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Semester 3 > orthopedic pathology (fractures) > Flashcards

orthopedic pathology (fractures) Flashcards

1
Q

fracture

A

break/defect in bone

“broken bone”

bery common

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2
Q

fracture accompanied by soft tissue injury

A

The physical force that is required to break a bone practically always produces some soft tissue injury

Difficult to determine the extent of soft tissue injury

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3
Q

causes

A

Trauma or sudden force

Direct – a bone breaks at the point of impact

Indirect – bone breaks some distance from the force (closed chain?)

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4
Q

other cause

A

Overuse or repeated wear
Stress fracture

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5
Q

pathologies as acause

A

Pathologies

Osteoporosis,
osteopenia (?)
tumours,
local infection
or bone cysts

Can cause weakening of bone

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6
Q

symptoms fracture

A

Unnatural mobility

Muscle splinting

Visible deformity

Pain (SHARP)

Bleeding

Swelling, bruising

Decreased function

Internal organ damage
Shock

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7
Q

daignosis

A

Imaging
X-ray
CT
MRI
Ultrasound (not as common)

Physical examination:
Fracture Screen:
Four step test

Torsion test (resisted isometric contraction)

Palpation (bony prominences)

Percussion/tuning fork (based on sound pattern/pain w/ fork distal to site?)

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8
Q

treatment

A

immobilization
(cast/splint)

surgical reduction
(screws, wires, metal plates)

Meds
NSAIDS (advil, naproxen, etc)

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9
Q

healing

A

Depends on:
The amount of damage incurred

Amount of movement at fracture site

Concurrent disease

Age

Overall health status

Complications

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10
Q

complications (early = within first few weeks)

A

Soft tissue injuries (muscles, ligaments, etc)

Acute compartment syndrome (within 48 hours):
Most commonly in forearm or leg

Swelling/bleeding increases pressure within fascial compartment

Cycle of reduced circulation -> ischemia -> edema -> reduced circulation

–>Leading to necrosis and gangrene
(Medical emergency)

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11
Q

complications (early)

A

Nerve compression

Bone/soft tissue infection

fever, pain, edema, pus

Deep vein thrombosis
(Blood clot in deep vein)

Cast dermatitis (allergic reaction)

Pressure or plaster sore
(ischemia over bony prominence)

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12
Q

late complications (few weeks to years)

A

Nerve compression or entrapment

Joint stiffness

Disuse atrophy

Disuse osteoporosis

Myositis ossificans

Metal plates may cause discomfort forever

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13
Q

other late compications

A

Delayed union:
Bone does not unite within expected time frame

Via inadequate circulation, insufficient splinting, infection

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14
Q

non-union

A

Failure of bone to heal before repair process finishes

Due to large gap, bone destruction, bone loss

rebreak bone and join together surgically so they form union and heal as one structure

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15
Q

malunion

A

union occurs but not correctly (offset, at an angle etc.)

Can lead to altered biomechanics, tendinitis, bursitis, osteoarthritis

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16
Q

other late complicaitons

A

avascular necrosis:
Tissue ischemia
via impaired vascular flow

Minimum of 2 hours of anoxia required for permanent loss of bone tissue

(May be secondary to trauma or thrombosis)

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17
Q

note tissue hypoxia survival time

A

Brain <3 min

Kidney and liver 15-20 min

Skeletal muscle 60-90 min

Vascular smooth muscle 24-72 h

Hair and nails Several days

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18
Q

osteonecrosis (same as avascular necrosis of bone????)

A

avascular necrosis of bone

Occurs in bones that are poorly vascularized

scaphoid, neck of femur, talus, lunate

Ischemia occurs shortly after fracture, but necrosis may not be noticed on x-ray for weeks

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19
Q

bone healing stage 1 (SEVERAL WEEKS)

A

fracture hematoma

Blood vessels are damaged and cause a mass of blood to form around Fx (Fx hematoma)

Forms 6 to 8 hours after injury

Lack of blood flow causes nearby bone cells to die, which creates additional swelling/inflammation.

Phagocytes and Osteoclasts clean up dead/damaged tissue around Fx

This stage may last up to several weeks.

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20
Q

stage 2

A

FC callus formation (3 weeks)

Fibroblasts invade fracture site and produce collagen fibers.

Chondroblasts invade fracture site and produce fibrocartilage

= SOFT CALLUS (FC callus)
helps to bridge the broken edge of the bones.

Formation of a soft callus takes about 3 weeks

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21
Q

chondrocytes and collagen

A

The pericellular region immediately surrounding the chondrocyte contains type VI collagen

(referring to a different area of cartilage, not FC callus, but FC callus also has collagen)

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22
Q

stage 3 (3-4 months)

A

bony callus

Osteogenic cells develop into osteoblasts and produce spongy bone trabeculae

The trabeculae join living and dead bone fragments together, replacing the fibrocartilage.

This new callus is referred to as a hard callus (bony callus)

The bony callus lasts about 3 to 4 months.

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23
Q

stage 4

A

Bone remodeling is a slow process that may last 6-9 years, which is 70% of the total healing time. In the remodeling, osteoclasts (cells that break down bone tissue) resorb the trabecular bone, and osteoblasts deposit compact bone.

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24
Q

stage 4 …

A

Bone remodeling of the callus

Remaining dead portions of bone are reabsorbed by osteoclasts.

Compact bone replaces around spongy

Realignment along lines of stress (Wolff’s law)

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25
Q

general classification of fractures

A

via:
1. Site

  1. Extent
  2. Configuration
  3. Relationship of fragments to each other
  4. Relationship of fragments to external environment
26
Q

1) site

A

Diaphyseal

Metaphyseal

Epiphyseal

Intra-Articular
(Articular surface)

Fracture-dislocation

27
Q

2) extent

A

Complete
Bone is broken into two or more pieces

Incomplete
Bone is bent or cracked, but (most of?) the periosteum remains intact, which allows the bone to remain whole
E.g.
Compression
Greenstick
Stress/Hairline

28
Q

compression fracture

A

The bone is crushed

Occur in cancellous (spongy) bone
E.g.
Vertebral body

29
Q

greenstick fracture

A

The bone is bent or partially broken

ound in children younger than 10 years old
–> Bones are more pliable than those of adults

30
Q

stress/hairline fracture

A

Crack in the bone due to overuse or repetitive actions

common @
MOST COMMON TIBIA (50%)

MT (march fracture)

navicular

femur

pelvis

31
Q

3) configuration

A

Linear
Parallel to the long axis of a bone

Transverse (chalkstick)
Right angle to the bone’s long axis

Oblique
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
A ligament (or tendon) pulls a portion of the bone away from the bone itself

32
Q

4) relationship of fragments to each other

A

Undisplaced
Fragment ends are in line with each other

Displaced
Fragment ends have moved and no longer line up

33
Q

5) relationship of fragments to external environment

A

Closed/simple fracture
Skin is intact

Open/compound fracture
Ends of the bone have broken through the skin or into a body cavity; more prone to infection

“Closed fractures are easier to treat with better prognosis.”

34
Q

named fractures

A

.

35
Q

lower extremity named fractures

A

..

36
Q

Galeazzi fracture

A

Fracture of radial shaft and dislocation of distal radioulnar joint

FOOSH

37
Q

Monteggia Fracture

A

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

38
Q

Colles Fracture

A

Transverse fracture of distal radius

Distal fragment rotates and displaces dorsally

FOOSH

“Dinner fork” deformity

39
Q

Smith’s Fracture

A

Aka reverse Colles fracture

The distal fracture fragment is displaced ventrally (volar/palmar)

“spoon”

40
Q

Barton’s Fracture

A

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

Two types
Dorsal and palmar (Reverse Bartons’s)

FOOSH

41
Q

Bennett’s Fracture

A

Intra-articular fracture of proximal 1st metacarpal with dislocation of CMC joint

Longitudinal force along the axis of the 1st MC when thumb is flexed

42
Q

Reverse Bennett’s

A

5th MC (proximal)

43
Q

Rolando Fracture

A

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

Fracture consisting of 3 distinct fragments
–> T or Y shaped

44
Q

Boxer’s (Brawler’s) fracture

A

Fracture of the (distal?) 5th MC

Due to punching an object with a closed fist

45
Q

Salter-Harris Fracture

A

Refers to any fracture that occurs through the growth plate.

More common in the upper extremity

Typically only happens in children (epiphyseal plate)

(Growth plates are weak, joint capsules are strong in comparison)

46
Q

named fractures of lower extremity

A

..

47
Q

Pott’s Fracture

A

One or both malleoli

Can also involve deltoid ligament rupture or avulsion to medial malleoli

48
Q

Jones Fracture

A

Aka dancer’s fracture

Is an injury to the 5th metatarsal (PROXIMAL END)

Occurs at the proximal end (midfoot)

MOI: forceful inversion and plantar flexion

49
Q

Maisonneuve Fracture

A

Spiral fracture of the PROXIMAL third of the fibula

associated with a tear of the DISTAL tibiofibular joint and interosseous membrane

Medial malleolus avulsion and possible rupture of the deltoid ligament (???)

50
Q

Toddler’s Fracture

A

Aka childhood accidental spiral tibial fractures
(CAST fracture)

Occurs in children usually under 3 years old, but up to 8 years old

Involves the distal third to distal half of the tibia

Undisplaced and in a spiral pattern

51
Q

Trimalleolar Fracture

A

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

52
Q

fractures of spine

A

..

53
Q

skull fractures

A

linear fracture (most common

depressed fracture (high velocity impact by small object)

54
Q

Jefferson Fracture

A

AKA Burst Fracture of the Atlas

Fracture(s) of anterior and/or posterior arches of C1

Compression injury
Usually MVA or diving injuries

55
Q

Clay Shoveler’s Fracture

A

Avulsive fracture of the spinous process

Occurs typically between C6-T1, C7 being most common

MOI:
Hyperflexion of neck with contraction of erector muscles

56
Q

Teardrop fracture

A

Usually occur in the cervical spine

Flexion Teardrop: Hyperflexion causes anterior vertebral body to compress and shear off an anterioinferior fragment.

Extension Teardrop: Hyperextension causes an avulsion fracture of the anterioinferior portion.

Usually very SEVERE and unstable:
Due to ligamentous disruption the spinal cord can be compromised, leading to paralysis

57
Q

Compression Fracture

A

Combined flexion and axial compressive forces

Most common fracture of lumbar spine
(M/C at T12 and L1)

Commonly seen in patients with osteoporosis in C-spine
–> Dowager’s hump

58
Q

Rib Fracture

A

via blunt or penetrating chest trauma.

Ribs 4-10 are most commonly fractured.

Upper 3 ribs require higher force impact

May lead to complications with internal organ injury

59
Q

Flail Chest

A

When three of more contiguous ribs are fractured in two or more places.

MOI
High impact blunt trauma with severe anteroposterior compression.

60
Q
A

Semester 3 (32 decks)

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