Fractures - skeletal system

First step of the repair of a broken bone or fracture

Hematoma formation

Bone breaks ---> blood vessels + surrounding tissues damaged --> bleeding at site --> large blood clot = hematoma

this plugs gap between bone ends which then triggers inflammation

why is inflammation crucial during the first step of hematoma formation?

inflammation then increases amount of white blood cells, platelets, blood flow, brings nutrients and O2 the to site
- this clears away dead tissue + initiates healing process

Second step of repair of bone fracture

Fibrocartilage callus formation

Fibroblasts form fibrocartilaginous callus, which is made of fibrocartilage to connect broken bone ends

- new capillaries grow into break site

- fibroblasts and chondroblasts invade fracture sit to produce collagen fibers and cartilage matrix --> forms soft bridge

3rd step of repair of bone fracture

bony callus formation

Fibrocartilaginous callus and spongy bone gradually replaced by compact bone (bony callus)

4th step of repair of fracture

Bone remodeling

Spongy bone replaced w/ compact bone and bone is reshaped to resemble OG

- osteoclasts break down excess bony callus

- osteoblasts build new, stronger bone

what are the 4 bone fracture classifications?

1.) position of bone
2.) completeness of break
3.) orientation of break
4.) Penetration of skin

Terms for position of bone in fractures

non displaced fracture (normal alignment) & displaced fracture (out of alignment)

Terms for completeness of fracture

• Complete Fracture: Bone is broken all the way through.

• Incomplete Fracture: Bone is only partially broken.

Terms for orientation of break

Transverse fracture + linear fracture

Terms for skin penetration in fractures

simple fracture (break does not penetrate the skin) + compound fracture (break penetrates the skin, damages surrounding skin, risk of infection)

medical treatments for fractures

reduction

what is reduction

realignment of broken bone ends

closed reduction

bone ends coaxed into position by physician's hands (manipulation)

open reduction

bone ends sewed together surgically w/ pins, wires, plates, etc

why do bones fracture in general?

Bones fracture due to high-force impacts or excessive stress placed on them, often from accidents, falls, or sudden pressure beyond the bone's capacity to handle.

other causes of fractures

diseases that weaken the bones
ex. osteoporosis, some cancers, osteogenesis imperfecta

comminuted fracture

bone is shattered into many pieces

compression fracture

Often occurs in spongy bone in spine

- crush fracture

ex: front portion of vertebrae in spine collapse due to osteoporosis

greenstick fracture

When the bone partly fractures on one side, but doesn't break completely because rest of the bone can bend

Greenstick fractures are most common in what group of people?

children because their bones are softer, more elastic

Hairline fracture

A partial fracture of the bone that is difficult to detect- harder to detect w/ routine xrays

Longitudinal (linear) fracture

The break is along length of the bone

sprial fracture

a fracture where at least one part of the bone has been twisted

Torus (buckle) fracture

bone deforms but doesn't crack

- more common in children

*painful but stable

transverse fracture

a straight break across a bone

symptoms of fractured bone

pain, swelling, unable to put weight on injured area, bleed (compound fracture), grating sensation, angulation (bent at unusual angle), nausea, pale

why are elderly prone to fractures?

bones less healthy= less tough, resilient, unable to withstand powerful impact
- weaker bones + great risk of falling

pathological fracture

fractures that are a result of underlying illnesses that may weaken bones leading to high risk of fractures
ex. osteoporosis, infection, tumor

stress fracture

fracture that resulted from repeated stresses and strains

-common in prof. sports

how is alignment of bones done?

manipulation (closed reduction) or surgery (open reuction)

when does healing process begin after fracture?

after bones are properly aligned

what does immobilization do?

makes sure that the bone stays aligned while they heal

4 ways immobilization is accomplished

plaster casts/plastic functional braces (hold bone in position until healed)
metal plates + screws (hold bone fragments tg)
Intra-medullary nails (internal metal rods placed down center of long bones. flexible wires for children)

roles of osteoblast + osteoclasts in healing process

osteoblasts absorb old and damaged bones
osteoclasts create new bone

Benefits of PT in recovery process of fracture

restores muscle strength and mobility to the affected area

non unions

fractures that fail to heal properly

how to physicians treat non unions?

ultrasound therapy, bone graft (natural or synthetic bone transplanted to stimulate broken bone), stem cell therapy

complications of fracture repair

• Malunion: Improper healing, causing the bone to heal in the wrong position.

• Disruption of Bone Growth: Interruption in normal bone development, especially in children.

• Persistent Infection: Infection in the bone or bone marrow (osteomyelitis).

• Bone Death: Death of bone tissue, often due to lack of blood supply (avascular necrosis).

malunion

heals in wrong position or shifts

disruption of bone growth

fracture as child affect growth plate, risk normal development of bone

persistent bone or bone marrow

bacteria can enter when break in skin and infect bone or bone marrow --> persistent infection

bone death

when bone loses essential supply of blood and dies

what dose menopause have to do with increased risk of fracture?

estrogen regulated woman's calcium, drops
--> density and strength of bones decreased

Endochondral Ossification

Endochondral ossification is the process by which hyaline cartilage is replaced by bone tissue to form most of the bones in the body, including long bones. This process begins with a cartilage model that gradually ossifies, starting at the primary ossification center in the diaphysis, followed by secondary ossification centers in the epiphyses.

what are the 6 different type of common injuries of the skeletal system?

1. Shoulder Seperation

2. Nursemaid Elbow

3. Shin Splint

4. Stress Factures

5. herniated disc

6. sprained ankle

what is shoulder seperation?

its the ligament attaching to underside of clavice are turned. Seperation of collarbone and shoulder blades

what is Nursemaid elbows?

its pulled and partially dislocated. (closed reduction happens commonly in young kids)

what is Shin Splints?

its when the muscles,tendons and bone tissues around the tibia become inflammed (repetitive stress,overuse)

what is stress fracture

its tiny cracks in the bone. (happens when repetive stress or pressure. Breaks down fatty than the body can rebuild it.)

what is a herniated disc?

its a jelly like nucleus pushes against outer ring, often pressing on nearby nerves

what is a sprained ankle?

its a ligament that supports the ankle stretch beyond their limits and tears.