Week 2 Flashcards
Fractures (28 cards)
Types of classifications
- etiology
-fracture line/anatomical description
-involvement of the overlying skin (gustillo classification) - muller AO classification of fractures (based on anatomical location and clinical severity )
- slater-harris classification (only for childhood fractures involving growth plate)
-fractures specific classifications
According to etiology
- traumatic
-applied load exceeds elastic limits of bone (tension, compression, shear, bending or torsion) - stress or fatigue
-repetitive injury - pathological
-often the bone gives way from trivial injury or even spontaneous
-metabolic bone diseases; osteoporosis, rickets, scurvy, paget’s)
-endocrine disorders; HPT, crushing
- osteomyelitis; pyogenic, TB
- bone cysts and tumours; malignant, benign, primary, secondary
congenital bone disease; osteogenesis imperfect, osteoporosis
-bone marrow diseases (ALL, sickle cell anemia, Gaucher disease)
-fibrodysplasia
-neuromuscular disorders; polio, cerebra palsy
-immobilisation
-iatrogenic; radiation
according to fracture line
- transverse
- oblique
- spiral
- comminuted
- segmental
- avulsed
- impacted
- torus
- greenstick
- compression
based on involvement of the overlying skin
- Simple closed fracture: no communication between the site if fracture and the exterior of the body
- Compound open fracture: direct communication between the body surface and the fractured bone
types of open fractures
he mentioned in the lecture that you don’t need to memorise the types however just know
type 1 fracture: involves minimal soft tissue injury and no contamination
type 2 : extensive soft tissue damage and mild contamination
type 3: involves a, b, c however all involve severe contamination and sever loss of tussie or tissue damage and neurovascular damage
clinical determinants of traumatic fractures
- type of fracture line
- open versus closed fractures
- associated soft tissue injury (especially high-energy fractures)
- displacement /stability/impaction
- loss of joint integrity (subluxation/dislocation)
- involvement of articular surface
-epiphyseal injury
Stages of fracture healing
- Hematoma formation: disruption of blood vessels – formation of hematoma — inflammatory reaction and production of growth factors — recruitments of mesenchymal stem ells — differentiation into cartilage producing chondroblasts
- fibrocartilaginous callus formation; hyaline cartilage replaces hematoma bridging of fracture site with endochondral soft callus— more stability
- bony callus formation: mineralisation of cartilaginous matrix by osteoblasts forms bony callus and stabilises fracture
- bone remodelling; bone remodelling by osteoblast-osteoclast interaction fortifies the clallus along the mechanical forces while callus not in line with mechanical forces is reabsorbed
fracture is a process of regeneration or repair?
regeneration. regeneration is the replacement of lost dead or damaged tissue by the original tissue
timeline for fracture healing
three phases are
1. inflammation phase; its intensity of response is 10% and lasts 0-7 days
- reparative phase; its intensity of response is 40% and lasts 1 week to 3 months
- remodelling phase: its intensity of response is 70% and lasts months to years
fracture callus includes
- bone marrow
- intramembranous osteogenesis — periosteal cells
- endosteal cells — internal medullary callus
- endochondral osteogenesis —- external bridging callus
growth factors in fracture healing
- TGFB : mitogenic for undifferentiated mesenchymal cells
-BMPS: promote differentiation of mesenchymal cells into chondrocytes, osteoblasts
-FGFs : mitogenic for mesenchymal cells, chondrocytes, osteoblasts
-IGFs: mitogenic and promote differentiation of mesenchymal cells, osteoblasts
-PDGF: mitogenic for mesenchymal cells, osteoblasts
fractures in children
- higher capacity for healing; most often treated non-operatively
-majority are simple/closed fractures (97%)
- might cause permanent growth problems ; growth plate fractures or Salter Harris fractures
-often bend their bones rather than break them: incomplete fractures like greenstick and torus or buckle fractures
incidence of long bone fractures in children
Bone %
Radius 45.1
Humerus 18.4
Tibia 15.1
Clavicle 13.8
Femur 7.6
etiology of fractures in children
-accidental trauma
home, school, playground, and recreational activities, motor vehicle and road accidents
-birth trauma: clavicle, humerus, elbow, femur, vertebrae
-non-accidental injury : child abuse
-pathological
goals of fracture healing
-assurance of healing
-speed of healing
-avoidance of complications: local and systemic and complications of treatment
-rehabilitation
-cost-effectiveness
principles of treatment
-proper reduction;
1. closed reduction: most common procedure done under general anesthesia
2. reduction by mechanical traction: by weight or screw device especially in shaft of femur, displacement of cervical spines 3. operative open reduction: fractures involving articular surface and involvement of vessels and/or nerves
-immobilisation: aim of immobilisation is to
1. to prevent movement that may interfere with healing
2. to prevent displacement or angulations
3. to relieve pain
Method :
1. casts or external splints
2. sustained traction usually in combination with splints
3. external skeletal fixation
4. internal skeletal fixation
-preservation of function
types of internal fixation
- plates and screws ; used for long bones
- intramedullary nails: used for long bones, middle of the shaft
- compression screw plate: used for neck of femur and trochanteric fractures
- plates and nails: trochanteric fractures
- transfixition screws: small detached fragments ( olecranon, capitulum, medial malleolus)
- circumferential wires or bands; used for patella and mandible
immobilisation is not always required
-always require rigid immobilisation; scaphoid bone, shaft of ulna, neck of femur
- do not require immobilisation; scapula, ribs, clavicle, stable pelvic ring fracture
- may not require immobilisation; metacarpals, metatarsals, and phalanges
facilitation of healing
-electrical fields
-ultrasound
-bone grafts
-growth factors
assessing fracture healing
- radiological; intercortical bridgind, bridging by external or endosteal callus
-clinical: independent weight bearing, non-tender, no detectable movement
-biological: fracture stiffness, remodelling
complications of fractures: acute
-hemorrhage: femur, pelvis, skull, humerus, thorax
-visceral injury: ribs
-neurological damage :
1. peripheral nerves: femur, humerus, fibula
2. brain and spinal cord: skull and vertebra
-compartment synddromes
-crush syndrome
complications: intermediate
-locla infections;
1. wound infection: sepsis, tetanus, gas gangrene
2. osteomyelitis
-systemic infection:
1. pneumonia
2. sepsis
-thromboembolism
1. deep venous thrombosis: pulmonary embolism
2. fat embolism : DIC
complications: late
-limitation of movement
1. osteoarthritis
2. avascular necrosis
-ischemic contractures
1. volkmann’s contracturre
-permanent CNS or peripheral nerve damage
-impaired bone growth
-abnormal healing
-reflex sympathetic dystrophy
abnormal fracture healing
-delayed union
-mal-union
-non-union: fibrous, pseudoarthrosis
