Introduction to Fracture Repair and Classification PDF

ATTENDANCE Have you checked in? Please remember to check into the session via Osler! 8/11/2023 CRICOS Provider Code: 00017B TEQSA: PRV12072  Agenda...

ATTENDANCE Have you checked in? Please remember to check into the session via Osler! 8/11/2023 CRICOS Provider Code: 00017B TEQSA: PRV12072  Agenda Anthropologist Margaret Mead was asked by a student what she considered to be the first sign of civilization in a culture. Mead said that the first sign of civilization in an ancient culture was a femur (thighbone) that had been broken and then healed. Mead explained that in the animal kingdom, if you break your leg, you die. You cannot run from danger, get to the river for a drink or hunt for food. You are meat for prowling beasts. No animal survives a broken leg long enough for the bone to heal. Broken femur that has healed is evidence that someone has taken time to stay with the one who fell, has bound up the wound, has carried the person to safety and has tended the person through recovery. Helping someone else through difficulty is where civilization starts. We are at our best when we serve others. Be civilized. Ira Byock, MD. The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life https://amzn.to/44PZHgn 8/11/2023 CRICOS Provider Code: 00017B TEQSA: PRV12072  Introduction to Fracture Repair and Classification Assistant Professor Joan Roehl 8/11/2023 CRICOS Provider Code: 00017B TEQSA: PRV12072  Acknowledgement of Country Bond University acknowledges the Kombumerri people, the traditional Owners and Custodians of the land on which the University now stands. We pay respect to Elders past, present and emerging. Copyright Warning. This material has been reproduced and communicated to you by or on behalf of Bond University in accordance with section 113P of the Copyright Act 1968 (Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. 8/11/2023 CRICOS Provider Code: 00017B TEQSA: PRV12072  23yo male 2yo female 85yo female 8/11/2023 CRICOS Provider Code: 00017B TEQSA: PRV12072  Week learning outcomes At the end of this week, students should be able to:  Describe the classification of fractures  Describe the major features of the process of fracture repair 8/11/2023 CRICOS Provider Code: 00017B TEQSA: PRV12072  Session learning outcomes During this session you will learn about  The causes of bone fractures  The structure of bone across the lifespan and how certain mechanisms of injuries can result in the common appearances of fractures  The types and usual classification of bone fractures  The process of bone repair and types of fracture healing 8/11/2023 CRICOS Provider Code: 00017B TEQSA: PRV12072  A fracture is a break in a bone from force applied that exceeds its tensile or compressive strength 8/11/2023 CRICOS Provider Code: 00017B TEQSA: PRV12072 Causes of bone fractures Grouped according to cause, fractures can be divided into three major categories: Fractures caused by sudden injury, Fatigue or stress fractures, and Pathologic fractures. CRICOS Provider Code: 00017B TEQSA: PRV12072 Incidence of bone fractures Highest incidence of fractures in young males (15-24) and the elderly (65+) Fractures of healthy bones in young people usually due to heavy trauma (e.g. fall, car accident, sports…) – tibia, clavicle, distal humerus; workplace – hands and feet Fractures in older people often associated with bone disease (e.g. osteoporosis) – proximal femur, proximal humerus, vertebrae, wrist and pelvis CRICOS Provider Code: 00017B TEQSA: PRV12072 11 Risk factors and factors that influence bone fractures Age Sex Health Diet Impact Smoking Alcohol Bone Occupation CRICOS Provider Code: 00017B TEQSA: PRV12072 12  Classification of fractures 8/11/2023 CRICOS Provider Code: 00017B TEQSA: PRV12072 Classification of fractures A bone may be completely or partially fractured. A. Complete fracture: bone is broken all the way through A. Incomplete fracture: bone is damaged but still in one piece The severity of a bone fracture depends on the type of bone, the nature and cause of its injury, as well as the person’s age and health. CRICOS Provider Code: 00017B TEQSA: PRV12072  1 2 3 4 Classification of fractures 5 6 TYPE OF FRACTURE DEFINITION Typical complete fractures 7 Closed (simple) Non-communicating wound between bone and skin Open (compound) Communicating wound between bone and skin 8 9 Comminuted Multiple bone fragments Oblique Fracture line at an angle to long axis of bone Transverse Fracture line perpendicular to long axis of bone Pathological Fracture at a point where bone has been weakened by disease (e.g. by tumours or osteoporosis) Compression Fracture wedged or squeezed together on one side of bone Displaced Fracture with one, both or all fragments out of normal alignment 10 Typical incomplete fractures Greenstick Break in one cortex of bone with splintering of inner bone surface; commonly occurs in children Stress Microfracture CRICOS Provider Code: 00017B TEQSA: PRV12072 Classification of fractures: Closed Fractures are often simply named by conditions associated with the bone breakage and the overlying tissue Closed (simple) fracture: if skin is not broken 2yo female CRICOS Provider Code: 00017B TEQSA: PRV12072 85yo female Classification of fractures: Open 23yo male Open (compound) fracture: if the skin is broken Possible soft tissue trauma Due to moderate to severe force that exceeds tissue tolerances Infection and external bleeding more likely This is a medical emergency! Possible complications: blood loss, injuries to organs, acute compartment syndrome, infection (osteomyelitis) CRICOS Provider Code: 00017B TEQSA: PRV12072 Classification of fractures: Displaced Bone has broken into two or more pieces and the pieces of broken bone have moved out of normal alignment. CRICOS Provider Code: 00017B TEQSA: PRV12072 Classification of fractures: Comminuted The bone has broken into three or more pieces generally due to high energy trauma (MVA, fall from height) CRICOS Provider Code: 00017B TEQSA: PRV12072 Classification of fractures: Transverse This type of fracture has a horizontal fracture line/is at a right angle to the bone’s axis (perpendicular) Usually caused by directly applied force to fracture site CRICOS Provider Code: 00017B TEQSA: PRV12072 Classification of fractures: Oblique This type of fracture has an angled pattern Caused by direct or indirect energy, with angulation and some compression CRICOS Provider Code: 00017B TEQSA: PRV12072 Classification of fractures: Pathologic Fracture at site of pre-existing abnormality tumours, osteoporosis, infections, metabolic bone disorders bone weakened by a disease Usually by a force that would not fracture a normal bone CRICOS Provider Code: 00017B TEQSA: PRV12072 Classification of fractures: Pathologic Patient data: 75yo, female Presentation: painful, swollen left upper arm after falling at home. Displaced fracture of the proximal diaphysis of the humerus. Underlying moth eaten appearance of the medullary bone with a wide zone of transition in keeping with an aggressive bone lesion. CRICOS Provider Code: 00017B TEQSA: PRV12072 Classification of fractures: Pathologic 85yo female Patient data: 85yo, female Presentation: immediate onset of excruciating right hip pain with the inability to walk or even move without severe pain after fall at home. Fractured her right hip. CRICOS Provider Code: 00017B TEQSA: PRV12072 Classification of fractures: Compression Bone is crushed causing the fractured bone to be wider or flatter in appearance, occurs when two bones (often vertebrae) are forced against each other Older people, particularly those with osteoporosis, are at higher risk. CRICOS Provider Code: 00017B TEQSA: PRV12072 Classification of fractures: Greenstick Disrupts outer surface (cortex), bone is fractured on one side only, and bent on the other side (like a young tree branch bent sharply); typically proximal tibia, radius and ulna These commonly occur in children CRICOS Provider Code: 00017B TEQSA: PRV12072 2yo female Classification of fractures: Stress A hairline crack in a bone caused by repetitive force Fatigue (overuse) fracture Chronic application of abnormal stress (e.g. running) on normal bone, resulting in microfractures and eventually, macroscopic failure, typically in bones of the legs and feet Insufficiency fracture Normal stress on weakened bone due to metabolic abnormalities (e.g. osteoporosis) or genetic abnormalities (e.g. osteogenesis imperfecta CRICOS Provider Code: 00017B TEQSA: PRV12072  Fracture repair 8/11/2023 CRICOS Provider Code: 00017B TEQSA: PRV12072 28 Bone healing Bone heals generally in two ways: Direct/Primary bone healing Micro gap 1mm; callus formation more common than direct healing and involves endochondral healing CRICOS Provider Code: 00017B TEQSA: PRV12072 Bone healing Primary and secondary bone healing. (A) Fibula fracture (see arrow). (B) Fibula fracture healed by primary bone healing following open reduction internal fixation (see arrow). (C) Tibia and fibula fracture. (D) Tibia and fibula fracture healed by secondary bone healing with callus formation (see bracket). McEwan, Josephine & Tribe, Howard & Jacobs, Neal & Hancock, Nicholas & Qureshi, Amir & Dunlop, Doug & Oreffo, Richard. (2018). Regenerative medicine in lower limb reconstruction. Regenerative Medicine. 13. 477-490. 10.2217/rme-2018-0011. CRICOS Provider Code: 00017B TEQSA: PRV12072 Bone healing - Indirect/Secondary bone healing The sequence of events that occur following a fracture for bone healing can be divided into 3-4 main phases 1. Haematoma Phase 2. Inflammatory Phase 3. Reparative Phase 4. Remodelling Phase CRICOS Provider Code: 00017B TEQSA: PRV12072 Bone healing - Indirect/Secondary bone healing Phase 1-2 - Inflammatory Phase (Hours - Days) CRICOS Provider Code: 00017B TEQSA: PRV12072 Bone healing - Indirect/Secondary bone healing Phase 3 - Reparative Phase (Days - Weeks) CRICOS Provider Code: 00017B TEQSA: PRV12072 Bone healing - Indirect/Secondary bone healing Phase 4 - Remodelling Phase (Months to Years) CRICOS Provider Code: 00017B TEQSA: PRV12072 Bone healing - Factors influencing healing Age Immuno- competency, Nutrition blood supply, infections Health / comorbidities, medications Treatment, Nature and stress on extent of fracture site injury Healing complications: CRICOS Provider Code: 00017B TEQSA: PRV12072 malunion, delayed union or non-union.  References Craft, Judy. & Gordon, Christopher. & Huether, Sue E. & McCance, Kathryn L. & Brashers, Valentina L. & Rote, Neal S. (2018). Understanding pathophysiology. St. Louis, Missouri : Elsevier Kumar, V., Abbas, A. K., & Aster, J. C. (2015). Robbins and Cotran pathologic basis of disease (Ninth edition.). Philadelphia, PA: Elsevier/Saunders. https://aoa.org.au/for-patients/celebrating-orthopaedics/bone- fractures https://www.orthopedic-institute.org/fracture-care/types-of-fractures/ https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/b one- fractures https://www.physio-pedia.com/Fracture https://radiopaedia.org/cases 8/11/2023 CRICOS Provider Code: 00017B TEQSA: PRV12072  bond.edu.au Assistant Professor Joan Roehl Faculty of Health Sciences and Medicine Bond University, Gold Coast, Australia 8/11/2023 CRICOS Provider Code: 00017B TEQSA: PRV12072