Radiology - Fracture and Bone Healing

klistu's version from 2016-03-27 21:14


Fracture Terminology
Question Answer
Pulloff fracture consisting of a fragment of bone pulled off by a muscle, tendon, or ligamentAvulsion Fracture
Triangular shaped cortical fragment that is part of a communuted fractureButterfly Fracture
Small fragment of bone from a joint marginChip/Corner Fracture
Fracture that does not penetrate the skinClosed Fracture
Fracture consisting of more than 2 piecesComminuted Fracture
Telescoping of the bone segments of the fracture that results in shortening of the segment (also called bayonetting)Impaction Fracture
Incomplete fracture in which one cortex is affected and the fracture line follows down the axial line of the boneGreenstick Fracture
Trabeculae are buckled inwards with a cortical bulge around the fracture siteTorus Fracture
Pathological fracture caused by normal physiological stresses through a diseased boneInsufficiency Fracture
Fracture that is 45 degrees from the long axis of the boneOblique Fracture
A fracture that is subtle and difficult to identify Occult Fracture
A fracture where the skin is penetratedOpen/Compound Fracture
A fracture where only 2 bone fragments are involvedSimple Fracture
A fracture that is circumferential and longitudinal in boneSpiral Fracture
A fracture due to repetitive stresses, no fracture line is apparent but a bony callus forms 10-14 days later on x-rayStress Fracture
Fracture at 90 degrees to the long axis of boneTransverse Fracture


Question Answer
Reparative Phasegoverned by vascularity, involves the formation of callus
Remodeling Phasethe callus is resorbed and the trabecular bone is remodeled along lines of stress resulting in bone that is stronger than when it broke
Collar Callusforms around the bone to stabilize, dictated by the periosteum
Internal Callusdictated by the endosteum and dictates bridging and union between the two segments
Compressionencourages bone rather than fibrous tissue formation
Clinical Unionthe goal of reduction, the resolution of symptoms with palpable rigidity to the affected bone
Cortical HealingLimited by vascularity and the amount of movement permitted during the healing phase
Delayed Unionunion is not achieved within the expected time (6 weeks) due to inadequate reduction, soft-tissue imposition in the fracture, excess soft tissue destruction, vascular disruption, inadequate immobilization, fragment distraction or inadequate fixation
Non-Unioncomplete arrest of bony repair, replaced instead by fibrous, cartilaginous, or synovial compensation for the fracture site. Some say it can be diagnosed within 3 months while others wait 6-8 months post fracture.
Periosteum fibrous sheet around bone. Outer fibrous and inner cambium layer.
Cambiumresponsible for active new bone proliferation during fracture repair, contains osteoblasts and undifferentiated cells.
Endochondral Ossificationmechanism for tubular bone growth and secondary repair
Intramembranous Ossificationmechanism for flat bone growth and primary repair
Induction during Inflammatory Phasefibroblasts differentiate to become osteoblasts
Inflammation during Inflammatory Phaseperiosteum, soft tissue, and haversian blood vessels tear, hematoma forms and is invaded by primitive pluripotent cells/osteoblasts.
Remodeling phaseImmature woven bone replaced by lamellar bone
Cancellous Bonebetter prognosis, rapid repair, rich in blood supply, and lack of callus
Cortical Bonepoor prognosis, slower repair process, limited vascularity, and extensive callus
Primary bone healingoccurs when fracture is stable and in close proximity or when rigid internal fixation is used, bone healing proceeds without formation of external callus and without intermediate cartilaginous stage


Question Answer
Horse Hoofa hypertrophic non-union caused by inadequate internal fixation that has allowed movement across the fracture site
Elephant Foota hypertrophic non-union caused by early WB and inadequate stabilization
Oligotrophica hypertrophic non-union caused by inadequate alignment of the fracture ends
Torsion Wedgea hypotrophic non-union where only some pieces of the fracture fuse because of inadequate vascularity
Comminuteda hypotrophic non-union where one or more fragments has become necrotic and the callus fails
Defecta hypotrophic non-union where there is a loss of devitalized fragment of cortical bone that leaves a dead space in the bone that can’t be bridged
Atrophica hypotrophic non-union where intermediate fragments are missing and scar tissue that does not have osteogenic potential takes its place


Question Answer
Areas stressed or under compression in electrical bone growth stimulationelectronegative
Areas under tension in electrical bone growth stimulationelectropositive
Too little currentno bone growth
Too much currentnecrosis
Stimulates expression of genes involved in the healing process and incorporation of calcium in chondrocytes and boneUltrasound Bone Stimulator

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