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Gen Ortho- Fractures

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taylormaloney's version from 2016-12-05 03:46

Section 1

Question Answer
Define FractureA break in the continuity of a bone.
Define Closed vs Open FracturesClosed- the skin surrounding break is intact. Open/Compound- Bone fragments have pierced skin or body cavities.
Define Complete vs Incomplete FracturesComplete- bone is broken in two or more pieces. Incomplete- bone is bent or cracked but with periosteum intact.
What are the six types of complete fractures?Transverse, Oblique, Spiral, Comminuted, Avulsion, Osteochondral.
Would an oblique or spiral fracture heal quicker than a transverse fracture? Which is easier to put back into place?Oblique/Spiral are quicker to heal, but harder to keep together. Transverse- longer to heal, easier to keep together.
What type of fracture is most commonly unstable?Comminuted, due to 2 or more fragments broken off of the bones.
What is an avulsion fracture?A break caused by a ligament pulling away it's attachment from the rest of the bone.
What is an osteochondral fracture, and what type of injuries are likely to cause it?Fragments of articular cartilage sheared away from a joint surface. Dislocations/Sprains.
What are the four major types of incomplete fractures?Compression, Greenstick, Perforation, and Stress.
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Section 2

Question Answer
What is a Colle's Fracture?A transverse fracture of the radius just proximal to wrist.
What demographic is this fracture most likely to be seen in?#1 common fracture of elderly.
How would this fracture occur?Usually caused by FOOSH.
What type of deformity is associated with this fracture? 'Dinner Fork' deformity.
What is a Galeazzi Fracture?A fracture of the radial shaft combined with the dislocation of inf radioulnar joint.
How would this fracture occur?Usually a FOOSH with a rotational component.
What neurological consequences could occur from this type of fracture?Ulnar nerve lesion.
What is a Pott's Ankle Fracture?A break of the distal fibula close to the lateral malleoli.
Is the Pott's Fracture specific to the L malleoli?No, could affect medial, lateral or both.
What other damage could accompany this fracture?Possible rupture of the deltoid ligament and/or avulsion of medial malleoli.
What is a Dupuytren's Fracture?A combination of a fibular fracture higher up, avulsion of the medial malleolus, and superior displacement of the talus between the tibia and fibula.
How is this type of fracture likely to occur?Eversion of the ankle with some external rotation.
What type of mechanisms may be used to aid in the reduction and stabilization?Metal screws or wires.
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Section 3

Question Answer
What are the most common sites of stress fractures?Tibia, metatarsals, navicular, femur, and pelvis.
The head and neck of humerus are most likely to suffer what type of fractures?Complete fractures.
What are the causes of fractures?Trauma or sudden force causing more stress than the bone can absorb.
What is the difference between a Direct/Indirect Force- what type of fractures would be most likely caused by each?Direct- object striking bone causing breakage at point of impact. (Transverse, comminuted.) Indirect- Bone breaks at a distance from source of impact. (Spiral, stess.)
What other pathologies could increase the risk of fractures?Osteoporosis, tumours, local infections, or bone cysts.
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Section 4

Question Answer
What takes place during the first stage of fracture healing?Hematoma formation around ends of fracture within 72 hrs. Mesh of fibrin forms. Ends of bone die several millimeters from site of break.
What takes place during the second stage of fracture healing?Inflammatory reaction and proliferation of osteoblasts at periosteum. Formation of fibrocartilaginous bridge between ends.
What takes place during the third stage of healing?Soft callus formed from mass of osteoblasts, osteoclasts clean up debris. Immature bone at ends calcifies gradually- limiting the movement at the ends. Union formed by 4th wk, not yet matured. Cannot withstand stress, still tender locally.
What takes place during the fourth stage of healing?Immature woven bone changes into lamellar bone. Consolidation is complete due to ossification of callus. May take several months for bone to withstand stress. No tenderness.
What takes place during the fifth stage of healing?Remodeling of the irregular bone's outer surface, reshaping of marrow space within.
What is Wolff's Law and how does it relate to bone healing?Wolff's law states that bone responds to mechanical stresses placed on it by becoming stronger and thicker.
What causes the callus formation between the two ends of a broken bone?Micromovement, not immobility.
Healing by callus formation is referred to as..Indirect/Secondary healing.
When a broken bone is immobilized via plates/screws, how does healing take place?Osteoblasts and capillaries move into the gap between bones.
What is direct osteoblastic bone repair called?Gap Healing/Primary Repair.
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Section 5

Question Answer
What is the medical treatment given in the case of fracture?Reduction and the maintenance for the reduction to allow healing.
What are the two different categories of reduction and what is the difference?Open- surgical reduction. Closed- manual traction without surgical intervention followed by immobilization of reduction site.
What are the methods of holding reduction?Casting, continuous skeletal traction and external fixation.
Where is the most common site for the use of continuous skeletal traction?Femur/Tibia.
How does an open reduction take place?Bone fragments stabilized with plates/screws/wires etc,
What is an external fixation?Fragments secured via screws/wires/plates, then attached to external frame which is adjusted throughout healing process.
What type of reduction is most likely to be used in the case of an open fracture?External fixation, due to the ease of caring for the wound site.
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Section 6

Question Answer
What are some early complications relating to fractures?Torn mm's/lig/tendons, compartment syndrome, nerve injuries, vascular injuries, joint hemarthrosis, bone/soft tissue infections, DVTs.
What is Compartment Syndrome?Swelling caused by edema/hematoma/inflammation increased pressure within fascial compartment. Causes ischemia and reduced circulation, which further increases pressure. Muscle/nerve tissues begin to necrose.
Where is compartment syndrome most commonly seen?Forearms and legs.
What are the potential late complications following a fracture?Delayed union, malunion, non-union, myostitis ossifcans, nerve compression, nerve entrapment, bony necrosis, volkmann's ischemic contracture, joint stiffness and disuse atrophy.
What is Volkmann's ischemic contracture?Flexion deformity, muscle atrophy, stiffness, and parasthesia caused by ischemic contracture. Likely seen in forearm and hand.
What are the common symptoms seen in a fracture immediately after it takes place?Unnatural mobility and deformity, shock, pain, bleeding, swelling, loss of function, muscle splinting and edema. Soft tissue injuries.
What are the common symptoms seen in a fracture during mobilization?Pain is present locally and possibly at a distance, tissue repair and callus formation, adhesions developing, decreased circulation, edema, disuse atrophy and CT contractures. HT and TPs.
What are the common symptoms seen in a fracture after immobilization has been removed?Decreased tissue health, tissue fragility, decreased mm tone, adhesions matured, CT contractures, pain and stiffness on joints affected, scars, HT and TPs, muscle weakness and disuse atrophy. Altered gait/posture.
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