| Define "Fracture". | "a break in the continuity of a bone" |
| Describe this type of fracture: closed/simple | Skin is intact in this fracture |
| Describe this type of fracture: Open/Compound | Bone has torn through the skin or a body cavity in this fracture |
| Describe this type of fracture: Complete | Broken into 2 or more pieces in this fracture |
| Describe this type of fracture: Incomplete | periosteum intact, bone is bent or cracked in this fracture |
| Describe this type of Complete fracture: Transverse | Usually stay in place after reduction(surgery or tractioning
to bring separated edges together) take longer to heal in this fracture |
| Describe this type of Complete fracture: Oblique/Spiral | Heal quicker, but harder to keep in place, even when splinted |
| Describe this type of Complete fracture: Comminuted | often unstable. Consists of 2 or more fragments, making healing difficult |
| Describe this type of Complete fracture: Avulsion | ligament/tendon pulls off portion of bone it is attached to |
| Describe this type of Complete fracture: Osteochondral | fragments of articular cartilage shear away from joint surface, often during a dislocation or sprain |
| Describe this type of incomplete fracture: Compression | bone is crushed. Occurs in cancellous bone – vertebral body |
| Describe this type of incomplete fracture: Greenstick | bone is bent or partially broken. Found in children under 10 years old |
| Describe this type of incomplete fracture: Perforation | From a missile wound - gunshot wound |
| Describe this type of incomplete fracture: Stress | cracks in bone due to over use or repetitive actions. Common sites are tibia, metatarsals, navicular, femur & pelvis. Often simply resembles a crack. |
| What kind of fracture is this: | Colle`s fracture – transverse fracture of the radius just proximal to
the wrist allows the fragment to rotate and displace dorsally, giving a
‘dinner fork’ deformity. Mechanism of injury fall onto outstretched
hand |
| What kind of fracture is this, AND what kind of movement in a fall is reqired for this to happen? | Galeazzi fracture – break of the radial shaft & dislocation of the
inferior radioulnar joint. Mechanism of injury fall on hand with a
rotational component |
| What kind of fracture is this: | Pott`s fracture – distal fibula breaks close to lateral malleolus.
Deltoid ligament may also rupture or avulse the medial malleali.
Mechanism of injury is eversion with some external rotation. |
| What kind of fracture is this: | Dupuytren`s fracture – the fibula fractures higher up, the medial
malleaoli avulses and the talus is pushed superiorly between the
tibia & fibula. Mechanism of injury is eversion with some external
rotation. Eversion of the heel (the heel bone pushes away from the body) |
| True or False:
Indirect Fracture damageL bone usually breaks at point of impact. Associated soft tissue damage. A blow causes a transverse fracture and minor soft tissue damage whilst a crush injury will cause a comminuted fracture and major soft tissue damage | False. This is the definition of a Direct fracture. |
| True or False
Indirect Fracture: bone breaks away from impact site. A torqueing or twisting force causes a spiral fracture, usually minimal tissue damage | True. |
| What 3 broad reasons can cause a fracture? | - Trauma or sudden force, which creates more stress than the bone can absorb; direct or indirect.
- Overuse or repeated wear
- Pathology |
| What are some common pathologies that might cause an increase in fractures? Name 2. | Osteoporosis, bone cysts, tumours, (any illness/abnormality that decreases bone density) |
| What are 3 possible EARLY COMPLICATIONS (first few weeks) for fractures? | - torn muscles, tendon & ligamentous damage
- compartment syndrome
- nerve injuries
- vascular injuries
- joint hemathrosis (bleeding)
- bone & soft tissue infections
- deep vein thrombosis
- various problems caused by poorly fitting casts |
| What are 3 possible LATE COMPLICATIONS (X > a few weeks) for fractures? | - delayed union and non-union of the fracture, malunion,
myositis ossificans,
- nerve compression,
- nerve entrapment,
- bone necrosis,
- volkmans ischemic contracture, - joint stiffness, - disuse atrophy.
- There may also be complications relating to the external fixators or
metal plates used. |
| Describe the symptom picture of someone during the immobilization stage of a fracture. Describe 3. | • pain near and at injury site, as well as swelling/bruising
• Antalgic posture/gait
• Tissue repair and callus formation occuring. Adhesions
developing around injury
• Reduced circulation, edema, disuse atrophy & connective tissue contracture
in tissues under cast. Possible cartilage health decrease in joints – lack of
succusive action & reduced circulation.
• Hypertonicity & trigger points present |
| Describe the symptom picture of someone after the immobilization of a fracture has been removed. | • Fracture site healing and remodelling
• Poor tissue health. Dry skin. Bruising may be brown, yellow & green/gone.
•Pain/Stiffness at injury site
• Muscle Weakness
•Antalgic gait/posture
•Hyper tonicity, trigger points in crossing/supporting structures and
•Possibly pocket of edema still remaining |
| How do you treat a fracture DURING the immobilization period?
Name 3 Dos/Don'ts | During immobilization;
• Do not interfere with healing process. Refer if complications suspected
• Reduce inflammation, pain & sympathetic nervous system firing.
• Treat compensating structures - DO NOT TREAT INJURY SITE DIRECTY
• Reduce edema – lymph drainage
• Maintain local circulation proximal to injury site – effleurage/petrisage
• Maintain ROM – proximal & distal joints |
| How do you treat a fracture AFTER the immobilization period?
Name 3 Dos/Don'ts | • Reduce pain, decrease sympathetic nervous system firing. (i.e. massage)
• Reduce edema/promote distal venous return (circulation)
• Improve tissue health – remove dry flaky skin
• Treat compensating structures
• Reduce hypertonicity & trigger points
• Treat compensative structures (including Mobilize hypomobile)
•Maintain ROM -- Do not mobilize structures
•Once consolidation of joint/break has occurred mobilize joints that were under cast -- not possible if pins/wires were added |
| What are contradictions in treating immobilized fractures (when should you not treat)? Name at least 2. | • Limb not tractioned before union has occurred
• Hot hydrotherapy not applied distal or immediately proximal to cast
• With open reduction, no on site work performed until skin heals
• With stress fractures no on site massage while fracture point is tender |
| What are contradictions in treating fractures AFTER immobilization has been REMOVED (Dos and Don'ts)? Name at least 3. | • No overpressure of involved joints until union has occurred
• Hydrotherapy temperature extremes avoided on tissue that were under the cast.
• No long deep longitudinal strokes on tissues that were under cast until
muscle tone & tissue health has improved
• Passive stretching should be pain free until tissue health & muscle tone
improve
• No local heat over pins, screws or wires |
