Fractures & CRPS

Most typical complications of fractures

- edema

- hematoma

- ecchymosis

Fracture

- also called a break

- caused by trauma or disease in a bone or joint

- determined by amount of force applied and overall bone

- pain may be similar to soft tissue damage, tendinitis, pain, sprain, strain, or bursitis

Age + health + size of bone

= ability to withstand force

Closed fracture

Skin is closed

Open fracture

Skin is open

Transverse fracture

Bone is broken by compression force

Spiral fracture

Bone is broken by twisting force

Comminuted fracture

Bone is broken into fragments

Impacted fracture

Bone is fragmented and the pieces are driving into one another

Greenstick fracture

Bone is broken halfway through, more common in children

Oblique fracture

Bone is broken by a twisting force, usually at 30°-45° degrees

Complete fracture

Full bone break

Incomplete fracture

Partial break

Longitudinal fracture

Break spans through entire length of bone

In most cases of fractures...

Displacement of the limb occurs

With use or at rest, a limb with a fracture may experience...

Atypical bone pain

Severe complications of fractures

- Complex Regional Pain Syndrome (CRPS)

- Heterotypic Ossification

3 primary phases of healing

- inflammatory

- reparative

- remodeling

Proper healing

Return to typical activities after physician clearance

Improper healing

- delayed union, malunion, or nonunion

- severe cases can result in CRPS or heterotypic ossification

Process of fracture healing (model on Katie's slide)

- hematoma

- new blood vessels

- internal callus

- external callus

- bony callus of spongy bone

- healed fracture

Etiology of fractures

- severe bodily trauma or lower limb injuries

- poor circulation, diabetes, autoimmune, prior nerve damage, and genetics

Osteopenia

- reversible bone weakening

- vital to incorporate a diet high in calcium and vitamin D as well as prioritizing weight bearing exercise

- affects half of adults > 50 in the U.S.

Osteoporosis

- disease of low bone density deterioration

- common in postmenopausal women

- 1 in 2 women and 1 in 4 men over age 50 will experience fracture as a result of osteoporosis

New fractures globally

178 million

New fractures increase since 1990

33.4%

Acute or long-term symptoms of fractures

455 million

Acute or long-term symptoms of fractures increase since 1990

70.1%

Most common sites for a "fragility fracture" (weak bones)

- spine

- hip

- wrist

- proximal humerus

Mean age of fractures

57.9 years old

Fractures occurring in women

64.5%

SDOH of fractures

- working in a highly physical occupation

- access to care: proper diagnosis, treatment, recovery plan to ensure adequate healing

- health literacy

- access to nutrient-dense food

- transportation

- socioeconomic status

- social supports during healing

Complex Regional Pain Syndrome (CRPS)

- persistent, ongoing pain in a limb, generally post-injury

- burning, throbbing, aching

- vascular abnormalities & temperature sensitivity (acute or chronic); changes in skin color

- stiffness in affected joints and impaired muscle strength

- evaluation done by professional familiar with the condition

- nerve conduction studies, ultrasounds, MRIs

- many doctors deny the existence of CRPS

Health management of CRPS

- temporarily non-weight bearing during healing

- timeline determined by physician & others on the rehabilitative team

- diet rich in vitamin D and calcium to strengthen bones

- limit alcohol intake and smoking

- gradual return to ADLs after period of immobilization to prevent re- injury

- integrating regular weight-bearing exercise or strength training after healing

Ecchymosis

Skin discoloration caused by minor localized bleeding beneath the skin's surface

Hematoma

Large collection of blood pooling outside of the blood vessels beneath the skin; raised and painful

Edema

Swelling due to excess fluid in tissues

Malunion

Non-anatomical, improper bone healing or position

Occupational impact

- work participation

- physical activity restrictions & decreased mobility

- challenges completing ADLs

- caring for children/family

- mental health concerns

- driving

- sleep comfort and quality

- sexual behavior

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