Session 10 Flashcards Preview

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Flashcards in Session 10 Deck (21):
1

What are the Signs and Symptoms of a Fracture?

Pain

Swelling

Deformity

Crepitus

Loss of function

‘Bony’ tenderness

 Abnormal movement
 

 

2

What to consider when describing fractures?

Location

Configuration e.g. spiral

Parts

 

Articular (joint surface)

Displacement (of distal fragment)

~Angulation (the younger the child is the more angulation you can accept because bones grow so fast)

~Displacement

~Axial

~Rotation

Clinical Assessment

3

How would you describe the Mechanism of a Fracture?


 

Fracture pattern

Energy

Soft tissue envelope

Skeletal maturity

 

4

What is meant by a Pathological Fracture?

Fracture occurring through abnormal bone under physiological load

- local

- systemic


 

E.g. osteoporosis ‘normal bone but less of it’, osteomalacia ‘abnormal bone’ , tumour

 

 

5

What does Fracture Healing depend on, and name the 3 phases


 

Fracture Healing is a balance between stability and biology

3 Phases:

 

Inflammatory 1-5 days

Reparative 4-40 days

Remodelling 25-200 days (can go for more much longer)

Healing by Callus

 

6

What are the Local Factors influencing Fracture Healing?


 

Injury – configuration/soft tissue injury

 

Bone – cancellous v cortical

Treatment – reduction (restore anatomy)/ stability (e.g. plaster, frame, screws, rod) / infection

 

7

What are the Regional and Systemic Fractures influencing Fracture Healing?

Regional


 

Blood supply / muscle cover

Systemic

 

Age/co-morbidity (e.g. renal failure)/ bone pathology / head injury (healing speeds up due to the response to the head injury)

 

8

What is Pearson's Rule?

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9

What happens when fracture healing goes wrong?


 

Malunion (healed in the wrong position) --> deformity, late arthrosis (degeneration of articular cartilage with a subsequent change in the bony articular surfaces, development of osteophyte, deformation of the joint and the development of moderate synovitis)

 

Non-Union: hypertrophic (extra callus has been laid due to lots of movement causing instability – hypertrophy is body’s response to try to achieve stability), atrophic (no healing potential)

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10

What are Early Local Fracture Complications?


 

Nerve injury

 

Vascular injury

Compartment syndrome

Avascular necrosis

Infection

Surgical

 

11

What are Early Systemic Fracture Complications?


 

Hypovolaemia (due to blood loss) / shock

 

Fat embolism --> due to fat being released from bone fracture (yellow marrow) --> same effect as pulmonary embolism

Acute respiratory distress syndrome

Disseminated intravascular coagulation (all clotting factors have been used up --> continuous bleeding)

 

12

What are Late Local Fracture Complications?


 

Delayed union

 

Non-union

Malunion

Myositis ossificans

Re-fracture (muscle doesn’t heal properly – becomes calcified --> joint stiffens)

 

13

What are Late Regional Fracture Complications?

Osteoporosis

Joint stiffness

 

Chronic regional pain syndrome

Abnormal biomechanics

Osteoarthrosis

 

14

What is Compartment Syndrome?

raised pressure within an enclosed fascial space leading to localised tissue ischaemia

Pain – excessive/progressive/not relieved by analgesia / ‘passive stretch pain’

Neurovascular changes are late – by the time the pulses have disappeared an amputation is required

If in doubt, perform surgical decompression

 

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15

Check for puncture wounds when looking at Open v Closed Fractures. How do you assess Open Injuries?

(After surgical removal of dead tissue)

Gustillo and Anderson

I: <1cm, clean

II: >1cm, mod contamination (most common)

III: high velocity, farmyard (including neurovascular damage)

A: adequate skin cover

B: bone exposed

C: circulatory compromise

 

16

What do you consider when looking at Children's Fractures?


 

Incomplete Fractures:

 

  • Buckle (Torus) fractures – compression (the topmost layer of bone on side of the bone is compressed causing the other side to bend away from the growth plate)
  • Greenstick fractures - Tension

Rapid healing

Growth plate (Epiphyseal) fractures

Non-accidental injury

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17

What do you need to consider when looking at Epiphyseal Fractures?

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18

What are Stress Fractures?


 

Repetitive, non-violent ‘subtle’ stresses

 

‘Fatigue’ v ‘Insufficiency’ – bone hasn’t had time to develop e.g. suddenly running a marathon

Female > men

Predispositions: osteoporosis, sports, eating disorders

 

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19

Discuss Osteoporotic Fractures


 

Osteoporosis is characterised by low bone mineral content, enhanced bone fragility and consequent increased fracture risk/

 

Sensitivity to osteogrens

Prevention: weight-bearing exercise pre 35 years, vitamin D + calcium

Diagnosis: DEXA Scan wrist / hip / spine (compare against normal bone)

 

20

Discuss Non-Operative Treatment

Protection

Wool and crepe

 

Sling / collar and cuff

Crutches

Cast – POP / fibreglass

Functional brace

Traction – skin / skeletal

 

21

Discuss Operative Treatment

Protect soft tissues / avoid infection

 

Open or closed reduction (break put in right space)

Implants – biologically inert

Anatomical reduction *intra-articular*

Inter-fragmentary compression

Stable fixation

Early joint / muscle rehabilitation