Clinical Anatomy: Vertebral Column and Pelvis 2 Flashcards
How are fractures healed?
- Haematoma forms
- Granular material formation (Soft granular tissue formation i.e soft callus)
- Hard callus formation (trabecular bone formation within soft callus)
- Remodelling (Excess material around fracture site and from within medullary is removed.)
What happens during the stage of haematoma formation in bone?
Blood vessels in periosteum torn and haemorrhage, bone cells begin to die and tissue is inflamed, swollen, and painful.
What happens during granular material formation?
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
How is the hard callus formed? When does this stage begin and continue?
Initially osteoblasts produce trabecular bone within the soft callus.
This occurs 3 - 4 weeks after injury and continues for 2 - 3 months
How does bone remodelling occur? When does this stage begin and continue?
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.
How are fractures treated?
Treated by reduction (i.e realignment of broken bone ends and then casting)
What are the types of reduction and how are they different?
Closed reduction (bone ends coaxed back into position manually)
Open reduction (Bone ends secured together surgically with pins or wires)
What causes stress fractures?
Submaximal repeated loading
What is Osgood-Schlatter syndrome?
Traction periostitis of the tibial tuberosity which is caused by pulling of periosteum repeatedly at the tibial tuberosity.
What causes shin soreness/tibial pain?
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
What happens to tibia during tibial flexing?
Increased tibial flexing at region of smallest CSA
Stimulation of periosteum to build bone in this region
Increased microtrauma and periostitis.
What causes linear pain in the shins?
Increased muscle activity:
Metabolic activity
Blood flow
Muscle volume
Pressure on fascia and periosteum
What factors predispose people to tibial pain?
Bad running biomechanics
Bad shoe design
Training surfaces
Training methods (too much too soon)
How are overuse injuries treated?
Rest
Ice
Compression
Elevation
Referral to medical practitioner (physiotherapy, anti-inflammatory medication, modify activity, orthotics/change footwear)
When is surgery indicated in a meniscal tear? What are the associated risks?
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.
What is osteochondritis dessicans?
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
What is chondromalacia patellae? What causes this?
More commonly known as patella femoral syndrome.
Damage to the articular surface of the patella
Why are women more likely to suffer from chondromalacia patellae?
Due to bad patella tracking being more likely in females due to the angle of their femur.
How is chondromalacia patellae treated?
Conservative treatment: Patella taping, or strengthening vastus medialis.
Surgical options include tibial tubercle transfer
What causes cartilage injuries?
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
How are cartilage injuries fixed?
Traditionally by sub-chondral bone drilling and mosaicplasty
Autologous Chondrocyte implantation
What are the phases of autologous chondrocyte implantation?
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)
What are the contributing factors to a hamstring strain?
Cold
Fatigue
Pre-existing injury
Neuro-mechanical factors
How are muscle strains treated?
Initial treatment: RICE + NSAIDs
Rehabilitation: Early mobilisation to regain full ROM, Constant Passive Motion machine + ice, Gradual and staged return to activity
What are the signs of hamstring tear?
Feeling of a “snap” in the hamstring.
Massive inter and intramuscular haematoma
What is plantar fasciitis?
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)
How is plantar fasciitis treated?
Conservative treatments:
NSAIDs, acupuncture, shock-wave therapy, and recalcitrant solutions.
What is hallux valgus?
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.
What causes hallux valgus?
Multiple causes:
Inflammatory and rheumatoid arthritis
Gout
Biomechanical instability
How is hallux valgus treated?
Conservative management methods:
Splinting
After skeletal maturation - management of symptoms only
Surgical interventions:
Distal osteotomy to realign the bones
Resection arthroplasty
Arthrodesis (joint fusion)
