Fracture

Question 1

What is a break in a bone?

Answer 1

Fracture

Question 2

What is a closed/simple fracture?

Answer 2

The skin is intact

Question 3

What is an open or compound fracture?

Answer 3

The ends of the bone have broken through the skin or into one of the body cavities

Question 4

What is a complete fracutre?

Answer 4

The bone is broken into two or more pieces

Question 5

What is an incomplete fracture?

Answer 5

The bone is bent or cracked but the periosteum is intact

Question 6

What is an avulsion fracture?

Answer 6

A piece of bone attached to a tendon or ligament gets pulled away from the main part of the bone

Question 7

Which type of fracture occurs when it is shattered or crushed?

Answer 7

Comminuted

Question 8

Which type of fracture occurs when the bone does not break all the way through?

Answer 8

Greenstick

Question 9

Which fracture occurs when break line runs at an angle to the length of the bone?

Answer 9

Oblique

Question 10

Which type of fracture occurs when it spirals down the bone?

Answer 10

Spiral

Question 11

Which type of fracture occurs when the bone is broken in 2 transversely?

Answer 11

Transverse

Question 12

Which type of fracture occurs when small, hairline cracks in the bone, usually due to repeated activity?

Answer 12

Stress

Question 13

What is the etiology of fracture?

Answer 13

1. Trauma
2. Contributing factors
   - pathologies such as osteoporosis, osteopenia, tumors, local infection

Question 14

Where are the common fractures?

Answer 14

1. Humerus
2. Distal radius (Colle’s & Gelazzi)
3. Ankle (Pott’s)
4. Femur
5. Tibia
6. Metatarsals
7. PelvisW

Question 15

What are the signs & symptoms?

Answer 15

1. Inflammation; the pain is severe
2. Deformity
3. Bleeding
4. Bruising
5. Severe fracture can cause numbness & tingling due to the nerve damage

Question 16

What are the signs & symptoms during immobilization?

Answer 16

1. Pain, local and possibly distant
2. Tissue repair is occurring at the fracture site
3. Under the cast :
   - reduced circulation, edema, disuse atrophy, contracture, decreased cartilage health
4. HT, TPs in compensatory mm

Question 17

What are the signs & symptoms following immobilization?

Answer 17

1. Fracture site continues to heal
2. Decreased tissue health, fragility, disuse atrophy & weakness
3. Possible loss of proprioception & altered gait & posture
4. Scars (open reduction)
5. HT, TPs
6. Adhesions
7. Contractuer

Question 18

What are complicatons?

Answer 18

1. Infection : open fractures
2. Delayed union : healing takes longer
3. Nonunion : gap does not fill
4. Acute compartment syndrome
5. DVT

Question 19

What are CI’s & Precautions DURING immobilization?

Answer 19

1. No testing of muscles & joints directly involved
2. No traction of the limb until union has occurred
3. No heat applications distal or immediately proximal to the cast
4. Only careful, pain free AROM proximal & distal
5. AROM & PROM with physician approval only, if the fracture sire is a muscle attachment, or if a tendon cross the fracture site was severed or lacerated.
6. No local treatment following reduction until the wound has healed
7. Stress fractures that are point tender are local CI

Question 20

What are CI’s & Precautions FOLLOWING immobilization?

Answer 20

1. No overpressure on involved joints until union has occurred
2. Until tissue health & muscle tone normalize, avoid deep techniques & temp extremes
3. Caution with stretching
4. Avoid local hot hydrotherapy over metal implants

Question 21

What are assessment findings DURING immobilization?

Answer 21

1. Antalgic giant and/or posture
2. Crutches, cane, or sling may be present
   3.Possible pained facial expression
   4.Pain referred to nearby tissue
   5Protective spasm palpated in muscles crossing the injury
   6.AROM (pain free proximal & distal only) limited
   7.Physician approval
3. Stress fractures are painful upon direct compression
4. Likely impact on ADLs

Question 22

What are assessment findings FOLLOWING immobilization?

Answer 22

1. Habituated antalgic gait & posture may be observed
2. Initially dry, scaly or flaky skin where cast was
   3.Disuse atrophy, residual edema, bruising, point tenderness, inflammation or ischemia may be noted
   4.Hypertonicity & TPs in compensatory structures
   5.AROM (pain free proximal & distal only) limited
   6.PROM (careful, pain free & no overpressure until consolidation has occurred) limited, tissue stretch end feel
   7.RROM (submaximal & pain free) weakness
   8.Stress fractures are painful upon direct compression

Question 23

What is the stage where new bone trabeculae appear in the fibrocartilaginous callus, which then converts into a bony callus? This occurs how many weeks after injury?

Answer 23

Consolidation, 3-4 weeks

Question 24

What are goals DURING immobilization?

Answer 24

1. Reduce excess inflammation
2. Treat compensatory structures without disturbing the healing process
3. Maintain proximal circulation
4. Maintain proximal & distal ROM

Question 25

What are goals FOLLOWING immobilization?

Answer 25

1. Reduce excess inflammation 2. Improve tissue health 3. Reduce HT & TPs 4. Maintain & eventually increase ROM 5. Decrease ADH

Question 26

What are goals FOLLOWING consolidation?

Answer 26

1. Normalize mm tone, strength, tissue health & ROM 2. Decrease pain 3. Decrease postural imbalances 4. Restore function

Question 27

What are homecare exercises during immobilization?

Answer 27

1. RICE for pain reduction 2. Cold application for any distal edema 3. ROM & submaximal isometrics if safe 4. Address compensatory tissue changes

Question 28

What are homecare exercises following immobilization?

Answer 28

1. Elevation for residual edema 2. Thermal applications (warm & cool) 3. Px free ROM & strengthening (isometric to isotonic) 4. Self massage to adhesions 5. Dry brushing for tissue health