Week 1. Bone Fractures Flashcards
(11 cards)
Which age groups have the most fractures and why? Which bones are most common?
15-24 usually secondary to trauma. Tibia, clavicle, lower humerus
>65 usually secondary to OP. Upper femur, upper humerus, vertebrae, pelvis.
What is a pathological fracture? Discuss.
When a small/moderate force acts on a weakened or diseased bone, causing fracture. May be caused by:
- Focal bone lesions (neoplasms, cycsts, infections)
- Metabolic disorders - lead to poor mineral absorption and hormonal changes that decrease bone calcification
- Disuse - muscle atrophy and osteopenia
Discuss the classification of Fractures.
- Aetiology - Physiological (strong force, normal bone) / pathological (weak force, weak bone)
- Location of force on bone - direct (fracture at point of trauma) / indirect (bone breaks at distant site)
- Visual characteristics of fracture - Spiral, transverse, oblique, chip, impacted, linear depressed
- Type of bone damage - compression, comminuted (splintered/ fragmented), avulsion (pull from joint capsule, ligament, tendon or muscle), greenstick (incomplete fractures involving one side of periosteum), complete (disrupted of both sides of periosteum)
- Skin trauma - closed / simple, open / compound
List and describe the events occurring during the healing of fractures. Discuss the approximate times necessary for each stage.
- Haematoma Formation.
a. Intense / acute activation and migration of inflammatory cells
b. Activation and proliferation of local connective tissue cells (3 BLASTS - osteo, fibro, chondro) - Procallus formation - Organisation of haematoma into granulation tissue.
a. Phagocytes remove debris and kill bacteria
b. Formation of woven bone (Osteoblasts), collagen (fibroblasts) and cartilage (chondroblasts)
c. Angiogenesis - Fibrocartilaginous callus formation
a. Rapid formation of collagen (fibroblasts) and cartilage (chdonroblasts) cause fibrocartilaginous callus composition - requires limited oxygen - Bony callus formation
a. Blood vessels have invaded deepest part of callus forming rich network (increased oxygen) - increased osteoblastic and osteoclastic activity
b. Destruction of fibrocartilage (osteoclasts) and increased woven bone formation (osteoblasts) - Remodelling of bony callus
a. Osteoclast activity > osteoblast activity
b. Woven bone destroyed (osteoclasts) and replaced by compact bone (osteoblasts)
c. Internal and external calluses reabsorbed
List the signs and symptoms that could indicated the presence of a fracture.
General Ssx
- Shock
- Ssx of secondary damage sustained by CNS or viscera
- Ssx of underlying disease
Local Ssx
- Observation – Deformity, oedema, bruising, loss of function
- Palpation – Pulselessness (BVs compromised), paraesthesia (nerves compromised), tenderness
- Movement – Abnormal movement, local muscle spasm, crepitation
Local and systemic causes of delayed healing
- Average fracture takes ~6 weeks to heal (depending on age, type of bone broken, general health etc)
Local:
- Malalignment
- Excessive movement
- Communition
- Bone disease
- Severe soft tissue injury
- Infection
- Ischaemia
- Soft-tissue interposition
Systemic:
- Mineral deficiency
- Vitamin deficiency
- Systemic infections
- Ischaemia (eg atherosclerosis)
- Endocrine disease (eg hyperparathyroidism, hyperthyroidism etc)
- Medications
- Poor general health
- Advanced age
Briefly define the following term:
delayed union
prolonged healing time
Briefly define the following term: Non-union
bone ends fail to unite
Briefly define the following term: malunion
union of bone in non-anatomical position
Psudoarthrosis
Non-union in which a fluid filled space forms between fractured ends of a bone
list the complications of a fracture
- Delayed healing
- Bone necrosis
- Shock
- Infection (open / compound fractures)
- Deformity
- Fat embolism
