Bone Pathology and Fracture

Question 1

Bone Homeostasis - Definition

Answer 1

Life long process of bone remodeling to maintain density, chemical composition and shape of bone.

Question 2

Cycle of Bone Remodeling

Answer 2

Activation of osteoclasts → Bone reabsorption → Reversal of bone reabsorption → Bone formation →
First 3 phases: 3 weeks, formation: 3-4 months.
Imbalance between reabsorption and formation will lead to a nr. of diseases.

Question 3

Fracture Classification (3)

Answer 3

Environmental Exposure
Mechanism of Injury
Number and orientation of fragments

Question 4

Fracture Classification - Environmental Exposure (2)

Answer 4

Simple fracture: fragments not exposed to external environment.
Compound fracture: fragments exposed to environment, risk of infection.

Question 5

Fracture Classification - Mechanism of Injury (3)

Answer 5

Stress Fracture: Repetitive loading (runners).
Pathological Fracture: Already weakened bone by primary disease. Osteoporosis, osteomalacia, cancer.
Sudden Trauma.

Question 6

Fracture Classification - Number and Orientation of Fragments (6)

Answer 6

Transverse
Oblique
Spiral
Segmental
Butterfly
Comminuted: >2 fragments

Question 7

Fracture Healing (2) - Phases (4)

Answer 7

Primary (rare) and Secondary:
1. Inflammation
2. Soft callus
3. Hard callus
4. Remodeling

Question 8

Factors Affecting Fracture Healing - Delay Healing (7)

Answer 8

Delay:
- Too much gap between fragments.
- Malnutrition - diet or reduced blood supply.
- Infection
- Radiation therapy or over exposure to x-rays.
- Inadequate immobilization - movement at fracture site.
- Inadequate reduction - overlap, angulation, twist at fracture site.
- Medication: NSAID and steroids.

Question 9

Factors Affecting Fracture Healing - Promote Healing (2)

Answer 9

Promote:
- Therapeutic pulsed ultrasound and electrical muscle stimulation.
- Early movement - partial or non-weight bearing.

Question 10

Fracture Management (3)

Answer 10

Reduction: restoration of alignment of fragments.
Immobilization: splinting, external/internal fixation.
Rehab: restoration of function, mobilization usually within 24h of reduction and immobilization.

Question 11

Fracture Complications (10)

Answer 11

Non-union
Malunion
Infection
Nerve injury
Blood vessel injury
Injury to organs
Pseudoarthrosis
Thrombosis-embolism
Fat embolism
Joint stiffness

Question 12

Spinal Fractures - Signs and Symptoms (7)

Answer 12

Spinal shock
Breathing difficulty
Paralysis below level of injury
Incontinence
Temperature dysregulation (above C6)
Pain
Dysphonia

Question 13

Spinal Shock - Characteristics (3)

Answer 13

Areflexia: Loss of all reflexes below SCI for 24h.
Return of bulbospongiosus reflexes.
Hyperreflexia with spasticity below SCI.

Question 14

Spinal Fractures - Treatment (6)

Answer 14

Mechanical ventilation
Spinal decompression surgery
Continuous spinal traction
Spinal bracing
24h postural management
Physiotherapy specific to injury level

Question 15

Guidelines for 1st Aid in Suspected Spinal Fracture (5)

Answer 15

Do not move victim
Do not tilt the head back
Do not remove clothing (helmet)
Hold head steady or put towels on the sides.
If you need to roll the victim, one person holds head while the other log rolls.