Bio of Injury and Healing: Clinical Correlations Flashcards

1
Q

What is the most common mechanism of an ankle sprain?

A

Inversion

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2
Q

What are two commonly sprained ligaments in the ankle?

A

ATFL: Anterior talofibular ligament

CFL: Calcaneofibular ligament

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3
Q

What anatomical structure prevents eversion sprains?

A

The fibula is in the way

Also the Deltoid ligment complex

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4
Q

What are the phases of acute injury?

A
  1. Bleeding
  2. Clot formation
  3. Inflammation
  4. Repair: Fibroblast proliferation, neovascularization
  5. Remodeling
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5
Q

What are the types of 5th metatarsal fractures?

A
  • Avulsion: 5th metatarsal base @ peroneus brevis insertion
  • Jones: traumatic fracture metaphyseal-diaphysis junction
  • Pseudo-Jones: stress fracture proximal diaphyseal
  • Dancer’s: spiral fracture mid to distal diaphysis
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6
Q

Where is a common location in the foot for avulsion fractures? Which tendon causes this?

A

The Fibularis tertius** tendon attaches to the **base of the 5th metatarsal. Can roll foot on to lateral aspect and get avulsion fx of 5th metatarsal.

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7
Q

What is a Maisonneuve fracture? What is a good physical exam technique to test for this and how does it work?

A

Spiral fracture of the proximal fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane.

Can test for this fracture by the Squeeze Test: squeeze the fib and tib together, this causes the ends to bow out and increases pressure. A positive test is pain at the ankle or knee. At the knee would raise suspicion of Maisonneuve fx.

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8
Q

If a patient has a lateral ankle sprain what type of reaction would you expect with external rotation of the ankle?

A

No change. This test does not stress the lateral side at all. If this was positive, there may be a medial or high ankle sprain - changing your differential.

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9
Q

Which type of tissue heals the least completely?

A

Cartilage

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10
Q

In a loose body (or joint mice) what do you need to be sure to check for on imaging?

A

You need to not only look for the loose body but also the donor site of where the loose body came from.

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11
Q

What sort of patient complaint would make you most suspicious of a loose body in a joint?

A

Locking

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12
Q

What are some requirements for good ligament healing?

A
  1. Good blood supply
  2. Damage section approximated or guided to correct area
  3. Rest
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13
Q

What is a commonly torn ligament that is difficult to heal? Why?

A

ACL – it is located inside the knee and gets little vasculature, it is also within the joint capsule and doesn’t heal up as well.

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14
Q

What are the stages of bony healing?

A
  1. Bleeding (seconds-minutes)
  2. Clot formation (minutes-hours)
  3. Inflammatory stage (hours-days)
  4. Repair stage (1-2+ weeks - 3+ months): osteoclasts and osteoblasts invade the blood clot
  5. Remodeling stage (1-2 years)
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15
Q

Break down the repair stage of bony healing from 1-2 weeks to 3+ months.

A
  • Osteoclasts and osteoblasts invade blood clot
  • Soft callus (2-6 wks)
  • Hard callus (4-12+ wks)
  • Callus matures (12-26 wks)
  • Bony gaps bridged (6-12 mos)
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16
Q

Which factor most influences strength of healed bone?

A

Calcium content of bony repair

17
Q

What is the reasoning behind apophysitis conditions such as Osgood-Schlatter disease?

A

There is a relative weakness in the immature skeleton of children compared to the mature skeleton – places repetitive tension on certain tendons

18
Q

Describe the Diaphysis, Metaphysis, Physis and Epiphyses in a long bone.

A
  • Diaphysis = shaft
  • Metaphysis = area between shaft & growth plate
  • Physis = growth plate
  • Epiphysis = end of long bone
19
Q

What is apophysitis?

A

Pain and inflammation of ossification centers from repetitive tension.

20
Q

What is the treatment for Apophysitis? Are there any complications from this condition?

A

Treatments: activity as tolerated, stretching, ice +/- NSAIDs

Complications: bony hypertrophy; fracture (rare)

21
Q

Osgood-Schlatter

A

Tibial tubercle

22
Q

Sever’s

A

Calcaneal apophysitis

23
Q

Sinding-Larsen-Johansson

A

Distal patellar pole

24
Q

Anterior superior iliac spine (ASIS)

A

Sartorius

25
Q

Anterior inferior iliac spine (AIIS)

A

Rectus femoris

26
Q

Little leaguer’s elbow

A

Medial epicondyle

27
Q

ACL graft healing timeline

Ligamentization: revascularization with vascular synovial layer

A

Allografts: starts at 4-6 weeks, complete revascularization ~20 wks, fixation weakest link until healed, remodeling 1 year ~ histological & biochemical properties of native ACL

Autografts: patellar tendon – graft remodeling 4-8 wks, hamstring by 12 wks