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musculoskeletal and rheumatology > 1a injury and healing p1 > Flashcards

1a injury and healing p1 Flashcards

1
Q

what are the 3 components of the MSK system?

A

bone, muscle, connective tissue

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2
Q

what are the 3 components of connective tissue?

A

tendon, ligaments and cartilage

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3
Q

what is a joint?

A

a junction between 2 or more separate bones

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4
Q

what are the 2 parts of the human skeleton?

A

axial and appendicular skeleton

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5
Q

what is the the axial skeleton?

A

forms the main part of body e.g cranium, vertebral column + rib cage

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6
Q

what is the appendicular skeleton?

A

bones which attach to axial skeleton e.g upper and lower limbs

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7
Q

what are the major functions of bones?

A

support
protection of vital organs
movement
mineral storage (calcium)
produces blood cells

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8
Q

what are the 2 ways that bones can develop?

A

Intramembranous or endochondrial ossification

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9
Q

which development do flat bones use?

A

intramembranous ossification

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10
Q

what are mesenchymal cells?

A

stem cells

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11
Q

which development does long bones use?

A

endochondral ossification

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12
Q

explain the process of intramembranous ossification?

A

1.mesenchymal cells ->osteoblasts
2.osteoblasts spread out -> ossification centrea
3.osteoblasts secrete osteiod
4.osteoid gets calcified -> stronger, trapping osteoblasts in the matrix
5. osteoblasts now called osteocytes
6. Forms trabecular matrix
7. osteoblasts present on surface form periosteum

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13
Q

explain the process of endochondral ossification?

A
  1. mesenchymal cells -> chondrocytes which produce cartilage
  2. blood vessels on edge of cartilage bring osteoblasts that deposit -> forms bony collar
  3. osteoclasts degrade hyaline cartilage at the centre
  4. This allows blood vessels to penetrate inside and deposit bone on inside -> primary ossification centre
  5. secondary ossification centre forms at edges of boens
  6. Hyaline cartilage still remains at edges of bones
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14
Q

what is the main aim of endochonral ossification?

A

for bones to grow in length and thickness

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15
Q

what 2 things are bones made up of?

A

bone + matrix

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16
Q

what are the 4 different types of bone cells?

A
  1. osteogenic
  2. osteoblasts
  3. Osteocytes
  4. Osteoclasts
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17
Q

what are osteogenic cells?

A

bone stem cells which can differentiate into anything

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18
Q

what are osteoblasts?

A

form bone
secrete osteoid
cataylses the mineralisation of osteoid

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19
Q

what are osteocytes?

A

mature bone cells

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20
Q

what are osteoclasts?

A

break bone

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21
Q

where can you find osteogenic cells?

A

in deep layers of periosteum (bone capsule)

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22
Q

what are the 2 layers of the periosteum?

A

fibrous and cellular layer

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23
Q

where are osteoblasts found?

A

in growing parts of bones

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24
Q

what are the 2 major components of bone matrix

A

organic and inorganic components

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25
Q

what are the organic components of bone matrix?

A

type 1 collagen + ground substance

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26
Q

what is ground substance?

A

proteoglycans, glycoproteins, cytokines, GFs

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27
Q

what is the inorganic component of the bone matrix? (2)

A

calcium hydroxyapatite and osteocalcium phosphate

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28
Q

what are the 2 major different bone types?:

A

immature bone
mature bone

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29
Q

what is immature bone?

A

soft bone, is the first bone that is put down, so is relatively weak. forms into mature bone when mineralised

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30
Q

what is mature bone?

A

mineralised woven bone, is much stronger than immature bone

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31
Q

what are the 2 main types of mature bone?

A
  1. Cortical/compact bone
  2. cancellous bone
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32
Q

what is cancellous bone?

A

spongy bone, honeycomb like structure

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33
Q

where is cortical/compact bone in this diagram?

A
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34
Q

what are the structural units called in compact/cortical bone?

A

osteons

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35
Q

what do the osteons form in compact bone?

A

lamellae

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36
Q

what is the Haversian canal?

A

found in bones and contains, blood vessels, nerves and lymphatics

37
Q

what are lacunae?

A

small spaces in compact bone where cells sit

38
Q

what is this?

A

periosteum

39
Q

what is this?

A

outer cortex- compact bones

40
Q

what is this?

A

medullary cavity

41
Q

what is this?

A

nutrient artery

42
Q

what is this?

A

articular cartilage

43
Q

what region of the bone is this?

A

diaphysis

44
Q

what region of the bone is this?

A

metaphysis

45
Q

what region of the bone is this?

A

physis

46
Q

what region of the bone is this?

A

epiphysis

47
Q

what is interstitial bone growth?

A

when bone grows in length

48
Q

what is appositional bone growth?

A

when bone grows in width

49
Q

how does interstitial growth work?

A

happens at the growth plates found at the physics (edge of bone)
in epiphyseal side, cartilage continues to grow
in diaphysial side, cartilage dies and is replaced with bone
overall, increases length of bone

50
Q

how does appositional bone growth work?

A

ridges in periosteum creates grooves which allows blood vessels to enter allowing more cells (osteoblasts) to be laid down

51
Q

a lady falls over and breaks her hip. what type of fracture is this?

A

traumatic, low energy fracture

52
Q

a guy is in a motorcycle accident and breaks his leg. what type of fracture is this?

A

traumatic, high energy fracture

53
Q

what are the 3 mechanisms of fractures?

A
  1. trauma
  2. Stress
  3. Pathological
54
Q

give some examples of pathological causes of bone fractures?

A

osteoporosis
cancers
vit d deficiency
OI
pagets

55
Q

how can stress lead to fractures?

A

overuse of bones => increased stress exerted on bones =. bone weakening => stress fracture

56
Q

what is the pathophysiology of osteoporosis?

A

osteoclast activity> osteoblast activity

57
Q

what is the difference between osteoporosis and osteopenia?

A

osteopenia - your levels are only 1-2.5 Standard deviations form the normal range
osteoporosis - levels are >2.5

58
Q

which groups of people are more likely to get osteoporosis?

A

women + old people

59
Q

why is osteoporosis more common in women?

A

as oestrogen usually protects them, but post-menopause, you no longer secrete it so get weaker boens

60
Q

what causes OI (osteogenesis Imperfecta)

A

genetic condition when you get decreased type 1 collagen

61
Q

what is a key sign of certain types of OI?

A

blueish scleras

62
Q

what is pagets disease?

A

when you get excessive bone breakdown, leading to excessive remodelling of bone-> deformed bones

63
Q

what are blastic tumours?

A

make bone thicker

64
Q

what are lytic tumours?

A

make holes in bones

65
Q

what are the 4 overall steps of fracture healing and the types of cells involved?

A
  1. bleeding -blood
  2. inflammation - neutrophils/macropahges
  3. repair - blast cells e.g fibroblasts
  4. Remodelling - osteoclasts/blasts
66
Q

Explain fracture healing?

A
  1. bone breaks
  2. Haematoma forms, which release cytokines
  3. get soft callus formation (type 2 collagen- cartilage)
  4. soft callus converted into hard callus = bone
  5. excess bone is removed
67
Q

what are the 2 types of bone healing?

A
  1. primary bone healing
  2. secondary bone healing
68
Q

how long does it take for bones to heal?

A

3-12 weeks

69
Q

What is Wolff’s law?

A

Bone grows and remodels in response to the forces that are placed on i

70
Q

What is primary bone healing?

A
  • Intramembranous healing
  • Mesenchymal stem cell goes straight to osteoblast and there’s direct formation of woven bone
  • Happens when you have a stable fracture and ends of bone are really close together
71
Q

What is secondary bone healing?

A
  • Endochondral healing
  • Results in more callus forming
  • Involves responses in the periosteum and external soft tissues
  • Occurs when you have a relatively stable fracture
  • Mesenchymal stem cell goes to chondral precursor which produces bone cells
72
Q

What are the main principles of fracture management?

A
  • Reduction- bring fracture ends together
  • Hold- the ends in the right position with metal or no metal
  • Rehabilitate- once bone has healed, limb will still be weak- needs rehabilitation
73
Q

What is closed reduction?

A
  • Pulling bones back together without opening skin
  • use hands to maneovoer bone pieces back into position
  • used for less severe bone fractures
  • Can be through traction of skin or skeletal (pins in bone)- wrapping bandage around leg/putting pin in bone and attaching weight to other end to realign bones
74
Q

What is open reduction?

A
  • Mini-incision
  • Full exposure
  • These are again to realign the bones
    essentially, undergo a surgery to reallign bones
75
Q

What are the different ways of holding a fracture?

A
  • Fixation
  • Plaster- closed
  • Traction (skin or skeletal)- closed
76
Q

what is traction?

A

basc when you use pulleys to help heal bones

77
Q

what are the 2 types of traction?

A
  1. skin
  2. skeletal
78
Q

what is bone fixation?

A

when you put some type of metal near bone to help hold the bone in plae

79
Q

what is bone fixation?

A

when you put some type of metal near bone to help hold the bone in place

80
Q

what are the 2 main ways of fixating a fracture?

A
  1. internally (through the bone)
  2. externally (on top of skin)
81
Q

what are the 2 ways of internally fixating a bone?

A
  1. intramedullary (through the bone) - uses pins and nails
  2. extramedullary (outside bone)- uses plates, pins and screws
82
Q

what type of fixation does this image show?

A

extramedullary internal fixation

83
Q

what type of fixation does this image show?

A

intramedullary internal fixation

84
Q

what are the 2 main types of external fixation?

A
  1. monoplanar
  2. mulitplanar
85
Q

what is monoplanar external fixation?

A

the pins are connected by a single rod in a plane

86
Q

what type of fixation is this?

A

monoplanar external fixation

87
Q

what is multiplanar external fixation?

A

when you have pins that are connected by mutliple rods in multiple planes

88
Q

what type of fixation is this?

A

multiplanar external fixation

89
Q

what are the different aspects of rehabilitation for bone?

A
  • Using the limb- retraining it with physiotherapy and using pain relief if necessary
  • Moving it
  • Strengthening it
  • Weight bearing (in case of lower limb)

musculoskeletal and rheumatology (7 decks)

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