MSK Trauma - fractures Flashcards
(45 cards)
Define fracture.
A break in the continuity of the bone.
Initiates a complex tissue repair process through bone death or damage to periosteum and blood vessels.
What groups may experience a complicated fracture repair process?
Osteoporosis
Diabetes
Infection
Diminished blood supply to area
older patients
outline the process of fracture repair:
- Vascular damage
2,. fracture haematoma - Fibrin mesh develops
- Granulation tissue containing inflammatory cells , fibroblasts, bone and cartilage forming cells.
- Precallus cartilaginous tissue forms and anchors ends of bone
- Osteoblasts form bony callus tissue collars broken end so healing can occur.
- Overtime callus tissue is replaced by normal bone as injury heals.
Define dislocation:
Complete loss of continuity of two bones forming joint.
Define subluxation:
Partial loss of continuity of 2 bones forming joint
Define open fracture:
A direct communication between the fracture and the external environment.
What are 3 causes of fractures:
- injury mechanism that exceeds maximum force bone can withstand (normal + abnormal bone)
- comorbidity that increased risk of fracture after injury
- Comorbidity that increases risk of injuries.
What are some congenital and acquired syndromes that increase risk of fracture after injury?
- Congenital e.g. osteogenesis imperfecta
- Acquired e.g.
metabolic such as rickets and osteomalacia or
degenerative like osteoporosis or tumours.
What are some types of complete fractures?
- Simple fractures: transverse, oblique, spiral
- Complex fractures
- Compression fractures
- extra/intra articular involvement.
What 3 things should you think about when requesting a radiograph?
- Specific area, XR joint, beam divergence
- 2+ views AP and lateral
- Special views to request e.g. mortise and scaphoid.
What is primary healing?
Primary fracture healing is direct healing without fracture callus, requires absolute stability hence only occurs in surgery. Haversian remodelling.
What is secondary healing
Secondary healing is all other types of fracture healing. Requires relative stability of fracture; endochondral ossification occurs involving inflammation repair and remodelling.
What happens in the inflammation stage of endochondral ossification?
haematoma and inflammatory cells, osteoblasts and fibroblasts proliferate, granulation tissue forms around bone edges.
What happens in the first repair stage of endochondral ossification?
New blood vessels and internal/external callus forms <2 weeks, primary soft callus is cartilage and is wider then bone contour for strength
What happens in the second repair stage of endochondral ossification?
Soft cartilage is replaced by woven bone (hard callus) which is produced rapidly but is disorganized and not stress oriented therefore weak.
What happens in the remodelling stage of endochondral ossification?
begins in the middle of repair stages. Woven bone is remodelled to laminar bone via cutting cones. Wolff’s law, stress orientated formation, and can take years.
What are 3 options for non-operative management and what are the positives and negatives of this?
- Nothing
- splints for comfort
- Devices to help control position
Positives: Cheap, easy to apply, no risks that are involved with operating.
Negatives: Stiffness, not fully controlled, pressure issues with casts and swelling, patient comfort.
What are the positives and negatives of operative fracture management?
Positives: Less immobilisation, earlier rehab and pain control, anatomical reduction and fixation prevents further disability especially when involving articular surfaces
Negatives: Expensive, may slow healing, risk of complications.
What are 3 features of high energy trauma?
- Poly trauma
- Complex and displaced fracture patterns
- Soft tissue injuries
What is the A->E assessment map for ortho trauma?
A - airway and c-spine control
B - breathing
C - circulation
D - disability
E - exposure
What is ATOM FC
reversible life threatening trauma:
A - Airway obstruction
T - Tension pneumothorax
O - Open pneumothorax
M - Massive haemothorax
F - Flail chest
C - Cardiac tamponade
What is important to remember in the ED management of open fractures? (6)
There is an increased risk of infection that could lead to infective non-union.
- Early ABX IV
- Anti tetanus jab if no within 5 years
- Splint or cast to connect length and alignment.
- tamponade bleeding vessel
- Sterile saline soaked dressing to cover wound
- Take a photo before dressing!!
How are open fractures managed in surgery?
- Sequential operations
- First for wound debridement and skeletal stabilisation
- Second for tissue inspection, further debridement and wound closure by plastics
What are the symptoms of compartment syndrome with a tibial shaft fracture?
- Serve pain that increases with severity
- Pain on passive stretching of toes
- Paraesthesia
- Normal pulses
- Muscles in calf feel tight
- PAIn disproportionate to injury
