Pathology: Week #12 - Fractures PDF

PATHOLOGY: WEEK #12 – Fractures FRACTURES 5. crepitus Represents a disruption in the continuity 6. abnormal mobility of a bone 7. deformity Angulation, shortening, rotation Occurs when more stress is...

PATHOLOGY: WEEK #12 – Fractures FRACTURES 5. crepitus Represents a disruption in the continuity 6. abnormal mobility of a bone 7. deformity Angulation, shortening, rotation Occurs when more stress is placed on 8. muscle spasm the bone than it is able to absorb. 9. numbness Causes of fracture (#) 10. tenderness o # caused by sudden injury eg. Diagnosis & Treatment Trauma Diagnosis ▪ Direct o X-ray ▪ Indirect o CT scan o Fatigue stress # o Bone scan ▪ Excess stress to normal Treatment bone o Reduction o Pathologic stress # o Immobilization ▪ Normal stress applied to o Preserve and restore function bones weakened by BONE HEALING disease Hematoma formation ▪ Osteoporosis, o From blood vessels of the osteomalacia, tumor periosteum resulting in weakness of o Neovascularization bone o Formation of fibrin meshwork and Classification of Fractures release of growth factors Location Soft tissue callus o Proximal, midshaft, distal o Procallus o Head/neck of bone o Fibroblasts and osteoblasts o Condyle, malleolus migrate to # site Type o Fibrocartilaginous callus develops o open/closed to connect bone fragments o Degree of # Ossification o Character of # pieces o Deposition of mineral salts into Direction/ Pattern callus to convert to bony callus o transverse# o Osteoblasts start on the outer o Spiral # surface of the bone and progress TYPES of Fractures (Simple and Compound inward Fracture) o Fibrocartilage converted to spongy 1. Transverse bone Remodeling Dead portions of 2. Spiral bone removed by osteoclasts 3. Oblique Compact bone replaces spongy 4. Impacted bone at periphery 5. Comminuted PATHOGENESIS 6. Greenstick Hematoma Formation - The hematoma 7. Avulsed is converted to granulation tissue by MANIFESTATIONS: invasion of cells and blood capillaries 1. Pain Soft Callus Formation – Deposition of 2. Ecchymosis collagen and fibrocartilage converts 3. Swelling granulation tissue to a soft callus 4. loss of function  PATHOLOGY: WEEK #12 – Fractures Hard Callus Formation – Osteoblasts Surgery if severe- Fasciotomy may be deposits a temporary bony collar around necessary (longitudinal incision of the the fracture to unite the broken pieces fascia to release the pressure while ossification occurs --------------------------------------- Bone Remodeling – Small bone Fat Embolism Syndrome fragments are removed by osteoclasts, Presence of fat droplets in small vessels while osteoblasts deposits spongy bone of lungs, brain etc. released from bone and then convert it to compact bone. marrow due to long bone # What influences healing? o Enter circulation via torn veins Nutritional status o Severity varies Age o Petechiae rash on chest 2 days Co-morbidities later Medication Manifestations: Smoking o respiratory failure, cerebral o *Function usually returns 6 dysfunction and skin/mucosal months later petechiae COMPLICATIONS OF FRACTURES: o Initial symptoms begin within a Compartment syndrome few hours to 3-4 days after injury Condition of increased pressure within a ▪ Highest risk period within 1 limited space (often a muscle week of injury compartment = contains fascia Diagnostics: surrounding muscles & nerves) Urgent CXR If the pressure is high, then tissue ABGs circulation is compromised… Treatment: Permanent damage may occur Prevent with early stabilization of Compartment syndrome may develop from: fractures 1. Decreased compartment size (cast, Supportive care: O2, IV fluids etc. dressing); Corticosteroids to decrease 2. Increase in volume of contents (trauma, inflammatory response of lung tissues, bleeding, swelling); decrease edema, stabilize lipid 3. Combination of both membranes Manifestations: Prognosis is good with early intervention severe pain – hallmark symptom Malunion – Deformity to fracture site and x-ray Paresthesia – nerve compression Delayed Union – NOT HEALING in predicted diminished pulses time inadequate immobilization or reduction DIAGNOSIS Nonunion Based on manifestations &history Failure to heal before process stops Physician can check pressure of Pain on weight bearing compartment with needle Muscle Atrophy/loss ROM Treatment – Emergency!!! FRACTURE BLISTERS Muscle necrosis can occur in 4-8 hours Skin bullae (blisters) - - - check pulse! Develop due to areas of epidermal Physician can check pressure of necrosis with separation of the epidermis compartment with needle from the underlying dermis by edema Remove cast or dressing, and elevate fluid limb o Most occur in the ankle, elbow, knee  PATHOLOGY: WEEK #12 – Fractures o Single or multiple Occurs more severe with motor vehicle accidents & falls Increased risk for infection