Orthopedic Pathology 3 Fractures

Question 0

Incidence and risk factors of fracture

Answer 0

Very common, increasing in occurrences due to high impact sports, high velocity travel, industry

Higher occurrence in elderly due to osteoporosis

Question 1

Fracture

Answer 1

Is a break/defect in the continuity of a bone

Question 2

Causes of Fractures

Answer 2

A trauma or sudden force
-Direct: a bone breaks at the point of impact
-Indirect: bone breaks at a distance from the force
Overuse or repeated wear
-Stress fracture
Pathologies
-Osteoporosis, tumors, local infection or bone cysts
-Can cause brittleness or weakening of bone

Question 3

Classification of fractures

Answer 3

site
extent
configuration
relationship of fragments to each other
Relationship to environment

Question 4

Site of Fracture

Answer 4

Diaphyseal
Metaphyseal
Epiphyseal
Intra-articular
Fracture-dislocation

Question 5

Salter-Harris Classification description

Answer 5

Classification system used to describe fractures affecting the epiphyseal plate or growth plate

Only applies while bone is still growing (0-20 years old)

Question 6

Salter Harris classification types

Answer 6

Type I
Transverse fracture through the growth place 5%
Type II
Fracture through the growth plate and metaphysis 75% MOST COMMON
Type III
Fracture through the growth plate and epiphysis 10%
Type IV
Fracture through the growth plate, epiphysis and metaphysis 10%
Type V
Compression fracture through the growth plate Uncommon

Question 7

Extent of Fracture

Answer 7

Complete: Bone is broken in two or more pieces

Incomplete: Bone is bent or cracked and the periosteum remains intact (e.g. compression, greenstick, perforation, stress)

Question 8

Compression Fracture

Answer 8

Bone is crushed, occur in cancellous bone (such as vetebral body)

Question 9

Greenstick fracture

Answer 9

Bone is bent or partially broken

Found in children younger than 10 years old (bones are more pliable than those of adults)

Question 10

Perforation fructure

Answer 10

Result of a missile wound, bullet

Question 11

Stress fracture

Answer 11

Cracks in the bone due to overuse or repetitive actions.

Common sites: Tibia, metatarsals, navicular, femur, pelvis, generally parallel to axis of the bone

Question 12

Configuration

Answer 12

Linear: Fracture that run parallel to the long axis of a bone
Transverse (chalkstick): fracture that is at a right angle to the bone’s long axis
Oblique: fracture that is diagonal to a bone’s long axis
Spiral: at least one part of the bone has been twisted
Comminuted: Consists of two or more fragments
Avulsion: Occurs when a ligaments pulls the portion of the bone that is attached away from the bone itself
Compacted/impacted: Bone or bone fragments are driven into each other
Osteochondral: Occurs when fragments of articular cartilage are shared from the joint surface

Question 13

Relationship of fragments to each other

Answer 13

• Consideration include displacement, distraction and angulation
• Reduction/surgery may be required
• Longer healing

Question 14

Relationship of fragment of environment

Answer 14

• Closed or simple fracture: skin is intact
• Open or compound fracture: the end of the bone have broken through the skin or into a body cavity, more prone to infection

Closed fracture easier to treat with better prognosis.

Question 15

Symptoms

Answer 15

Unnatural mobility
Muscle splinting
Deformity
Shock
Pain
Bleeding, 
Swelling, bruising
Decreased function

Question 16

Colles Fracture

Answer 16

Transverse fracture of radius proximal to wrist
Fragment rotates and displaces dorsally
Usually from fall on outstretched hand
Dinner fork appearance
Complications (reflex sympathetic dystrophy: doesn’t respond properly)
Malunion (bones don’t heal correctly)

Question 17

Smith’s fracure

Answer 17

AKA reverse Cole’s fracture
The distal fracture fragment is displaced ventrally
Spoon appearance

Question 18

Galeazzi Fracture

Answer 18

Fracture of radial shaft and dislocation of distal radioulnar joint
MOI- fall on hand with rotational component
Complications
Ulnar nerve injury

Question 19

Barton’s fracture

Answer 19

An intra-articular fracture of the distal radius with dislocation of the radiocarpal joint

Two types: Dorsal and palmar
Caused by a fall on an extended and pronated wrist

Question 20

Rolando fracture

Answer 20

Is a comminuted intra-articular fracture through the base of the first metacarpal bone

Fracture consist of 3 distinct fragments (T or Y shaped)

Question 21

Boxer’s (Brawler’s) fracture

Answer 21

Fracture of the 5th MC
Due to punching an object with a closed fist
Pain and denderness around knuckle, snapping/popping sensation, discolouration, misalignment of finger, cut on hand

Question 22

Bennett’s fracture

Answer 22

Fracture-dislocation of the 1st carpometacarpal jt.
Longitudinal force along the xis of the 1st MC when thumb is flexed
Significant swelling, tenderness and reluctance to use the thumb

Question 23

Monteggia fracture

Answer 23

A fracture in the proximal part of the ulna with dislocation of the head of the radius

Question 24

Pott's fracture

Answer 24

Ankle fracture affecting one of both malleoli Distal fibula fractures close to lateral malleolus Deltoid ligament can rupture and avulse medial malleoli

Question 25

Dupuytren's fracture

Answer 25

Fracture is higher up on fibula Medial malleoli avulses and talus pushed superior between tibia and fibula MOI: eversion with some external rotation Compications: malunion, joint stiffness

Question 26

Jones Fracture

Answer 26

AKA dancer's fractures | Is an injury to the 5th metatarsal bone of the foot: occurs at the proximal end (midfoot)

Question 27

Maisonneuve Fracture

Answer 27

Is a spiral fracture of the proximal third of the fibula -associated with a tear of the distal tibiofibular joint and interosseus membrane Medial malleolus fracture and possible rupture of the deltoid ligament

Question 28

Toddler's fracture

Answer 28

AKA childfood accidental spiral tibial fractures Distal part of the tibia in toddlers aged 9 months to 3 years and children under 8 years old Invovled the distal third to distal half of the tibia Undisplaced and in a spiral pattern

Question 29

Trimalleolar fracture

Answer 29

A fracture of the ankle that Involved the lateral malleolus, medial malleolus and the distal posterior aspect of the tibia

Question 30

Healing of fracture depends on...

Answer 30

``` Types of bone that is injured Amount of movement at fracture site Complications Nutrition Concurrent disease Age ```

Question 31

Stage 1 (cellular phase)

Answer 31

Hematoma forms around ends of fractured bone within 72 hours of initial trauma Incites an inflammatory response Mesh of fibrin forms around the injury site Granulation tissue eventually invades and replaces hematoma (will ultimately become a callus)

Question 32

Stage 2 (Vascular phase)

Answer 32

Inflammatory reaction continues Specialized circulatory network develops around fracture Proliferation of osteoblasts at periosteum Fibrocartilaginous bridge between fragment ends forms

Question 33

Stage 3 (primary callus phase)

Answer 33

Soft callus or splint is formed from mass of proliferating osteoblasts and exudate Osteoclasts clean up dead bone and debrisFibrous, immature bone (woven bone) is gradually calcified Movement decreases Union occurs at about 4 weeks Repair is incomplete as callus is not yet mature

Question 34

Stage 4 (reparative phase)

Answer 34

Consolidation | Immature bone matures into lamellar bone

Question 35

Stage 5 (remodeling phase)

Answer 35

Remodelling of irregular surfaces Reshaping of marrow space Realignment along lines of stress

Question 36

Early Complications

Answer 36

- Torn muscles and tendons - Ligament damage - Acute compartment syndrome (can occur in forearm or leg, swelling increases pressure within fascial compartment, cycle of reduced circulation, ischemia, edema can leading to necrosis and gangrene) - Nerve compression - vascular damage (red, black, blue bruising distal to FX) - Bone/soft tissue infection (fever, pain, edema, odour, seepage) - DVT (esp. in lower limb (calf with clients confined to bed, elderly and CV pathologies) - Cast dermatitis - pressure or plaster sore (ischemia over bony prominence) - Loose cast syndrome

Question 37

Late complication

Answer 37

- Nerve compression or entrapment - Joint stiffness -Disuse atrophy - Disuse osteoporosis - myositis ossificans - metal plates (local inflammation, screws may loosen or break) - non union Delayed union (bone dos not unite within expected time frame, due to inadequeate circulation, insufficient splinting, excessive traction, infection) - non union (failure of bone to heal before repair process finishes, due to large gap, bone destruction, bone loss) -Malunion (unacceptable joining of bony ends resulting in deformity, can leads to altered biomechanics, tendinitis, bursitis, osteoarthritis)

Question 38

Osteonecrosis

Answer 38

Avascular necrosis of bone Occurs in bones that are poorly vascularized Scaphoid, neck of femur, talus, lunate

Question 39

Avascular Necrosis

Answer 39

Tissue ischemia brought on by impairment of blood vessels Mimimum of 2 hours of anoxia required for permanent loss of bone tissue May be secondary to trauma or thrombosis Bone with limited circulation are susceptible Also bones covered extensively by cartilage joint may be irreparably damaged entire process takes years spontaneous healing does not occur

Question 40

Avascular necrosis conditions

Answer 40

Trauma, DM, gout, alchoholism, obesity, pregnancy, oral contraceptives, steroid use, transplantation, etc.

Question 41

Avasclar necrosis clinical Sx

Answer 41

``` Asymptomatic initially initial presenting complaint is pain Often mild Progresses to severe slow progressive stiffening of joint Deformity (late) DJD (Very late) ```

Question 42

Avascular Necrosis Diagnosis and treatment

Answer 42

X ray initially normal Watch and wait, surgery