q

identify if skin or bone traction

can be applied to distal areas like ankle

A

bone traction

68
Q

when is IF used

A

when other methods of maintaining is unreloable

69
Q

advantage of IF

A

direct visualization of fracture = anatomic reduction

70
Q

disadvantage of IF

A

converts closed to open fracture

infection

71
Q

disadvantage of IF

A

converts closed to open fracture

infection

72
Q

IF used for oblique fractures esp tibia

A

transfixation screw

73
Q

what are bone plates

A

IF - fastened to bone fragments above and below the fracture

74
Q

IF used commonly in femoral shaft fracture

A

intermedullary nails

75
Q

advantages of IM

A

promotes contact-compression

removes immob of joint

enables PWB - crutches

76
Q

what is fracture disease

A

from prolonged immob

pain and swelling
stiff joint
contractures and adhesions
atrophy
osteoporosis

77
Q

difference of pediatric bone

A

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
Q

method of reduction for pediatric

A

CLOSED

79
Q

weak spot in pediatric bone

A

physis kaya predispose ma injure - affects growth

80
Q

type 1 salter-harris

A

physeal fracture

81
Q

type 2 salter-harris

A

physeal and metaphyseal

82
Q

type 3 salter-harris

A

physeal until epiphysis

83
Q

type 4 salter-harris

A

physeal
metaphyseal
epyphyseal

84
Q

type 5 salter-harris

A

compression fracture of growth plate

85
Q

when is it considered delayed union in LE

A

20 wks

86
Q

when is it considered delayed union in UE

A

10 wks

87
Q

causes of delayrd union

A

inaccurate reduction
kulang or interrupted immob
local trauma
impairment to circulation
infection
bone loss
separation of fragments

88
Q

treatment for delayed union

A

prolong immob or repeat

control infection

WB in walking boot or wolfs law to accelerate
electrical stim

89
Q

when is it considered non union

A

6 months and above

90
Q

factors to non union

A

extensive soft tissue damage

impaired blood supply

infection

91
Q

clinical features of non union

A

mobility at fracture site

motion of fragments = pain
pain on WB
swelling

if sever atrophy

92
Q

pathology of non union

A

fracture ends are covered by fibrocartilage and pseudocapsule na may synovial fluid

93
Q

radiographic exam of non union

A

gap or line
marrow cavity sealed by scelrotic
proliferation of proximal rounding of distal fragment

94
Q

what is atrophic non union

A

ends are thinned and tapered

95
Q

treatment of non union

A

brace for stability

bone graft

96
Q

type of bone graft taken from patient

A

autogenous

97
Q

type of bone graft taken from another person

A

homogenous

98
Q

treatment that has greatest osteogenic potential

A

iliac cancellous bone graft

99
Q

15% of non union cases

A

femoral neck kase anatomically poor blood supply

100
Q

treatment for non union in femoral neck

A

< 60 - graft
> 70 - thr

101
Q

treatment for non union in femoral shaft

A

trim fracture end tas IM and graft

102
Q

most common site of non union

A

lower 1/3 of tibia kase poor din blood supply

103
Q

treatment for non union in tibia

A

compression plate and screw w bone graft

104
Q

causes of malunion

A

kulang reduction and immob

105
Q

where is shortening more problematic

A

LE

106
Q

acceptable shortening

A

up to 1 inch if more mag surgery na

107
Q

mechanism of rotational malunion

A

distal fragment heals naka IR or ER

108
Q

mechanism of angulation mal union

A

angulated so abnormal stress on adjacent joints

varus of femur = pain on medial knee

109
Q

treatment for malunion

A

if minor usually kaya naman mag adapt

pero pwede surgery if severe or cosmetic

110
Q

most common site for march fracture

A

2nd metatarsal neck kase less flexible and longest so prone to torsional tas sha pinaka WB

111
Q

occurence of march fracture

A

more in females

ATHLETES AND MILITARY

112
Q

pathology of march fracture

A

repetitive impact on metatarsals - osteoblastic lags behind during - WB exercises

113
Q

PE of march fracture

A

pain improves w rest but inc w activity
pain is dull and aching

bone tenderness

LIMP

114
Q

imaging for march

A

xray padin pero baka after 2-4 wks pa makita from onser

MRI w in 234 hrs of onser

115
Q

treatment for march

A

RICE
analgesics
walking boot 4-8 wks

stretch and gradual lng na exercise

116
Q

mechanism of smith

A

fall on flexed wrist or direct blow to back of wrist

117
Q

wha tis smith fracture

A

fracture of radius w volang angulation of distal fragment

118
Q

treatment of smith fracture

A

CR and cast

ORIF if malaki dispalcement

119
Q

what is monteggia fracture

A

fracture of proximal 1/3 of ulna w radial head dislocation

120
Q

here is monteggia common in population

A

children 4-10 yo

121
Q

treatment for montiagga

A

CR pag children - cast in supination

ORIF if acute and open or unstable
- adult at commninued
- if di nag reduce yung radius

122
Q

what is potts fracture

A

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
Q

MECHANISM of potts

A

twisting of ankle while running or walking

124
Q

imaging for potts

A

x ray of anke leg in 15-20 deg IR

125
Q

management for potts

A

nonop if undisplaced and stable

ORIF for falies CR, displaced and unstable

126
Q

most common osteoporotic fracture

A

vertebral compression fracture

127
Q

clinical features of VCF

A

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
Q

imaging for VCF

A

xray of entire spine

129
Q

treatment for VCF

A

non op - brace lng and bisphosphonates

op - vertebroplasty, kyphoplasty, decompress

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