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BRS 5: Musculoskeletal & Rheumatology > 5.4: Injury and healing (part 1 of 2) > Flashcards

5.4: Injury and healing (part 1 of 2) Flashcards

1
Q

3 mechanisms of bone fracture

A

Trauma
Stress
Pathological

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2
Q

What 2 things are bones made up of

A

Cells
Matrix

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3
Q

How do bones develop in utero

A

Intramembranous (flat bones e.g. skill, clavicle, mandible) and
endochondral (long bones, ribs, vertebrae)
ossification

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4
Q

Process of Intramembranous ossification

A

Mesenchymal cells condensate, differentiate into osteoblasts and secrete osteoid
This traps osteoblasts which become osteocytes - collate and form ossification centre
Multiple ossification centres form and fuse, forming trabecular matrix and periosteum
Compact bone develops

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5
Q

Intramembranous ossification is

A

Bone development from fibrous membranes

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6
Q

Process of endochondral ossification

A

Bone collar formation
Cavitation
Periostea’s bud invasion
Diaphysis elongation
Epiphyseal ossification

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7
Q

Which bone formation takes a longer amount of time?

A

Endochondral ossification

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8
Q

Primary ossification centre of endochondral ossification

A

Diaphysis

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9
Q

What is the secondary ossification centre of endochondral ossification

A

Epiphysis

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10
Q

2 Different types of bone structure

A

Immature bone
Mature bone

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11
Q

Characteristics of immature bone

A

First bone that’s produced
Laid down in a woven manner - relatively weak
Mineralised and replaced by mature bone

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12
Q

Characteristics of mature bone

A

Mineralised woven bone
Lamellar structure - relatively strong

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13
Q

2 types of mature bone

A

Cortical
Cancellous

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14
Q

Characteristics of cortical bones

A

Compact - dense
Suitable for weight bearing

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15
Q

Characteristics of cancellous bone

A

Spongy - honeycomb structure
Not suitable for weight bearing

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16
Q

Organisation of cortical bone (compact)

A

Osteons found in compact bone, repeated structural units , around central Haversian canal which contains blood vessels, nerves and lymphatics

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17
Q

Structure of long bones

A

Diaphysis - long part of bone
Metaphysis- area that flares up
Physis- growth plate
Piphysis - distal or proximal part of bone

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18
Q

2 locations of Osteogenic cells

A

Marrow
Deep layers of periosteum

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19
Q

Where are osteoblasts found

A

Growth portions of bone :
Periosteum and endosteum

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20
Q

Where are osteoclasts formed

A

Bone surfaces and at sites of old, injured or unneeded bone

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21
Q

Where are osteocytes found

A

Entrapped in matrix

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22
Q

2 ways that bones can grow

A

Interstitial - increased length
Appositionsl -increased thickness and diameter

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23
Q

Where does Interstitial occur

A

In the physis

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24
Q

Where does appositional growth occur

A

Periosteum :
Osteoblasts add more and more bone cells

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25
Role of bone in calcium homeostasis
Calcium hydroxyapatite- structural support Calcium deposited and withdrawn during bone remodelling Regulated by PTH and calcitriol Calcitonin stimulates calcium uptake into bone VitaminD helps body absorb and use calcium
26
Trauma causing bone to break
Low energy or high energy transfer
27
Stress fracture is
Abnormal stress on normal bone
28
A pathological fracture is
Normal stress on abnormal bone
29
How do stress fractures occur
Repetitive applications of forces on bone, results in stress exertion on localised region, excess remodelling capacity, bone weakening persists, stress fractures
30
When does a bone experience stress
When a force is loaded upon it , low levels of these forces cause bone to deform and place strain
31
4 weigh bearing bones in body
Femur, tibia, metatarsals, navicular
32
6 examples of conditions that can lead to a pathological/insufficiency fracture
Osteopenia and osteoporosis - Soft bone Malignancy Vitamin-D deficiency - Insufficient exposure to sunlight, reduced vitamin-D source → Osteomalacia + Ricket's Osteomyelitis Osteogenesis Imperfecta - Collagen deficiency Paget's disease
33
What causes osteopenia and osteoporosis?
Bone remodelling imbalance → Osteoclast activity greater than osteoblast activity Leads to disrupted microarchitecture
34
At what age do senile and postmenopausal osteoporosis occur?
- Senile osteoporosis: >70 Postmenopausal osteoporosis: Women 50-70 -
35
Is osteoporosis more common in men or women
Women 4:1
36
What fractures is osteoporosis associated with?
Fragility fractures - Hip, spine, wrist Low energy trauma fractures
37
What can secondary osteoporosis be caused by?
Hypogonadism - low oestrogen Glucocorticoid excess - glucocorticoids inhibit insulin growth factor-1 which can directly or indirectly reduce osteoblast function Alcoholism - increases PTH which leaches Ca2+ from the bone and excess alcohol can kill osteoblasts
38
What is the T-score of a person with osteoporosis and osteopenia respectively?
Osteoporosis: Equal to or less than -2.5 Osteopenia: Between -1 and -2.5
39
What does vitamin D facilitate
Calcium, magnesium and phosphate absorption
40
What can inadequate calcium or phosphate lead to in bones
Defect on osteoid matrix mineralisation
41
What can a Vitamin D deficiency cause in children and adults respectively?
Children - rickets Adults - osteomalacia
42
What type of inheritance pattern does congenital osteogenesis imperfecta (OI) display?
Autosomal dominant or recessive
43
Explain the pathogenesis of congenital OI
Reduction in type I collagen secretion Collagen is an ECM protein secreted by fibroblasts and osteoblasts and organised into insoluble fibres, comprising the ECM surrounding cells → Provides mechanical strength and rigidity to tissues and organs, especially to skeletal tissues: Bone cartilage, tendons and ligaments
44
What 4 things does congenital OI affect
Bones Hearing Heart Sight
45
What is Paget’s disease
Excessive bone degradation and disorganised bone remodelling→ Deformity, pain, fracture or arthritis May transform into malignant disease
46
4 stages of Paget’s disease
1. Osteoclastic activity (Increased bone resorption) 2. Mixed osteoclastic-osteoblastic activity (Imbalance) results in disorganised bone remodelling, considering the osteoid scaffold is disrupted and diverted through osteoclastic activity → Deformities arises 3. Osteoblastic activity 4. **Malignant degeneration**
47
4 primary bone cancers
Osteosarcoma Chondrosarcoma Ewing sarcoma Lymphoma
48
What is secondary bone cancer
Metastatic bone tumour from other tissues
49
What are the types of secondary bone cancers that can lead to a pathological bone fracture?
Lytic - Bone eating; Kidney, thyroid, lung and **breast** Blastic - Bone forming; Prostate and **breast**
50
3 ways to describe fractures
Soft tissue integrity : open or closed (skin remains intact) Bony fragments (greenstick- partial fracture in which one side of bone is broken, simple, multifrahmentory) Movement (displaced/undisplaced)
51
Process of fracture healing
1) Bleeding - release of cytokines causing inflammation 2) granulation - tissue deposited and blood vessel formation forms soft callus then forms a hard callus 3)bone remodelled through endochondral ossification
52
What is wolffs law
Bone grows and remodels in response to the forces that are placed on it
53
Outline the differences between primary and secondary bone healing
Primary: Intramembranous healing + Absolute stability Mesenchymal stem cell goes to the bone cells in fracture to start replacing bone cells Secondary: Endochondral healing involving responses in the periosteum and external soft tissues + Relative stability; Endochondral ossification → More callus Mesenchymal stem cell goes to the chondral precursor to start producing new bone cells
54
When do you see signs of healing visibly on an X-ray?
From 7-10 days
55
What is the duration for each step in fracture/bone healing?
Inflammatory - Hours to days Repair - Days to weeks Remodelling - Months to years
56
3 general principles of fracture management?
Reduce → Closed, open Hold → Metal; no metal Rehabilitate → Move, physiotherapy, use
57
What is reduction in terms of fracture management
Involves restoring the anatomical alignment of a fracture or dislocation of derormed limbs
58
What is skin traction
Wrap bandage around fracture and the add a weight to bring limb into natural alignment
59
What is skeletal traction
Put a pin through bone and use a larger weight
60
2 different types of hold
Fixation Closed - plaster and traction
61
4 methods to rehabilitate fractures
Use - Pain relief and strain Move Strengthen (Muscles) Weight-bear
62
2 examples of soft tissue injury
Tendinopathy: Tendinitis - Inflammation of tendon associated from overuse (In additions to infection or rheumatic disease). Swelling + pain → reduced mobility of tendon and muscle. Tendinosis - Caused by overuse of a tendon → Abnormal thickening. Rupture (Mainly ligaments/tendons tearing)
63
List and explain ligament injury classifications
Grade I - Slight incomplete tear → No notable joint instability. Grade II - Moderate/severe incomplete tear → Some joint instability. One ligament may be complete torn. Grade III - Complete tear of 1+ ligaments → Obvious indication of stability of instability surgical requirement.
64
How can we treat tendon or ligament tears?
Immobilise - Plaster OR boot/brace Surgical repair - Suture
65
Good effects of immobilisation on injured tissue
Less ligament laxity (lengthening)
66
Bad effects of immobilisation on injured tissue
Less overall length of ligament repair scar Protein degradation exceeds protein synthesis Production of inferior tissue by blast cells Resorption of bone at site of ligament insertion Decreased tissue tensile strength (50% in 6-9 weeks)
67
2 benefits of mobilisation on injured ligaments is tissue?
Ligament scars are wider, stronger and more elastic Better alignment/quality of collagen
68
2 factors affecting tissue healing
Mechanical environment - Movement and forces Biological environment - Blood supply, immune function, infection, nutrition

BRS 5: Musculoskeletal & Rheumatology (6 decks)

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