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74 Cards in this Set
- Front
- Back
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fracture
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-complete or incomplete break in structural continuity of bone
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causes (mechanism of injury) of fracture
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-single traumatic event
-repetitive stress -abnormal weakening of bone -direct force -indirect force -fatigue -pathology |
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direct force
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-fracture @ the point of impact
-soft tissue overlying may be injured -tapping -crushing -penetrating |
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tapping
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-momentary blow
-transverse or oblique fracture |
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crushing
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-fragmentation of bone
-soft tissue damage |
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penetrating
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-destroys bone and soft tissue
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indirect force
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-fracture @ a distance from applied force
-soft tissue damage less likely -bending -twisting -compression -traction |
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bending
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-fractures @ mid-shaft
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twisting
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-spiral fracture
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traction
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-avulsion fracture
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fatigue
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-repeated microtrauma
-stress fracture |
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pathology
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-pathological fracture: fracture w/ minimal stress
-weakness secondary to underlying disease (Paget's disease, osteoporosis, metastatic cancer) |
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signs/symptoms of fracture
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-history of trauma
-localized pain and swelling -decreased function/ROM loss (guarding/splinting) -deformity (displaced fracture) -ecchymosis (1-3 days post injury) |
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diagnosis of fracture
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-imaging (radiography, CT, bone scan, MRI)
-evaluate: vascular integritiy, nervous system integrity) -CDRs |
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Ottawa Ankle Rule
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-pain surrounding one or both malleoli AND
-tenderness @ posterior aspect or tip of lateral malleolus OR -tenderness @ posterior aspect or tip of medial malleolus OR -inability to bear weight both immediately and in emergency dept |
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ottawa ankle rules (foot)
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-pain about midfoot AND
-tenderness @ the 5th MT base OR -tenderness @ the navicular OR -inability to bear weight both immediately and in the emergency department |
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classification of fractures
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-anatomical location
-skin integrity -complete/incomplete (degree) -simple/complex (number of fragments) -configuration of fractures (fragments) -position of fragments (displaced/nondisplaced) -complication |
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classification of anatomical location
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-describes long bone fractures
-proximal shaft fracture (proximal 1/3 of shaft) -mid shaft fracture (middle 1/3) -distal shaft fracture (distal 1/3) |
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classifcaiton of integrity of skin
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-closed fracture
-open fracture |
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closed fracture
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-skin intact
-'simple fracture' (old terminology) |
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open fracture
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-skin penetrated
-'compound fracture' |
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classifcation of fractures by degree of fracture
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-complete
-incomplete |
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complete fracture
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-bone completely broken through both cortices
-@ least 2 bone fragments |
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incomplete fracture
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-through 1 cortex
-no fragments |
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classification of fractures by number of fragments
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-simple fracture
-complex fracture |
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simple fracture
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-2 fragments
-single disruption of bone |
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complex fracture
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-multifragmentary (more than 2 fragments AND/OR
-fracture through articular surface |
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transverse
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-direct blow or bending force
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oblique fracture
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-direct force w/ upward or downward thrust
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spiral fracture
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-twisting
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complex fracture
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-aka comminuted
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segmental or wedge fracture
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-segment (may be devascularized) b/t proximal and distal pieces
-aka butterfly fragment |
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avulsion fracture
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-bone fragment pulled off @ muscle/tendon junction
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hairline fracture
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-very small crack
-typically in adults |
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greenstick fracture
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-occurs in children
-fracture of only 1 cortex (on tension side) |
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torus fracture
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-buckle fracture
-occurs in children -fracture of only 1 cortex (on compression side) |
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compression fracture
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-bone collapses
-no fragments usually -vertebral bodies |
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non-displaced
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-anatomic position
-fragments still aligned -treatment is simple -recovery is faster |
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displaced
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-shifted
-fragments are shifted medially/laterally or anteriorly/posteriorly -named for position of distal fragment -can be angulated, rotated, distracted, overriding, or impacted |
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angulated
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-varus/valgus or dorsal/volar angulation
-named for position of distal fragment |
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rotated fracture
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-on longitudinal axis
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distracted fracture
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-fragment ends are separated
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overriding
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-ends overlap
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impacted fracture
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-one fragment driven into the other
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uncomplicated
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-absense of local or systemic complication
-no other implications to surrounding tissues |
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complicated
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-injury to adjacent tissues
-open fracture -fracture/dislocation |
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malleolar fractures
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-usually involves medial and/or lateral malleoli OR
-lateral malleolus fx and deltoid ligament avulsion -heals in 10-20 weeks -may require immobilization or ORIF depending upon amount of displacement |
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trimalleolar fracture
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-involves medial and lateral malleoli and the posterior tip of the tibia
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boot top fracture
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-fractures of the tibia and fibula proximal to the malleoli
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pilon fracture
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-tibial plafond fracture due to vertical loading (usually in addition to malleolar fractures)
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lisfranc injury
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-sprain or fracture/dislocation involving bases of MT and/or TMT joints
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jones fracture
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-base of 5th MT
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fracture healing
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-tissue destruction/hematoma formation
-inflammation and cellular proliferation -callus formation -consolidation -remodeling |
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-tissue destruction/hematoma formation
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-damage to bone and surrounding blood vessels
-small amount of bone necrosis |
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inflammation and cellular proliferation
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-up to 72 hours
-loose CT forms (bridges over fracture site) -new capillaries form |
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callus formation
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-osteoclasts absorb dead bone
-immature bone and cartilage form -as new bone matures, forms callus (b/t fragments, visible by 2-3 weeks) -union |
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consolidation
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-continued maturation (hard callous, several months)
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remodeling
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-patch reshaped (alternate resorption and proliferation, months to years)
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factors affecting healing time
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-age
-general health -blood supply -fracture type/severity -fracture site |
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age
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-children heal faster than adults
-young adults heal faster than old adults |
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location
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-UE heals faster than LE
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blood supply
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-heals faster w/ good perfusion
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fracture management
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-protection
-immobilization -closed reduction -external fixation |
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protection
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-buddy taping
-indications: stable, nondisplaced fractures; when displacement is not critical |
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immobilization
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-splinting or casting
-indication: non-displaced but unstable fractures |
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closed reduction
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-non-surgical realignment
-indication: minimally displaced fractures -manipulation (reduction) under anesthesia (followed by casting) -skin or external traction (Fractures difficult to reduce secondary strong muscle pull; immobilization) |
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external fixation
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-screws, wires, through soft tissues and bone (above and below fracture site; attached to external frame)
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open reduction, internally fixation (ORIF)
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-surgical reduction and repositioning secured w/ rods, nails, pins, plates, screws
-indications: unsuccessful closed reduction; very unstable fractures; fracture site w/ poor healing; multiple fractures; underlying conditions prevent healing; underlying conditions prolong healing time |
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open reduction external fixation
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-both internal and external fixation
-indications: severe soft tissue damage; blood vessel or nerve damage; severely comminuted fractures requiring lengthening; pelvic fractures; infected fractures; multiple injuries -may combine w/ traction |
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excision of fracture fragments
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-if avascular necrosis is inevitable (blood supply disrupted)
-hemiarthroplasty |
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bone grafting and transplant
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-for non-union or significant bone loss (fibula or ilium donor sites)
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PT management during immobilzation
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-ice, elevation
-isometric exercise (inside cast, decreases edema, prevents adhesions, increases circulation) -AROM joints above and below -resistive exercises -gait and transfer training |
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PT management post immobilization
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-gait training
-isometric exercise -AROM -PROM and/or joint mobs (joints not directly affected by fracture) -progressive strengthening -propioception and balance -return to activities |
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complications of fracture healing
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-delayed union
-non-union -mal-union |
