Radio-Fractures and healing

britt611's version from 2017-01-25 23:29

Section 1

Question Answer
What should you have to evaluate a radiograph for a fracture2 perpendicular views, poss sedation/anesthesia, opposite limb for comparison, joint space above and below, immediate post operative radiographs
What does the quality of the radiography for fracture recognition depend on?X-ray beam direction
what should you evaluate when assessing a possible fracture degree of displacement, overlying structures and key to know your anatomy!
How do you classify fractures?based on: external communication, extent of damage, direction, complexity, location, special types
What are examples of external communication?open vs closed
what are examples of extent to damagecomplete/incomplete
what are examples of complexitysimple vs comminuted
what are examples of locationsdiaphyseal, metaphyseal, physeal
what are 2 examples of special types of fracturesavulsion, pathologic

Section 2

Question Answer
Define open fractureexternal communication with wound/skin lesions
what might you see in an open fracturegas within soft tissue, large soft tissue defect, causative agent (ballistic object)
Define complete fractureboth cortices involved
define incomplete fractureonly one cortex involved
what do you see with an incomplete fracturegreenstick = folding fracture, fissure lines
What are examples of how to describe the direction of a fracture?transverse, oblique, spiral
Define comminuted fragement multiple fracture lines, usually meeting at a common point. can be one or several small fragments (butterfly fragment)
define segmental fragment2 or more fracture lines and fracture lines do NOT connect (difference from comminuted)
low vs high salter harris classificaiton of physeal fracturecorrelated with prognosis- higher the number the more likely to cause retardation of physeal growths
what are some example so what SH fractures can causeshortened bones, angular limb deformities
SH type 1through the physis
SH type 2thorugh the physis and metaphysis
SH type 3through physis and epiphysis
SH type 4through epiphysis, physis and metaphysis
SH type 5crush of physis
what is the most common SH fracture?type 2, fracture line travels through growth plat and extended into the metaphysis
which fragmented piece is most displaced?DISTAL

Section 3

Question Answer
What are some examples of specific fracture classificationsavulsion, impacted/compression, condylar/intercondylar, T-Y bicondylar, chip, slab
what are avulsion fractures?at a site of soft tissue attachment, common at apophysis
what might help evaluate an avulsion fractures stress views
what is a impacted/compression fracture?bone is crushed- forshortening and/or sclerosis of the vetebral bodies or open physes
what breed is intracondylar fractures common in?cocker paniels
what is an intracondylar fracturea fracture between 2 centers of ossificaiton
What is a T-Y fracture?break through the cortex and condyle
What is a chip fracture?involveds one articular surface- small bony fragment
what species are chip fractures inhorses
what are some causes of chip fracturesdirect bony trauma, hyperextension injury
What is a slab fractureinvolved 2 articular surfaces
what species are slab fractures seen inhorses

Section 4

Question Answer
what are 3 examples of fractures that have specific classification based on causeFatigue/stress, pathologic, folding
What are causes of fatigue/stress fracturesrepeated trauma or cyclic loading
what animals do you see fatigue/stress fractures in?performance horses, racing greyhounds
what are pathologic fractures due to? neoplasia, osteomyelitis, osteopenia, infection, hyperparathyroidism
what are folding fractures typically due to?osteopenia, hyperparathyroidism
what is a pathologic fracture?bone is weakened by pre-existing distease- fractures spontaneoulsy with mild or no trauma history (jumping off the couch)
what is important to remember when assessing pathologic fractures?lysis may be hard to see- so take 3 views!
what is the most common cause of pathologic fracturesneoplasia- osteosarcoma - fracture may be first sign of disease
describe a folding fracture from hyperparathyroidismbone appear less opaque with thin cortices, cortex is bent, fracture line appear sclerotic (overlapping), no distraction of fragments
What are general description word when reporting an orthopedic traumabone involvement, location, open vs closed, complete vs incomplete, simple vs comminuted, direction of fracture line
what are some anatomic positiong changes to consdier when reporting an orthopedic traumalength, angulation, displacement of distal fragment

Section 5

Question Answer
What are 2 types of fracture healingprimary (direct healing of bone by osseous tissue) and secondary (callus formation)
Where does primary bone healing take placeoccurs under rigid fixation- anatomic reduction and compression
what is primary bone healingdirect contact and extension of haversian osteons unite fragments
how is primary bone healing characterized radiographically?lack of periosteal callus, gradual loss of fracture lines
is primary or secondary healing slower?primary
which is the most commonly encounted form of bone healing?secondary bone healing
what is secondary bone healingfibrous connective tissue or fibrocatilagenous callus that is replaced by bone
what are the steps of secondary bone healingcallus formation which matures through a sequence of granulation tissue --> cartilage --> mineralized cartilage --> bone
what is the initial injury of secondary bone healingSHARP fracture ends; soft tissue swelling
Week 1 of secondary bone healingloss of sharp margins --> bone resorpiton --> increase fracture gap
week 2-3 of secondary bone healingvariable amounts of early periosteal and endosteal reaction ; decreased soft tissue swelling; hairline fracture widen
week 4-8 of secondary bone healingcallus is smoother with cuff of bone beginning to bridge gap--> filing in the fracture line
week 8-12+ of secondary bone healingremodeling of callus with reduction in size; restoration of cortices and cancellous bone pattern
What if there is not SHARP fracture ends?we think its an old fracture 7-8 days old

Section 6

Question Answer
what are some factors that affect fracture healingage (exuberant callus in young), nutritional, vascular integrity, fracture location (metaphyseal heal quicker), degree of motion, fracture type, degree of post reduction apposition
what part of the bone heals the quickestmetaphyseal
what type of callus can you find in younger animalsexuberant callus
what are some favorable conditions influencing rate of bone healing?immobilization, fracture is ina location of cancellous bone (blood supply), minimal soft tissue trauma, no infection
how long does it take for an immature, mature and aged animal to healimmature = 3-6 weeks, mature= 5-8 weeks, aged 7-16 weeks
what are some complication of fracture helaingabsence of callus formation, instability/large fracture gap, zone of decreased opacity around fixator, bending/breaking of implant (failure), aseptic necrosis, fracture associated sarcomas
what does zone of decreased opacity around fixator meaninstability or infection = osteomyelitis
what bone is associated with fractures associated with sarcomafemur (many years post)
What can you see with osteomyelitisdraining tracts, delayed healing, implant migration, non-reactive bone
What can premature growth plate closure of the radius causeslowed growth of radius leads to subluxation of humeral-radial joint and profound DJD
what are some causes/signs of neoplastic tranfomationco-incident or spontaneous- carinogenesis from metal corrosion bi product, co-carcinogenic effects of chronic inflammation

Section 7

Question Answer
What are 4 complications of fracture healing?delayed union, non-union, malunion, sequester
define delayed unionnot healed in expected time for bone/patient age
define non-unionqwhen all signs of repair have ceased and further healing will not occur with out surgical intervention
define malunionhealed or healing in a non-anatomic position
define sequestersclerotic fragment outlined by decreased opacity, involved a involucrum and +/- cloaca
what are 2 forms of non-unionatropic (no callus), hypertrophic (attempted callus)
describe atrophic non union poor leading response due to lack to blood support - fracture ends are pencil shaped
what breeds do atrophic non union commonly occur intoy breeds - radius/ulnar fracture
describe hypertrophic non unionlarge amount of callus, due to too much mobility at fracture site, blood supply is adequate, fracture ends look like elephant feet and are slcerotic
define involucrumis an outer rim of sclerotic bone surrounding a sequestrum
what is acloacaa draining tract
what are 3 examples of fracture disease that can cause complication of fracture fixationosteoporosis (bone atrophy) from disuse, mucle contacture and fibrosis, joint rigidity associated with capsular contracture
when should you recheck bone fractruesevery 4-6 weeks, if infection is suspect do every 7-10 days