Ortho: RAD FX

Question 1

What is the epiphysis?

Answer 1

The end of growing bone.
Initially composed of cartilage
Gradually ossifies
Eventually fuses with the end of the growth period

Question 2

what is the physics?

Answer 2

Growth Plate
Bone growth center
Layers of maturing cartilage and developing bone

Question 3

what is the ZPC?

Answer 3

Junction of physis and metaphysis
Region of calcification of the physis cartilage
Precursor to bone formation
Side of physis closest to the metaphysis

Question 4

what is the metaphysis?

Answer 4

Junction between the ZPC and diaphysis
Most metabolically active
Common site for tumors and infection

Question 5

what is the diaphysis?

Answer 5

Between both methaphyses in long bone

Longest part of the bone

Question 6

what is the cortex?

Answer 6

Strongest and most dense part of the bone

Question 7

how is cortical bone organized?

Answer 7

Lamellar bone organized concentrically to form osteons, each with a Haversian canal at its center
Canal contains blood vessels
Osteocytes occupy lacunae (Dark spots)

Question 8

where is the bone marrow contained?

Answer 8

MEDULLA = MARROW (spongy bone)
Internal cavity of bone
Traversed by thin trabeculae
Contains the bone marrow

Question 9

what is the periosteum?

Answer 9

Thin membrane of tissue that envelopes the diaphysis and metaphysis
Histologically divided into two layers
Outer fibrous
Inner cambium

Question 10

what is “Large force applied over a large area”

Answer 10

crush

Question 11

what is “Large force applied over a small area”

Answer 11

penetrating

Question 12

what is “Small force applied to a small area (nightstick)”

Answer 12

tapping fracture

Question 13

what are the different types of fractures?

Answer 13

Transverse
Oblique
Spiral
Comminuted (Segmental or Butterfly)
Impacted

Question 14

what is alignment?

Answer 14

Alignment: The relationship of the long axes of the fragments of a long bone to one another.

Question 15

what is apposition?

Answer 15

Apposition: The relationship of the fracture fragments to their normal anatomic location

Question 16

what is a stable versus unstable fracture:

Answer 16

Stable Fracture: Does not have a tendency to displace after reduction
Torus fracture

Unstable Fracture: Tends to displace
Colles Fracture

Question 17

what is simple and compound?

Answer 17

Simple (Closed) – Overlying skin intact

Compound (Open) – Overlying skin broken

Question 18

what is complicated and uncomplicated?

Answer 18

Uncomplicated – Only minimal soft tissue injury

Complicated – Associated with neurovascular, visceral, ligamentous or muscular damage. (also intra-articular)

Question 19

Salter-Harris Classification: Salter Harris I

Answer 19

Fracture through the physis
May be displaced or undisplaced
May not be obvious on initial x-ray
Circumferential tenderness along physeal area
Distal tibia and fibula common
Similar presentation to ankle sprain, no ligamentous tenderness

Question 20

Salter-Harris Classification: Salter Harris II

Answer 20

Fracture through the physis and extends into metaphysis
75% of all physeal injuries
Undisplaced SHII fractures generally do not cause growth disturbances

Question 21

Salter-Harris Classification: Salter Harris III

Answer 21

Fracture through physis extending into epiphysis
Intra-articular fractures that must be accurately reduced
Older children with partially-closed physes
Early referral to orthopedics imperative

Question 22

Salter-Harris Classification: Salter IV

Answer 22

Fracture through the physis and into both the epiphysis and metaphysis
Need accurate reduction
Prevent bone bridging across physis
Can lead to partial growth arrest
Early referral imperative

Question 23

Salter-Harris Classification: Salter V

Answer 23

Crush injury to the growth plate
1% of all physeal injuries, but MOST SERIOUS!
May not be clearly visible on initial films
Comparison views
Often diagnosed in retrospect when growth arrest is noted

Question 24

What is Wolff’s Law?

Answer 24

Bone is deposited and resorbed in accordance with the stresses placed upon it.
It responds dynamically to stress by altering its internal architecture

Question 25

What are the types of open fractures:

Answer 25

type 1: low energy–> bone fragment piercing the skin from inside.
type 2: medium energy–> low velocity gunshot wound with fracture
type 3: high energy or severe crush

Question 26

stages the healing:

Answer 26

1) inflammatory–> lasts days to weeks stage 1 (hematoma and granulation stage)
2) reparative–>lasts weeks to months. Stage 2) soft callus Stage3) hard callus
3) remodeling–> stage 4 ) lasts months to years

Question 27

What are some fracture complications?

Answer 27

1. fat embolism
2. compartment syndrome
3. myositis ossificans traumatica
4. reflex sympathetic dystrophy

Question 28

What is a fat embolism?

Answer 28

orthopedic manifestation of ARDS
(can occur post fracture)
decreased o2, increased c02..mental confusion, infiltrates on CXR

tx: minimize hypoemia, ventilatory support

Question 29

what is compartment syndrome:

Answer 29

sheath leaves no space for swelling. >30 mm HG = FASCIOTOMY!

affects most commonly:
forearm, hand, gluteus medius, 3 compartments of lower leg