Splinting and Fractures

Question 1

Osteoblasts

Answer 1

Derived from mesenchymal cells
Produce osteocalcin
Needs 1,25-Dihydroxyvitamin D
Produce Type I collagen

Question 2

Osteoblasts are effected by?

Answer 2

Interleukins
Platelet derived growth factor
Insulin derived growth factor

Question 3

Receptors for osteoblasts

Answer 3

Estrogen 
Prostaglandins  
Glucocorticoids  
1,25 vitamin D  
PTH

Question 4

Osteoclast stimulated by?

Answer 4

stim by calcitonin and inhibited by PTH

Multinucleated Giant cells

Question 5

collagen

Answer 5

90% of organic matrix

Tensile strength

Question 6

Prosteoglycans

Answer 6

Inhibit mineralization

Partially responsible for compressive strength

Question 7

3 Non-Collagenous proteins

Answer 7

Osteocalcin
Osteonectin
Osteopontin

Question 8

Bone Matrix (inorganic)

Answer 8

Calcium Hydroxyapatite
Responsible for compressive strength
Osteocalcium Phosphate
Brushite

Question 9

Cortical bone (Lamellar)

Answer 9

80% of skeleton
Haversian canals – nutrient supply
Stress oriented formation

Question 10

Cancellous bone (Lamellar)

Answer 10

Trabecular (spongy)

Higher rate of remodeling

Question 11

Immature (Woven)

Answer 11

Not stress oriented
Elastic in nature
Embryonic skeleton
Fracture healing

Question 12

Pathologic (Woven)

Answer 12

Random organization
Weak
Tumors

Question 13

Inflammatory response

Answer 13

Bleeding to area of insult

Hematoma – fibrin clot, growth factors

Question 14

repair of fracture

Answer 14

Primary callous @ 2 wks
Bridging occurs
Assisted by medullary callous

Question 15

remodeling of fracture

Answer 15

Initiates during repair

Complete when repopulation of marrow space

Question 16

initial response for fracture healing

Answer 16

decrease blood flow
Hours – days begins increase
Regional acceleratory phenomenon-
Returns to normal 3-5 months

Question 17

kids bone pathology

Answer 17

Thicker periostium

Cambium has increased ability for osteoblast formation

Question 18

Wolffs Law

Answer 18

Decrease stress = decrease density
Piezoelectric charges
Compression – electronegative
Stimulates osteoblasts
Tensile – electropositive
Stimulates osteoclasts

Question 19

Classification of Bones (6)

Answer 19

Long bones
Short bones
Flat bones
Irregular bones
Sesamoid bones
Accessory bones

Question 20

Closed reduction fractures

Answer 20

Most fractures can be treated closed
Must understand anatomy
Need good plain films minimum of 2 views
Peri-ostium can hold you up
Can’t accept rotation deformity
Difficult to manipulate after 10 days

Question 21

Kids and Fractures

Answer 21

Kids - angulations can be accepted
Kids remodel
Mid-shaft doesn’t remodel as well
Kids ok for shortening
Kids rarely form non-unions
Kids rarely need physical therapy

Question 22

2 layers of physis

Answer 22

Horizontal - physis

Spherical- epiphysis

Question 23

2 types of growth plate fractures

Answer 23

Traction
Usu. apophyseal
Compression
Usu. epiphyseal

Question 24

Salter Harris Classification Type 1

Answer 24

Type I – Transverse fracture through physis

Question 25

Salter Harris Classification Type 2

Answer 25

Type II – Fracture through physis with metaphysis fragment

Question 26

Salter Harris Classification Type 3

Answer 26

Type III – Fracture through physys with epiphysis fragment

Question 27

Salter Harris Classification Type 4

Answer 27

Type IV – Fracture through epiphysis, physis and metaphysis

Question 28

Salter Harris Classification type 5

Answer 28

Type V – Crush injury to physis

Question 29

Type I and Type II emergent open fractures

Answer 29

Type I <10 cm | Moderate energy

Question 30

Type IIIa emergent open fractures

Answer 30

Type IIIa High energy Adequate soft tissue coverage

Question 31

Type IIIc emergent open fractures

Answer 31

Type IIIc High energy Vascular injury

Question 32

Type IIIb emergent open fractures

Answer 32

Type IIIb High energy Massive soft tissue destruction Exsposed bone

Question 33

High complication rate of fractures in children

Answer 33

Supracondylar humerus fractures Radial neck fractures Radial head fractures Lateral condylar humerus fracture

Question 34

High complication rate of fractures in adults

Answer 34

Both bone extremity fractures Pilon fractures Distal Humerus fracture

Question 35

Splints for fractures

Answer 35

``` Immobilize fracture Joint above and below Allows for swelling Most swelling 6-12 hours post injury Extra padding to bony prominence Well applied splint is as good as a cast acutely ```

Question 36

Casting fractures

Answer 36

``` Apply after swelling decreases Extra padding of bony prominences Do not use fingers for molding Any complaints evaluate May need to remove Caution about reduction Apply without tension ```

Question 37

Caution for splinting and casting

Answer 37

Compartment syndrome Skin necrosis Foreign bodies

Question 38

Surgical Treatment for fractures

Answer 38

``` Percutaneous pinning Closed reduction with internal fixation Open reduction with internal fixation Intramedullary fixation External fixation ```