30 Questions
Which of the following is true about spiral fractures?
They typically result from twisting movements
What is the defining characteristic of a comminuted fracture?
It results in more than two bone fragments
What is the primary advantage of closed reduction of fractures?
It is less invasive, leading to a shorter healing time.
Which of the following fractures is most commonly associated with osteoporosis or bone marrow cancer?
Compression fracture
In an open reduction of fractures, which of the following is NOT typically used for stabilization?
Casting
What is a characteristic feature of a greenstick fracture?
It involves a partial break in the bone, where the bone bends but does not completely fracture
Which of the following is a common symptom of a fracture?
Inability to use the affected part
What is the primary reason for performing an open reduction of fractures?
The fracture is comminuted, making closed reduction impossible.
What is an important consideration in the management of fractures?
Immobilization is crucial to allow the bone to heal properly
What is the first step in performing an open reduction of fractures?
Taking an X-ray of the fractured site
What is an intramedullary nail?
A metal rod inserted into the bone marrow canal of a fractured long bone.
Which of the following fractures would most likely require open reduction?
A comminuted fracture of the femur
What is the first stage that occurs after a bone fracture?
Inflammation
Which type of cells get activated in response to bone cell death during the inflammation stage?
Osteoclasts
What is the purpose of reducing the fracture during the inflammation stage?
To promote osteoblast activity
Which tissue connects the fractured bone segments before the formation of soft callus?
Hematoma
What kind of tissue does the granulation tissue produce during the soft callus formation stage?
Chondrocytes
When does the hard callus formation stage, also known as ossification, occur in the healing process of fractures?
After remodeling
What is the primary purpose of using a diaper or sanitary napkin around the genital area when a child has a cast?
To prevent leakage or splashing of urine
Which of the following is NOT listed as a potential complication or indication that something is wrong with the cast?
Excessive itching under the cast
What is the most serious complication mentioned in the text related to casting?
Deep venous thrombosis leading to pulmonary embolism
What is the primary aim of physical therapy during the immobilization period?
To avoid anything that might delay repair or lead to non-union
Which of the following is NOT mentioned as a potential complication of casting?
Infection at the surgical site
What is the purpose of physical therapy after the removal of fixation, according to the text?
The text does not mention the purpose of physical therapy after removal of fixation
What is the purpose of adding cotton and synthetic materials inside the cast?
To provide padding around bony areas
Why is plaster usually used in the early stages of treatment?
It can be molded more precisely
Which casting material is recommended if swelling is not expected and the healing process has already started?
Fiberglass
What should be done to protect the skin from scratches due to rough edges of the cast?
Pad the rough edges with soft material
Why should water be avoided when dealing with a plaster cast?
Water distorts the shape of the cast
What is one important instruction for post-cast care to promote circulation?
Keep the limb elevated
Study Notes
Patterns of Fractures
- Spiral fractures: occur when bone breaks in a spiral manner, usually due to twisting movements.
- Comminuted fractures: lead to more than 2 fragments, often resulting from big trauma or RTA.
- Compression fractures: occur mostly in vertebrae due to pathological weakness (osteoporosis, bone marrow cancer, etc.).
- Green stick fracture: occurs in children (before age 10), where the bone is still slightly springy and trauma causes bending and partial fracture.
Clinical Features
- Symptoms: Pain, Swelling, Deformity, Inability to use the affected part.
- Examination: Look for deformity, swelling, and shortening. Feel for tenderness. Move to check for abnormal mobility and crepitus.
Management
- Open fracture requires more care than closed fracture.
- Transverse fracture may be easy to reduce, while comminuted fracture may need surgery.
- Immobilization is crucial to give the body time to rebuild tissue.
- Do not use the abduction bar on the cast to lift or carry the child.
- Use a diaper or sanitary napkin around the genital area to prevent leakage or splashing of urine.
Complications of Cast
- Compartment syndrome: tight cast that restricts swelling.
- Impaired distal neurovascular function.
- Deep venous thrombosis leading to pulmonary embolism.
- Re-displacement of fracture.
- Stiff joints, muscle wasting.
- Plaster sores.
- Malunion, nonunion, delayed union.
Rehabilitation
- Physical therapy during immobilization aims to:
- Avoid delayed repair or non-union.
- Maintain joint mobility and muscle strength.
- Physical therapy after removal of fixation aims to:
- Promote joint mobility and muscle strength.
- Prevent joint stiffness and muscle wasting.
Closed Reduction of Fractures
- Advantages: less invasive, shorter healing time, less risky, and leaves no scars.
- However, it cannot be done for all types of fractures (e.g., comminuted fractures).
Open Reduction of Fractures
- Involves the use of plate and screws, intramedullary nail, or external fixation.
- Also known as Open Reduction Internal Fixation (ORIF).
- Requires surgery to reduce the fracture.
Healing Process of Fractures
- Four main stages: Inflammation, Soft Callus Formation, Hard Callus Formation (Ossification), and Remodeling.
- Stage 1: Inflammation (4-5 days) - hematoma, swelling, and bruising.
- Stage 2: Soft Callus Formation - granulation tissue, fibroblasts, and cartilage formation.
- Stage 3: Hard Callus Formation (Ossification) - bone formation.
- Stage 4: Remodeling - bone reshaping.
Casts
- Made of:
- Plaster (POP) - white in color, hemihydrated calcium sulphate.
- Fiberglass - variety of colors, patterns, and designs.
- Inside of the cast: Cotton and other synthetic materials for padding and comfort.
Post-Cast Instructions
- Keep the limb elevated to prevent swelling.
- Apply an ice bag to the injured area.
- Keep the cast clean and dry.
- Check for cracks or breaks in the cast.
- Rough edges should be padded to protect the skin from scratches.
- Encourage patient to move their fingers or toes to promote circulation.
- Prevent small toys or objects from being put inside the cast.
- Do not put powders or lotion inside the cast.
- Cover the cast while eating to prevent food spills and crumbs from entering the cast.
Test your knowledge on different patterns of bone fractures such as spiral fractures, comminuted fractures, compression fractures, and green stick fractures. Learn about the causes and characteristics of each type of fracture.
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