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Musculoskeletal case > Bones, Fractures and healing > Flashcards

Bones, Fractures and healing Flashcards

1
Q

Function of the bones

A

Framework for organs -Supports lungs, heart
Protective function- Ribcage-Lungs,heart Skull-brain Vertebrae- spinal cord
Mobilise
Production of blood cells
Regulation of calcium homeostasis

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2
Q

What are the two main categories of bones and what do they consist of?

A

Axial- central, skull and spine encasing central nervous system
Appendicular- role of ambulation and movement. bones of the limn

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3
Q

What type of growth do irregular bones grow?

A

By both intramembranous and endochondral ossification

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4
Q

What are the different parts of the long bone?

A

Epiphysis- rounded end of a long bone covered in articular cartilage - terminal portion
Metaphysis- Where it starts to flare out on either end
Diaphysis- Long shaft of the bone

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5
Q

What proportion of skeletal mass is corticial bone

A

~80%

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6
Q

Why is the femur clinically important?

A

Mostly likely place for elderly people to get a hip fracture

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7
Q

What are Osteoprogenitor Cells

A

Multipotent

Differentiated from mesenchymal stem cells which are pluripotent and they differentiate into osteoblasts

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8
Q

What is one of the main transcription factors involved in coordinating mesenchymal stem cells into osteoprogenitor cells into

A

RUNX2

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9
Q

What is RUNX2

A

one of the main transcription factors involved in coordinating mesenchymal stem cells into osteoprogenitor cells into

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10
Q

What do osteoblasts produce?

A

Type I collagen
ALP — initiates calcification
Calcium phosphate
Depositing calcium and phosphate crystals in the form of calcium phosphate and calcium and calcium hydroxyapatite

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11
Q

What is the half-life of osteocytes?

A

t1/2 —25 years

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12
Q

What is the osteocytes roles?

A

mechanosensory role and important in bone remodelin

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13
Q

How do osteoclasts do their function

A

Bind to the surface of variable with protein osteopontin
acidified the extracellular fluid between ruffled border between the bone
aids in breaking down the matrix and mineralised portion of bone

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14
Q

What is osteopontin?

A

Proteins that help osteoclasts to bind to variable

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15
Q

What is the structure of osteoclasts? Importance

A 
Ruffled border increases surface area to secrete proteins active transport process
Secretes:
TRAP
osteopotin
Cathepsin K
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16
Q

What is the function of TRAP?

A

involved in producing reactive oxygen species that breaks down bone matrix

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17
Q

What is Cathepsin K ?

A

protease that breaks down the type one collagen bone matrix

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18
Q

What are the percentages of the composition of the bone matrix?

A

Organic ‘osteoid’ - 25%
Inorganic- 50%
Water - 25%

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19
Q

What is remodelling key for?

A

Adapting to new physical activity (Putting under new stress)

After trauma and after bone heals in re-establishing the normal architecture

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20
Q

What happens when osteoclastic activity predominates over osteoblastic activity

A

Osteoporosis- weak bones prone to fractures

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21
Q

How is osteoporosis caused?

A

osteoclastic activity predominates over osteoblastic activity

22
Q

What happens when osteoblastic activity predominates over osteoclastic activity

A

osteopetrosis bones like marble

also known as bone marble diesease

23
Q

What is disuse osteopenia

A

where low bone density because not using those bones ( not enough stress) because of injury

24
Q

How does bone break?

A

Hooks law
- Strain on bone ‘elastic material’ back to its original shape
too much strain elastic limit will break bone
apply a force to one side of a bone
nearest side is going to be compressed and bone is strong in compression. heals very well in compression
tension because bone is being pulled apart-
Bone hates tension and cant heal tension
Increase in force tension increases tension
tensile stresses increase, and the bone will break

25
Q

Types of bone healing? differences?

A

Primary- (NO CALLOUS)

Secondary - (CALLOUS FORMATION)

26
Q

What environment provides primary bone healing

A

absolute stability and compression

27
Q

What environment provides secondary bone healing

A

Relative stability

28
Q

What is better callous bone healing or no callous?

A

NO CALLOUS

29
Q

What is better primary or secondary bone healing

A

Primary

30
Q

When is callous reasonable for bone healing?

A

Where there is no joints fractured

31
Q

What strain causes primary bone healing?

A

Less than 2% strain

32
Q

What strain causes secondary bone healing?

A

2%-10% strain

33
Q

How is absolute stability achieved in bone healing?

A

Bolts and crews to keep fractured bone in place

34
Q

Which is natural primary or secondary bone healing

A

Secondary

35
Q

What strain causes no bone healing?

A

More than 10%

36
Q

If strain is less than 2% what type of healing would it be?

A

Primary

37
Q

If strain is 2%-10% what type of healing would it be?

A

Secondary

38
Q

If strain is more than 10% what type of healing would it be?

A

No healing

39
Q

What are the stages of secondary bone healing

A

Inflammatory/ Reactive Phase
Soft callous -Reparative Phase
Hard callous - Reparative Phase
Remodelling phase

40
Q

stages of secondary bone healing- Inflammatory/ Reactive Phase

A

Haematoma formation and bruising
platelet aggregation
initiation of the clotting cascade
blood clot forms template for the ongoing formation of the callous
cytokines, mesenchymal stem cells to lay osteoblasts Immune cells
key transcription factors

41
Q

stages of secondary bone healing- Reperative Phase

A

First stage - soft callous
Fibroblasts- make fibrous tissue and they produce a lot of type two collagen
et new blood vessels growing through that hematoma as well
connective tissue in them give an element of stability
Fibreblasts mature and differnetiate into chondroblasts that make cartiladge and lay down cartilage framework within this soft callus.

Stage 2- hard callous
Rigidity bone can actually go from a position of being in a high strain environment to higher than 10%
it stabilizes itself and creates the environment for bone healing
Osteoblasts come laying down type 1 colagen and mineralising bone

42
Q

Remodelling stage

A

Cutting cone formation for osteoclasts cut through irregular woven bone
reforming this normal lamella constructs

43
Q

Factors influencing healing

A

Fracture variables:

  • Blood supply (most important)
  • Complexity
  • Immobilisation/Biomechanical environment

Patient variables:

  • Nicotine
  • Diabetes mellitus
  • Diet, nutritional deficiencies, malabsorption (Ca2+ & Vit D)
  • COX-2 inhibitors / NSAIDSHIV
44
Q

What are the main examples of non- union?

A

hypertrophic

atrophic

45
Q

What is hypertrophic non- union?

A

Prolific callous formation causes gap in diaphysis

46
Q

What causes hypertrophic non- union?

A

Too much movement or strain

47
Q

Where is the most likely place to get hypertrophic non- union? Why?

A

Humerus- because hard to stabilise bone and if unstable then more callous formation

48
Q

What is the consequence of too much movement or strain

A

hypertrophic non-union

49
Q

Where is the most likely place to get atrophic non- union? Why?

A

tibia because it has a poor blood supply

50
Q

What is atrophic non-union

A

No callous formation but gap in diaphysis

Musculoskeletal case (8 decks)

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