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54 Cards in this Set
- Front
- Back
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THREE TYPES OF FRACTURES
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TRAMATUIC
PATHOLOGIC STRESS |
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D TRAMATUIC FRACTURES
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NORAML BONE WITH ABONRMOAL LOAD EX. CAR CRASH
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D PATHOLOGIC FRACTURE
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ABNORMAL BONE, NORMAL L OAD
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D STRESS FRACTURE
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NORMAL BONE, NORMAL LOAD BUT ABONRMAL FREQUENCY OF LOADING
OVERUSE |
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WHAT DO OSTEOCLASTS DO
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DECREASE PH THEREFORE MAKING HYDROXYAPAPTIE SOLUBLE
BREAK DOWN BONE |
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WHAT DO OSTOBLASTS DO
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THEY LAY DOWN OSTEIOD AND CAUSE MINERALIZAITON OF BONE
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D WOLF LAW 1892
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BONE ADAPTS AND RESPONDS TO SRESS
Alterations in shape of bone Change in inner structure of bone Change in distribution of matrix |
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REMODELING OF BONE IS CAUSED BY
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STRESS( FORCE) AND STRAIN (DEFORMATION)
Gravitational forces Impact Muscle pull Muscle fatigue |
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BONE ADAPTATION DEPENDS ON
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Number of loading cycles
Frequency of loading Amount of strain Strain rate Strain duration per cycle |
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Stress and Strain produce distortion in cell membranes with resultant
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changes in electrical potentials
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Convexity has positive charge and leads to
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resorption
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Concavity has negative charge and leads to
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deposition
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BONE GROWTH HORMONES
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INUSLIN
THYROXIN SOMATOMEDIN |
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STRESS FRACTURES HAPPEN WHEN
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REMODELING IS OUTPACED BY FATIGUE
DUE TO FREQENT REPITITION OF NORMAL LOADS |
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STRESS FRACTURES MOST COMMON IN
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LOWER EXTREMITY
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D FEMALE ATHLETE TRIAD
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ABONRAML MENSES
DISORDER EATING BONE LOSS/STRESS FRACUTRES THIS IS MORE OF A NUTRITIONAL THAN OVERUSE DISEASE |
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STRESS FRACTURES ARE CHARACTERIZED BY
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PAIN DURING LOADING. IT IS TENDOR TO TOUCH.
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ABNORMAL MENSES ARE ASSOCIATED WITH
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AN ABNORMAL BONE DENSITY
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D OSTEOPESROSIS
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decrease in bone mass, bone density 2.5 standard deviations below the peak of a 25 y.o.
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D OSTEOPENIA
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decrease in bone mass, between 1 and 2.5 standard deviations below the peak bone density of a 25 y.o.
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T/F 26 PERCENT OF REGULARLY MENSTRUATING EXCERCISING WOMEN HAVE OSTEOPENIA
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T
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WHAT DOES A PATHOLOGIC FRACURE HISTORY LOOK LIKE
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-HISTORY OF LOW GRADE ACHING
-SUDDEN ONSET OF PAIN -LOW ENERGY INJURY |
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CAUSES PATHOLOGIC BONE
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Osteomalacia-metabolic
Osteoporosis/osteopenia Primary tumor Metastatic tumor Bone cysts Infection |
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METASTIC TUMORS ARE MOSTLY COMMONLY FOUND IN
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BONE
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METASTATIC TURMORS ARE USUALLY FROM
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BREAST, PROSTATE, RENAL, THROID LUNG
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COMMON BONES SITES TO WHICH CANCER METASTESTIZES
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VERTEBRAE, PELVIS, FEMUR, HUMERUS
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MOST COMMON TUMOR ORIGINATING IN BONE IS
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Multiple Myeloma
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Oxygen + immobilization ->
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bone (union)
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Oxygen + motion ->
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fibrous tissue (non-union)
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No oxygen + motion ->
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cartilage (non-union)
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NO BLOOD =
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NO BONE
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STAGES FRACTURE HEALING
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1st week: Clot and inflammatory response
2nd week: Collagen & Proteoglycan synthesis, Osteoblast differentiation 3rd to 6th week: Mineralization (callus) 6th week to one year: Remodeling |
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F FIBROCARTILAGINOUS CALLUS
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SCAFFOLD FOR MINERALIZATION
REMODELS AS A RESULT OF STRESS AND STRAINS |
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PHYSICAL LOADS PRODUCE
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ELECTRICAL AND CHEMICAL CHANGES IN BONE
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D MALUNION
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A FRACTURE THAT HAS HEALED BUT IN AN ABNORMAL POSITION, EITHER ANGULATED, ROTATED, OR SHORTENED SIGNIFICANTLY.
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D NONUNION
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YOU WILL SEE CARTILAGE WHERE BONE HAS NOT HEALED. PT WOULD HAVE PAIN.
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FRACTURE LOCATIONS CAN BE DESCRIBES AS
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Intra-articular
Epiphyseal Metaphyseal Diaphyseal |
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D PHYSEAL FRACTURES
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FRACTUERS AT GROWTH PLATE. CHILDREN ONLY
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FRACTURE PATTERN TYPES
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Transverse-HORIZONTAL
Oblique-ANGLED Spiral-VERY ANGLED Compression-FROM COMPRESSED BONE |
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D COMMUNITION
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PIECES=EX. LOTS OF PIECES IN BROKEN BONE
REFLECTS ENERGY OF INJURY |
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D OPEN FRACTURE (VS. CLOSED FRACTURE)
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BREAKS THROUGH SKIN
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WHAT TO CONSIDER WITH OPEN FRACTURES
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SIZE OF WOUND?
CONTAMINATED ENV? PROTRUDING BONE? TIME SINCE INJURY? |
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OPEN FRACTURES CAN CAUSE
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OSTEOMYELITIS=BONE INFECTION!
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ALWAYS GIVE SOMEONE WITH AN OPEN FRACTURE A
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TETANUS SHOT
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HOW TO DESCRIBE FRACTUE ALIGNMENT
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ALIGNED
DISPLACED IF DISPLACED, IS IT ANGULATED OR TRANSLATED? |
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Always report the position of
the ------ relative
to the ------when describing
displacement
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DISTAL FRAGMENT
PROXIMAL FRAGMENT |
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D VALGUS KNEE
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the distal side of the joint is displaced away from the midline
VALGUS TERM IS USED TO DESCRIBE ALIGNMENT |
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D COMPARTMENT SYNDROME
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Increased pressure in an osseofascial compartment resulting in ischemia of nerve and muscle
Increased local tissue pressure -> increased venous pressure Increased venous pressure -> decreased AV gradient Decreased AV gradient -> decreased capillary blood flow to tissues = ischemia results |
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PRESENTATION ACUTE COMPARTMENT SYNDROME
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Swelling and tightness
PAIN - out of proportion Pain with passive stretch of involved muscles Hypesthesia in skin supplied by nerve in compartment Weakness of involved muscles |
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Acute Compartment Syndrome
LATE Symptoms and Signs
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Pulses - gone
Pallor - limb is pale Phrio - limb is cool MUSCLES IRRIVERSIBLY DAMAGED MOST LIEKLY |
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DX COMPARTMENT SYNDROME
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High index of suspicion ( energy of injury)
Symptoms and Signs (Compartmental pressure measurements) |
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TX COMPARTMENT SYNDROME
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RELEAVE VENOUS PRESSURE:
Limb at heart level Remove or loosen circumferential dressings Definitive treatment: Operative release ( fasciotomy) |
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WHAT ARE 2 ORTHOPEDIC EMERGENCIES?
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Compartment syndrome
Back pain with bowel or bladder changes |
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FRACTURE DESCRIPTION MUST INCLUDE
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Fracture description: bone, location, alignment, pattern, open or closed
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