Treatment of Fractures Flashcards by Alicia Daum

What does the skeleton provide for the body?

Strength
Stiffness
Rigidity

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Types of Cells within Bones

Osteoblasts
Osteocytes
Osteoclasts
Marrow elements

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What does type 1 collagen provide for the bone?

Tensile strength

Resiliency

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What does the periosteum provide for healing of fractures?

Vascular supply

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What triggers the healing process in bone fractures?

Bleeding

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3 Phases of Fracture Healing

Reactive phase
Reparative phase
Remodeling phase

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What is part of the reactive phase of fracture healing?

Fracture &amp; inflammatory phase
Formation of granulation tissue formation
Vessels contrac
Hematoma
Fibroblasts take over

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Parts of the Reparative Phase of Fracture Healing

Cartilage callus formation
Lamellar bone deposition
Periosteal cells -> chondroblasts
Form fracture callus

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Parts of the Remodeling Phase of Fracture Healing

Remodeling to original contour

Trabecular bone replaced with compact bone

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Factors Affecting Healing Rates

Age
Comorbidities
Nutritional Status
Thyroid &amp; GH levels
Calcitonin

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Common Conditions that Impair Healing

DM
Arteriovascular disease
Anemia
Vitamin A, C deficiencies
Tobacco use
Chronic alcohol abuse

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Medications that Impair Healing

NSAIDs
Glucocorticoids
Cipro

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Evaluation of the Fracture Patient

Vitals
Mental status
Mechanism of injury
Neurovascular status of the extremity
Where is the deformity?
Open or closed?
Check joints above and below
Minimum of 2 X-ray views

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Common Fractures when Landing on an Outstretched Hand

Scaphoid
Radial head
Wrist
Proximal humerus

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Common Fractures When Falling off of a Roof

Os calcis
Tibial plateau
TL compression fracture

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Describing Fractures

Name of bone
Location
Orientation of fracture
Condition of overlying tissues (open vs. closed)
Unique fracture names

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Location of Fractures

Dorsal
Volar
Epiphysis
Metaphysis
Diaphysis (proximal, middle, or distal third)

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Orientation of Fractures

Transverse
Oblique
Spiral
Angulated
Comminuted
Segmental
Intra-articular
Displaced
Compression
Impaction

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Unique Names of Fractures

Supracondylar
Colles
Boxer’s

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Factors that Effect Treatment

Open vs. closed
Nature &amp; severity of fracture
Possible neuro-vascular injuries/complications
Age
Health
Demands of patient

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Complications of Fractures

Pelvic &amp; femoral: severe bleeding
Injuries to other structures
Acute compartment syndrome
Increased risk of venous thrombosis with major trauma
Fat embolism syndrome 
Complex regional pain syndromes
Osteomyelitis
Non/mal-union, post-traumatic arthritis

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Principles of Fracture Treatment

Acute stabilization

Definitive treatment

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Possible Options when Stabilizing a Fracture

Splinting
Provide analgesia: ice, elevation, pain meds
Decide on definitive treatment

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Definitive Treatment of Fractures

Create conditions where body will heal the fracture while keeping the patient as functional as possible

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Treatment Options for Fractures

``` Reassurance Immobilization: cast, sprint, brace Traction: more historical Reduction: cast, hardware, both Surgical fixation ```

When is surgical fixation warranted?

``` Displaced,unstable fractures Early mobilization Quick return to function Displaced intra-articular fractures Down side: cost, complications ```

When are casts the prescription of choice for fractures?

Undisplaced Stable Some reduced fractures

How do you cast a diaphyseal fracture?

Include joints above & below

Complications of Casting

``` Pressure sores Neurovascular compromise Compartment syndrome Disuse atrophy Joint stiffness ```

Surgical Options for Fractures

``` Pins & wires Plates & screws External fixtures Intramedullary devices Replacements ```

Unique Fractures in Children

``` Buckle (torus) Growth plate injury Greenstick Plastic deformation Apophyseal avulsion ```

Salter Harris Classification of Fractures in Children

1: undisplaced 2: physis + metaphysis 3: physis + epiphysis 4: across the physics 5: crush injury

Treatment of Stable Mid-Shaft Clavicular Fractures

Sling | Figure 8 splint

Treatment of Displaced, Angulated, or Over Riding Clavicular fracture

Surgery

Treatment of Distal Third Clavicular Fractures

Undisplaced: conservative Others: surgery

Treatment of Proximal Third Clavicular Fractures

High energy injury Rare Watch for internal injuries

When do shoulder fractures generally occur?

Advancing age | Fall from standing height

Treatment of Impacted or Non-Displaced Shoulder Fractures

``` Sling Limitation of activities Pain meds Mobilize as tolerated PT/OT Sleep in recliner initially ```

What shoulder fractures should be referred to a specialist?

Anatomic neck Complex fractures Dislocations

What distal forearm fractures in children need to be referred?

Neurovascular compromise Open fractures Gross deformity Displaced Salter fracture

Treatment of Stable Distal Forearm Fractures in Children

Cast Brace Depends on patient/parent preference

Describe a Colle's Fracture

Dorsal displacement/angulation of distal radius | Increased risk with age

Treatment of a Colle's Fracture

Splint Pinning Plating

What does treatment of metacarpal fractures depend on?

Displacement Angulation Rotation

What determines treatment with a base of thumb fracture?

Stability of thumb joint

How do vertebral compression fractures occur?

With/without trauma | Osteoporosis

Treatment of Vertebral Compression Fractures

Pain relief Correction of osteoporosis Bracing Surgery

What does bracing provide for a compression fracture?

Pain relief | Increased activity

When is surgery performed for a compression fracture?

Neuro compromised | Unresponsive patient

Caution with Pelvic Fractures in Children

Major trauma Blood loss Injuries to other organs

Pelvic Fractures in the Elderly

See pubic rami or sacral fractures with minimal trauma

Risks for Pelvic Fractures in the Elderly

``` Osteoporosis Low body weight Smoking Steroids Limited activity ```

When should we be suspicious for a pelvic fracture in the elderly?

Vague pelvic pain Pain with leg motion Inability to bear weight

Diagnosing a Pelvic Fracture in the Elderly

X-rays | MRI

Treatment of Pelvic Fractures in the Elderly

Pain control | Early, protected ambulation

What is a significant source of morbidity & mortality in the elderly?

Hip fractures | Could be pathologic fractures

Treatment of Hip Fractures

Surgery: either pinning or total hip if previous arthritis

Diagnosis of Femoral Neck Fractures

Shortening & external rotation of leg | Groin pain

Treatment of Femoral Neck Fractures

Replacement > pinning

Treatment of Intertrochanteric Hip Fractures

Surgery: plate & screws

Major concern with Intertrochanteric Hip Fractures

Blood loss | Type & screen prior to surgery

Subtrochanteric Hip Fractures

Unstable Intramedullary device Significant blood loss

Location of Low Energy Tibial Shaft Fractures

Distal metaphysis

What type of tibial fractures are caused by rotational injuries?

Spiral Oblique Distal fractures

Location of High Energy Tibial Fractures

Mid-shaft fracture

Treatment of Tibial Shaft Fractures

Orthopedist Conservative (stable) Most: surgery

When do adults usually obtain ankle fractures?

Twisting injuries of the foot/ankle

Physical Exam Findings in Ankle Fractures in Adults

Neurovascular status | Medial & lateral tenderness

Treatment of Stable Ankle Fractures in Adults

Conservatively

Treatment of Unstable Ankle Fractures in Adults

Surgery

When is surgery mandatory for ankle fractures?

Ankle joint diastasis | LOOK AT MORTICE

Conservative Treatment of Forefoot Fractures

Short leg walking cast Walking boot Stable toe fracture: buddy tape Displaced or unstable toe fracture: pinning

Treatment of Metastatic Fractures

Stabilize fracture Remove tumor Early lesion (pre-fracture): radiotherapy

Diagnosing a Stress Fracture

X-ray: often not seen | MRI or bone scan

Treatment of Stress Fractures

Most: decreased activity, immobilization

Fractures & Child Abuse Signs

Injuries inconsistent with history Metaphyseal corner fracture Rib, sternum, scapula, spinous processes fractures Multiple fractures in different stages of healing Bilateral long-bone fractures Skull fractures in children less than 18 months

When to Refer Fractures to Ortho

``` Open injuries Neurovascular compromise High energy injuries Excessive pain Significantly angulated or displaced fracture Hip fractures Scaphoid fractures Displaced long bone fractures Patient or parent concerns ```

Treatment of Fractures Flashcards

(77 cards)