Exam (elaborations)
FRACTURES of the UPPER EXTREMITY EXAM QUESTIONS AND VERIFIED ANSWERS
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FRACTURES of the UPPER EXTREMITY EXAM QUESTIONS AND VERIFIED ANSWERS...
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Generally, fractures heal by _____ in children and ______ in adults -ANSWER 3-4 weeks
4-6 weeks
The most important factor in fracture healing is _________. - ANSWER
blood supply
Smoking (nicotine) and systemic diseases (diabetes) have been found to
________ healing time - ANSWER increase
Inflammatory stage - ANSWER Development of hematoma and
traumatic inflammation
Hematoma is gradually replaced by granulation tissues around fracture
ends
Begins immediately after injury and last several days
Swelling and hypoxia are present
Inflammatory cells migrate into the area
Fibroblasts, mesenchymal cells and osteoprogenitor cells present
Reparative stage-organization - ANSWER Overlaps the inflammatory
stage
Occurs within two weeks of injury
Pain usually decreases in this stage
Union by callus
Direct Healing (Primary Healing)
Indirect Healing (Secondary Healing)
Direct Healing (Primary Healing) - ANSWER Occurs with rigidly
immobilized fractures (i.e., plate and screws)
An implant replaces external callus
Primary healing does not hasten union but ensures it
Union occurs by direct bone healing across the fracture site
Indirect Healing (Secondary Healing) - ANSWER Motion at the fracture
site stimulates healing
, Callus formation is stimulated by motion at the fracture site
Enchondral calcification occurs
Fibroblasts and chondroblasts need to be present to sustain the
environment long enough for osteoblastic bone replacement
Indirect Healing (Secondary Healing)
5 factors are necessary: - ANSWER Hematoma
vibrant diversified cell populations to ensure healing
progression/nutrition
adequate blood supply
evolving scaffold for cellular differentiation
mechanical environment of relative stability that minimizes fragment
strain
Remodeling phase - ANSWER - As the callus forms, pain should
diminish significantly and with mature callus associated swelling, pain
and tenderness will diminish rapidly
- Remodeling of immature trabecular bone eventually evolves into
compact lamellar bone
Remodeling may continue for years but radiographic union occurs
within the first few months
Primary Fracture Healing - direct union
inflammatory phase: and time frame
POC
Regeneration Phase:
Remodeling Phase: - ANSWER Inflammatory Phase: surgery - day 21
-Protection with intermittent AROM out of splint; RICE
Regeneration Phase: 1-6 weeks
-AROM, PROM and splinting can be started sooner than in the
secondary healing reparative phase
Remodeling Phase: 6 weeks to 1 year
-Diverse exercise program is allowed
Fracture Healing Stages Occurring with Secondary Healing
Inflammatory Phase:
Reparative Phase:
Remodeling Phase: - ANSWER Inflammatory Phase: Injury to day 5
,* treat by protection (immobilization) protect hematoma; RICE
Reparative Phase: day 5- day 21
* protect fracture callus with removable splint; intermittent motion
Remodeling Phase: day 21- month 18 (can go several years)
* diverse exercise program
Fracture Healing Summary: - ANSWER Traumatic inflammation
Development of a hematoma
Organization
Union by callus
Remodeling of callus
Bony union
Elements of the classification of fractures include: - ANSWER Location
in the bone (diaphyseal, metaphyseal, etc.)
Angle of the fracture (transverse, oblique, etc.)
Number of fragments (simple, comminuted)
Skin closed or open
Primary Elements of deformity: - ANSWER Shortening, Angulation and
Rotation
midportion of the shaft of the bone - ANSWER Diaphyseal -
the end of the bone - ANSWER Epiphysis -
in the area of bony flare close to the articular surface where the shaft
merges with the epiphysis - ANSWER Metaphyseal - i
involves the end of the bone and enters into the joint. - ANSWER
Articular-
Angle of fracture through the bone - ANSWER Transverse
Oblique
Spiral
Stellate
Longitudinal
, Number of fragments
Simple -
Comminuted - - ANSWER produces 2 major fractures fragments
producing multiple fragments
Skin
Closed -
Open - - ANSWER the soft tissue is not exposed
soft tissue has been violated
Fracture Treatment Techniques
Closed treatment- - ANSWER typically requires ~3 weeks static
immobilization in orthoses which protects fracture and allows early ROM
of non-interfering joints
Closed treatment- reason for indication - ANSWER Preserves soft tissue
integrity and blood supply
Simple undisplaced or minimally displaced fractures are often stable
regardless of configuration, because the periosteum is undamaged or
minimally disrupted
Some fractures are stable after closed manipulative reduction
The patients should then be put in the safe position (0 degrees IP
flexion, 70 degrees MP flexion and 10-15 degrees wrist extension) to
protect the fractures
Percutaneous fracture management (k-wires) - ANSWER Minimally
traumatic; minimal exposure
Pins may be sunken below skin or allowed to protrude
Relatively weak fixation
Cost effective
Attractive technique if it can provide adequate stability
Good for simple fractures
Removed at approximately 4 weeks (in office or surgery center) for most
simple hand fractures
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