Clinical Anatomy: Vertebral Column and Pelvis 2

Question 1

How are fractures healed?

Answer 1

1. Haematoma forms
2. Granular material formation (Soft granular tissue formation i.e soft callus)
3. Hard callus formation (trabecular bone formation within soft callus)
4. Remodelling (Excess material around fracture site and from within medullary is removed.)

Question 2

What happens during the stage of haematoma formation in bone?

Answer 2

Blood vessels in periosteum torn and haemorrhage, bone cells begin to die and tissue is inflamed, swollen, and painful.

Question 3

What happens during granular material formation?

Answer 3

Within a few days soft granulation tissue forms due to invasion of capillaries, phagocytic cells cleaning up debris, and fibroblasts migrating into the site and filling the area with collagen, then osteoblasts migrate into the site from periosteum and begin bone formation

Question 4

How is the hard callus formed? When does this stage begin and continue?

Answer 4

Initially osteoblasts produce trabecular bone within the soft callus.

This occurs 3 - 4 weeks after injury and continues for 2 - 3 months

Question 5

How does bone remodelling occur? When does this stage begin and continue?

Answer 5

Compact bone is laid down to reform shaft walls.

Excess materal around fracture site and within medullary cavity is removed.

This occurs during the hard callus stage and continues for several months.

Question 6

How are fractures treated?

Answer 6

Treated by reduction (i.e realignment of broken bone ends and then casting)

Question 7

What are the types of reduction and how are they different?

Answer 7

Closed reduction (bone ends coaxed back into position manually)

Open reduction (Bone ends secured together surgically with pins or wires)

Question 8

What causes stress fractures?

Answer 8

Submaximal repeated loading

Question 9

What is Osgood-Schlatter syndrome?

Answer 9

Traction periostitis of the tibial tuberosity which is caused by pulling of periosteum repeatedly at the tibial tuberosity.

Question 10

What causes shin soreness/tibial pain?

Answer 10

2 common causes with distinct anatomical origins. Both, results in periostitis:

Tibial flexing causes pain in middle 1/3 of shaft

Linear pain pain along posterior-medial border

Question 11

What happens to tibia during tibial flexing?

Answer 11

Increased tibial flexing at region of smallest CSA

Stimulation of periosteum to build bone in this region

Increased microtrauma and periostitis.

Question 12

What causes linear pain in the shins?

Answer 12

Increased muscle activity:

Metabolic activity

Blood flow

Muscle volume

Pressure on fascia and periosteum

Question 13

What factors predispose people to tibial pain?

Answer 13

Bad running biomechanics

Bad shoe design

Training surfaces

Training methods (too much too soon)

Question 14

How are overuse injuries treated?

Answer 14

Rest

Ice

Compression

Elevation

Referral to medical practitioner (physiotherapy, anti-inflammatory medication, modify activity, orthotics/change footwear)

Question 15

When is surgery indicated in a meniscal tear? What are the associated risks?

Answer 15

If a meniscal flap causes the joint to ‘catch’

Even partial removal increases contact pressures within the joint leading to early onset osteoarthritis. Surgery aims to remove as little as possible and preserve the remaining part of the meniscus as much as possible.

Question 16

What is osteochondritis dessicans?

Answer 16

Lesion that occurs on the articular surface of the femoral condyle. This lesion can float about in the joint. It if breaks free it may calcify further and eventually lock up the joint

Question 17

What is chondromalacia patellae? What causes this?

Answer 17

More commonly known as patella femoral syndrome.

Damage to the articular surface of the patella

Question 18

Why are women more likely to suffer from chondromalacia patellae?

Answer 18

Due to bad patella tracking being more likely in females due to the angle of their femur.

Question 19

How is chondromalacia patellae treated?

Answer 19

Conservative treatment: Patella taping, or strengthening vastus medialis.

Surgical options include tibial tubercle transfer

Question 20

What causes cartilage injuries?

Answer 20

Full thickness, focal defects are caused by games that involve landing and twisting/evading actions

The cartilage has no ability to repair itself. Instead the defect fills with fibrocartilage which can lead to early onset osteoarthritis

Question 21

How are cartilage injuries fixed?

Answer 21

Traditionally by sub-chondral bone drilling and mosaicplasty

Autologous Chondrocyte implantation

Question 22

What are the phases of autologous chondrocyte implantation?

Answer 22

1: Cartilage retrieval
2: Cell culture (taken from body processed in lab and then cultured then reintroduced in the joint)
3: Second surgery to implant chondrocyte impregnated patch into the defect
4: Graduated rehab program to cause chondrocytes to migrate, differentiate, and hypertrophy. (This must be done over time with only compression forces)

Question 23

What are the contributing factors to a hamstring strain?

Answer 23

Cold

Fatigue

Pre-existing injury

Neuro-mechanical factors

Question 24

How are muscle strains treated?

Answer 24

Initial treatment: RICE + NSAIDs

Rehabilitation: Early mobilisation to regain full ROM, Constant Passive Motion machine + ice, Gradual and staged return to activity

Question 25

What are the signs of hamstring tear?

Answer 25

Feeling of a “snap” in the hamstring.

Massive inter and intramuscular haematoma

Question 26

What is plantar fasciitis?

Answer 26

Condition resulting from repeated stressing of the plantar fascia. This starts with tendinitis (pain and swelling) but may lead to tendinosis (disruption of collagen matrix)

Question 27

How is plantar fasciitis treated?

Answer 27

Conservative treatments:

NSAIDs, acupuncture, shock-wave therapy, and recalcitrant solutions.

Question 28

What is hallux valgus?

Answer 28

A progressive deformity in the alignment of the first metatarsal head and proximal phalanx of the hallux (lateral deviation)

Bunions often result on the medial side of the MTP joint.

Question 29

What causes hallux valgus?

Answer 29

Multiple causes:

Inflammatory and rheumatoid arthritis

Gout

Biomechanical instability

Question 30

How is hallux valgus treated?

Answer 30

Conservative management methods:

Splinting

After skeletal maturation - management of symptoms only

Surgical interventions:

Distal osteotomy to realign the bones

Resection arthroplasty

Arthrodesis (joint fusion)