Bone fracture and fracture healing Flashcards
Disorder of development- osteogenesis imperfecta
brittle bones- less collagen
Disorder of development- spina bifida
to do with arches that grow amd arch to form spinal processes- doesn’t form properly- spinal cord could go out- risk of damage
Disorder of development- achondroplasias
long bones don’t form properly, they are shorter
Endocrine disorders- gigantism
produce too much growth hormone, occurs and causes problems pre puberty, people larger than average
Endocrine disorders- acromegaly
too much growth hormone after the formation of epithelial plates have formed, means there is an increase in density rather than length, affects face more
Endocrine disorders- pituitary dwarfism
inadequate production of growth hormone
Endocrine disorders- postmenopausal osteoporosis
Postmenopausal women are susceptible to primary osteoporosis since osteoporosis is closely related to estrogen deficiency.
Endocrine disorders- hyper/ hypoparathyroidism
controls calcium- too much/ little can affect the levels calcium- effects amount laid down or destroyed at bone level
Nutritional problems- rickets
lack of vitamin D, reduces amount of calcitriol produced- involved in calcium homeostasis, not enough calcium is laid down or destroyed at bone level, in adults it causes
Nutritional problems- osteomalacia
causes bones to become soft
Nutritional problems- scurvy
vitamin C- needed for collagen production and stimulation of osteoblasts- effects building of bones, symptoms include bleeding gums
Disorders of the bones linking to ageing- ostopina
bones get weaker as we age, to do with disposition and reabsorption, cell building properties are lost- inadequate ossification, osteoblasts activity declines, whereas osteoclasts stays the same (mainly affects the jaw)
Disorders of the bones linking to ageing- osteoporosis
reduction in bone mass happens and effects the function, the reduction in bone mass is greater than at expected at that age, lack of weight bearing can cause it , can be classified as primary and secondary
who does osteoporosis affect the most
mostly females over 70%, if menopause happens early or goes on too long
What is primary osteoporosis
simple form seen in older people and women past menopause, it is accelerated bone loss but is predicted
What is secondary osteoporosis
not necessarily related to older people, menopause, osteoporosis can be caused by metabolic bone disease, or cancerous, maligins, severe malnutrition, certain drugs can lead to it for example corticosteroids, can lead to lack of ability to weight bear
Modifiable risk of osteoporosis
smoking increases risk, alcohol abuse, excessive caffeine , excessive dietary production, lack of dietary calcium, lack of sunlight exposure
Changes in bone mass with ageing
after mid 30’s, you begin to lose bone mass, women loss bone mass faster after menopause, but happens in men too
bones can weaken early in life without a healthy diet and right kinds of physical activity
when is osteoporosis usually found
usually found after fracture
What are fractures
fractures are breaks were mechanical stress is placed on this are it create excessive amount of force and bone cannot cope
Classification of fractures- severity- open/compound
bone has broken through skin, lots of skin tissue trauma
Classification of fractures- severity- impacted
one fragment is driven into another with such force that the 2 bones breaks. are forced into each other
Classification of fractures- severity- comminated
lots of different fracture pieces- broken into
Classification of fractures- severity- close/ simple
skin is not broken and soft tissue involvement is less
Classification of fractures- severity- displaced
normally 2 fragments, they have moved from original position, usually involve muscle spasm
Classification of fractures- severity- compressed
A compression fracture is a type of fracture or break in your vertebrae.
Classification of fractures- shape- spiral
twisting forces causes spiral forces along long axis of bones
Classification of fractures- shape- oblique
combination of twisting and direct force
what are fractures named according to
severity, shape, position, physicians name
Classification of fractures- shape- greenstick
only seen in children, bone doesn’t snap, and then a couple of bits splinter of
Classification of fractures- shape- depressed
skull fracture- a bit of the skull has depressed downwards
Classification of fractures- shape- transverse
direct blow in horizontal axis
Classification of fractures- positions
Distal/ proximal, neck, shaft, epiphyseal
Classification of fractures- physicians name
Colle’s- distal end of radius fracture, Pott’s- one or both ends of malleoli fracture
4 stages of fracture healing
Haematoma formation, fibrocartilaginous callus formation, bony callus formation, bone remodelling
4 stages of fracture healing- step 1 haematoma
clot produced 6-8 hours, one cell does, inflammation bring phagocytic cells- osteoclast cells arrive to clear up debris, new capillaries grow in that area, bleeding occurs- damaged blood vessels and nutrient arteries, disruption in periosteum of bone, blood clot formed in medullary cavity
4 stages of fracture healing- step 2 fibrocartilaginous formation
fibroblasts invade the procallus and produce/ secrete collagen to make ends of the bones more solid, happens inside (medullary cavity in shaft bone) and outside. Unites 2 ends of the bone- week temporary, chondroblasts produce fibrocartilage, arrival of new capillaries become organised
length of fibrocartilaginous callus formation
starts after a couple of days- can take months
4 stages of fracture healing- step 3 formation of bony callus
osteoblasts (differentiate from mesenchymal progenitors) secrete spongy bone (ontop of callus) that joins the broken ends of the bone, bone grows and units until ends are connected with bridge of spongy bone (callus), this is when the fracture site is firmly held
Formation of bony callus length
last 3-4 months
4 stages of fracture healing- step 4 bone remodelling
compact bone replaces the spongy bone in the bone callu, osteoblasts take away spongy bones, surface is remodelled back to normal shape, sometimes a palpable lump remains
what is needed in the bone remodelling stage
normal mechanical stress is needed- immobilisation needs to stop
how long does the bone remodelling stage lasts
can continue for up to a year
type of fracture, location, union, consolidation- Spiral
upper limb, union- 3/52, consolidation- 6/52
type of fracture, location, union, consolidation- transverse
upper limb, union- 6/52, consolidation 12/52
type of fracture, location, union, consolidation- spiral (Lower)
lower limb, union- 6/52, consolidation- 12/52
type of fracture, location, union, consolidation- transverse (lower)
lower limb union 12/52, consolidation 24/ 42
why do spinal fractures heal quicker
due to surface area of bone involved
what does union mean
fibrocartilaginous formation point
what does consolidation phase mean
bony callus formation
Factors that affect the rate of healing
type off, site off, vascular supply, age of patient, movement at, separation of bone ends, infection, bone pathology
Clinical feature of a fracture
pain and tenderness, swelling and bruising, deformity and angulation, impaired function, shock
Test for a fracture
X- ray, AP and lateral- more than one angle
What is reduction- fracture treatment
application of longitudinal force to make sure limb is aligned
Reduction- closed/ simple
closed= simple fracture with minimal soft tissue damage
Reduction- open/ simple
open= simple fracture which needs higher level of immobilisation: near the joint and comminuted fractures
Reduction- open/ compound
open/ compound fractures including damage and at risk of infection
What is immobilisation- fracture treatment
only want micro movements as big movements can affect callus formation
Immobilisation- closed/ simple
sling, cast, splint
Immobilisation- open/ simple
O.R.I.G, open reduction external, fixation
Immobilisation- open/ compound
O.R.E.F, open reduction external
Rehabilitation- closed/ simple
once consolidation achieved if necessary
Rehabilitation- open/ simple
may commence immediately
Rehabilitation- open compound
fractures including tissue damage and at risk of infection
Complications of fracture treatment- delayed
not healing in correct time/ mal/ non-union- bone alignment not right, bone won’t heal
Complications of fracture treatment- avascular necrosis
bone dies due to poor blood supply
Complications of fracture treatment- sudek’s atrophy
mainly in 40- 60 year old females, disruption in sympathetic nervous system, type 1- no neurological involvement, type 2- nerve involvement, symptoms are disproportionate pain
Complications of fracture treatment- Compartment syndrome
too much bleeding and swelling of area- increase pressure in compartment- cuts of blood supply
Complications of fracture treatment- volkman’s ischaemia
increase pressure within forearm due to bleeding and swelling- can affect nerves in hand
Complications of fracture treatment- myositis ossification
bone laid down in the muscle by accident- usually reabsorbed over time, can require surgery
Complications of fracture treatment- blood vessel and tendon
blood vessel, nerve or visceral damage,
tendon injury- can tear
Complications of fracture treatment- fat embolus
log bones- lots of yellow bone marrow, if this gets into blood supply it can cause a stroke or heart attack
Complications of fracture treatment- osteoarthritis and growth
osteoarthritis, growth impairment
